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Cribado para el trastorno bipolar en una práctica de atención primaria.

Amar K Das¹, Mark Olfson, Marc J Gameroff

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

|February 25, 2005

Resumen

El trastorno bipolar es común en la atención primaria, pero a menudo se pasa por alto. La detección temprana y la educación del médico son cruciales para el diagnóstico y el tratamiento precisos para evitar diagnósticos erróneos, especialmente con la depresión.

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Área de la Ciencia:

La psiquiatría es la psiquiatría.
Medicina de la Atención Primaria Medicina de la Atención Primaria.
Cribado de la salud mental.

Sus antecedentes:

El trastorno bipolar implica episodios maníacos y depresivos.
La detección de la depresión por sí sola puede diagnosticar erróneamente el trastorno bipolar en la atención primaria.

Objetivo del estudio:

Para detectar el trastorno bipolar en pacientes adultos de atención primaria.
Examinar su presentación clínica y su impacto en el funcionamiento.

Principales métodos:

Muestra sistemática de 1157 pacientes adultos de atención primaria (18-70 años).
Utilizado cuestionario de trastornos del estado de ánimo, PRIME-MD, SF-12, Escala de discapacidad de Sheehan y revisión de registros médicos.
Datos recopilados entre diciembre de 2001 y enero de 2003 en una clínica urbana de bajos ingresos.

Principales resultados:

La prevalencia de detección positiva del trastorno bipolar fue del 9,8%, sin diferencias demográficas significativas.
Solo el 8,4% de las pruebas positivas recibieron un diagnóstico de trastorno bipolar, a pesar de buscar ayuda.
Los pacientes que dieron positivo en el cribado informaron una peor calidad de vida y un mayor deterioro funcional.

Conclusiones:

El trastorno bipolar es común, significativo y poco reconocido en la atención primaria urbana.
La educación de los médicos sobre el cribado, el manejo y la farmacoterapia es esencial.
Evite la monoterapia con antidepresivos debido a los riesgos en pacientes con trastorno bipolar.