The role of primary care clinicians in diagnosing and treating bipolar disorder

Abstract

Because many patients with bipolar disorder seek treatment in primary care practices, physicians in these settings need to be able to diagnose bipolar disorder and common psychiatric and medical comorbidities and to initiate and manage treatment. Unfortunately, bipolar disorder is often underrecognized. The most common symptoms in patients with bipolar disorder are depressive, but these patients may also have anxiety, mood swings, sleep problems, irritability, difficulty concentrating, relationship issues, alcohol- or drug-related problems, and infections. Social and family history and screening tools can help clarify diagnosis. The goal of treatment should be recovery, but periodic relapse and medication nonadherence should be expected. Primary care physicians should decide what level of intervention their practices can support. To manage these patients effectively, practices may need to train office staff, set up monitoring and follow-up systems, establish links with referral and community support services, develop therapeutic alliances with patients, and provide psychoeducation for patients and significant others. Receiving comprehensive psychiatric and medical care and support can be life-changing for patients with bipolar disorder and their families.

Figure 1

Domains and Cardinal Symptoms of Bipolar Disorder^{a a}Based on Goodwin and Jamison.⁵

Figure 2

Distribution of Bipolar Disorder by Age at Onset in 2 Birth-Year Cohorts of Stanley Center Bipolar Registry Participants^{a a}Reprinted with permission from Chengappa et al.¹⁸

Figure 3

Psychosocial and Health Problems Reported by 600 Respondents With Bipolar Disorder in the National Depressive and Manic-Depressive Association 2000 Survey^{a a}Data from Hirschfeld et al.¹⁷ Abbreviation: NA=not available.