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Screening for bipolar disorder in a primary care practice.

Amar K Das1, Mark Olfson, Marc J Gameroff

  • 1Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York 10032, USA.

JAMA
|February 25, 2005
PubMed
Summary

Bipolar disorder is common in primary care, yet often missed. Early screening and physician education are crucial for accurate diagnosis and treatment to prevent misdiagnosis, especially with depression.

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Area of Science:

  • Psychiatry
  • Primary Care Medicine
  • Mental Health Screening

Background:

  • Bipolar disorder involves manic and depressive episodes.
  • Screening for depression alone can misdiagnose bipolar disorder in primary care.

Purpose of the Study:

  • To screen for bipolar disorder in adult primary care patients.
  • To examine its clinical presentation and impact on functioning.

Main Methods:

  • Systematic sample of 1157 adult primary care patients (18-70 years).
  • Utilized Mood Disorder Questionnaire, PRIME-MD, SF-12, Sheehan Disability Scale, and medical record review.
  • Data collected from December 2001 to January 2003 in an urban, low-income clinic.

Main Results:

  • Prevalence of positive bipolar disorder screen was 9.8%, with no significant demographic differences.
  • Only 8.4% of positive screens received a bipolar disorder diagnosis, despite seeking help.
  • Patients screening positive reported worse quality of life and increased functional impairment.

Conclusions:

  • Bipolar disorder is common, significant, and underrecognized in urban primary care.
  • Physician education on screening, management, and pharmacotherapy is essential.
  • Avoid antidepressant monotherapy due to risks in bipolar disorder patients.