Screening for bipolar disorder in a primary care practice

Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York 10032, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 03/2005; 293(8):956-63. DOI: 10.1001/jama.293.8.956
Source: PubMed


Bipolar disorder consists of episodes of manic and depressive symptoms. Efforts to screen for depression in a primary care setting without assessment of past manic symptoms can lead to incorrect diagnosis and treatment of bipolar disorder.
To screen for bipolar disorder in adult primary care patients and to examine its clinical presentation and effect on functioning.
A systematic sample of 1157 patients between 18 and 70 years of age who were seeking primary care at an urban general medicine clinic serving a low-income population. The study was conducted between December 2001 and January 2003.
Prevalence of bipolar disorder, its treatment and patient functioning. Study measures included the Mood Disorder Questionnaire, the PRIME-MD Patient Health Questionnaire, the Medical Outcomes Study 12-Item Short Form health survey, the Sheehan Disability Scale, data on past mental health treatments, and a review of medical records and International Classification of Diseases, Ninth Revision codes for each visit dating from 6 months prior to the screening day.
The prevalence of receiving positive screening results for lifetime bipolar disorder was 9.8% (n = 112; 95% confidence interval, 8.0%-11.5%) and did not differ significantly by age, sex, or race/ethnicity. Eighty-one patients (72.3%) who screened positive for bipolar disorder sought professional help for their symptoms, but only 9 (8.4%) reported receiving a diagnosis of bipolar disorder. Seventy-five patients (68.2%) who screened positive for bipolar disorder had a current major depressive episode or an anxiety or substance use disorder. Of 112 patients, only 7 (6.5%) reported taking a mood-stabilizing agent in the past month. Primary care physicians recorded evidence of current depression in 47 patients (49.0%) who screened positive for bipolar disorder, but did not record a bipolar disorder diagnosis either in administrative billing or the medical record of any of these patients. Patients who screened positive for bipolar disorder reported worse health-related quality of life as well as increased social and family life impairment compared with those who screened negative.
In an urban general medicine clinic, a positive screen for bipolar disorder appears to be common, clinically significant, and underrecognized. Because of the risks associated with treating bipolar disorder with antidepressant monotherapy, efforts are needed to educate primary care physicians about the screening, management, and pharmacotherapy of bipolar disorders.

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    • "Patients with BD experience depressive episodes or depressive symptoms significantly more often than manic symptoms (Judd and Akiskal, 2003; Judd et al., 2003). A number of studies have shown that timely recognition of BD in primary care settings does not occur for most affected patients (Das et al., 2005; Manning et al., 1997; Smith et al., 2011). Treatment of BD (notably type I BD) solely with antidepressants may precipitate manic switches (Ghaemi et al., 2003; Ghaemi et al., 2004), mixed episodes (Ghaemi et al., 2004) or rapid cycling (Ghaemi et al., 2003), although there are controversies in this regard (Licht et al., 2008). "
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    ABSTRACT: To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning. In this cross-sectional study, participants (N=1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into 'bipolar' and 'unipolar' depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire. The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4-5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression. The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed. Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.
    Journal of Affective Disorders 06/2014; 162:120-7. DOI:10.1016/j.jad.2014.03.040 · 3.38 Impact Factor
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    • "Serrano-Blanco et al. [30] conducted a study with over 3,800 primary care patients and found that 29.9% had a diagnosis of major depressive disorder. Das et al. [31] screened 1,157 primary care patients and found that approximately 10% met diagnostic criteria for bipolar disorder. Blount [32] reported that 80% of individuals with a mental health disorder will see their primary care physician in a given year, while only 50% will see a mental health provider. "
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    Systematic Reviews 12/2013; 2(1):116. DOI:10.1186/2046-4053-2-116
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    • "The same researchers also found that the onset of psychiatric symptoms in the early puerperium increases the chance of diagnostic conversion into BD approximately four-fold (Munk- Olsen et al., 2012). While the prevalence rate of PPD symptoms observed in the study remains consistent with epidemiological data (Gavin et al., 2005), the percentage of positive scores in the MDQ in the whole sample was notably high, further highlighting the problem of significant discrepancies between community studies regarding ratios of MDQ-positive subjects (ranging from 2.5% to 17.7%) (Hirschfeld et al., 2003; Das et al., 2005; Goldney et al., 2005; Mangelli et al., 2005). However, the application of the cut-off score of 8 pts. "
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    ABSTRACT: The goals of this study have been to determine the prevalence of the bipolar spectrum features in the population of women with postpartum depression (PPD) symptoms, as well as to analyze the personality differences between putative 'unipolar' and 'bipolar' PPD subjects. The sample enrolled into the cross-sectional study consisted of 344 women at 6-12 weeks postpartum. The authors used the Edinburgh Postnatal Depression Scale (EPDS; cut-off score: 13 pts.) for the assessment of the PPD symptoms, the Mood Disorder Questionnaire (MDQ; cut-off scores: 7 or 8 pts.) for diagnosing the bipolar features, and the NEO-Five Factor Inventory (NEO-FFI) for the assessment of personality traits. The EPDS-positive subjects were more likely to score positively on the MDQ, as compared to the EPDS-negative ones. The EPDS-positive subjects who also scored ≥8 pts. on the MDQ were characterized by higher index of neuroticism, as compared to those who scored positively on the EPDS only. The results suggest that the presence of PPD symptoms is related to significantly higher scores of bipolarity and neuroticism. The more robust trait of neuroticism might be a marker of the 'bipolar' PPD, as compared to the 'unipolar' form of the disorder.
    10/2013; 215(1). DOI:10.1016/j.psychres.2013.10.013
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