Diagnosis and management of patients with bipolar disorder in primary care.

Bipolar disorder has previously been reported as having a prevalence of approximately 1%, although there is new data that prevalence rates may actually be as high as 5%.1 It is therefore likely that GPs will frequently encounter bipolar patients in their practice. New research suggests that up to 30% of patients presenting with depression in primary care may have a primary diagnosis of bipolar disorder.2 The disorder is characterised by mood fluctuations that include mania, hypomania, depression, and mixed episodes. It is chronic and highly recurrent, and associated with significant distress and disability.3 The World Health Organisation ranks bipolar disorder as the world's sixth leading cause of disability-adjusted life years among people aged 15–44 years. As many as 25–50% of patients with bipolar disorder attempt suicide during their lifetime.4 Bipolar disorder is distinguished from unipolar depression by the presence of a current or past episode of mania or hypomania.5 Most bipolar patients present with depressive symptoms rather than mania. Active enquiry regarding past mania or hypomania is essential to establish the true diagnosis. The diagnosis may also be blurred by common comorbidities, in particular substance abuse, personality and anxiety disorders. As a consequence, bipolarity is characteristically hard to diagnose in primary care. In one study, only 52% of sufferers receive a diagnosis by the first or second …