 |
|
Screening for Bipolar Disorder in a Primary Care Practice
Amar K. Das, MD, PhD;
Mark Olfson, MD, MPH;
Marc J. Gameroff, PhD;
Daniel J. Pilowsky, MD, MPH;
Carlos Blanco, MD, PhD;
Adriana Feder, MD;
Raz Gross, MD, MPH;
Yuval Neria, PhD;
Rafael Lantigua, MD;
Steven Shea, MD;
Myrna M. Weissman, PhD
JAMA. 2005;293:956-963.
Context 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.
Objectives To screen for bipolar disorder in adult primary care patients and to examine its clinical presentation and effect on functioning.
Design, Setting, and Participants 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.
Main Outcome Measures 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.
Results 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.
Conclusions 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.
Author Affiliations: Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York (Drs Das, Olfson, Gameroff, Pilowsky, Blanco, and Feder); Department of Psychiatry, College of Physicians and Surgeons (Drs Das, Olfson, Gameroff, Pilowsky, Blanco, Feder, Gross, Neria, and Weissman); Department of Epidemiology, Mailman School of Public Health (Drs Gross, Neria, and Shea); Division of General Medicine, Department of Medicine, College of Physicians and Surgeons (Drs Lantigua and Shea) Columbia University, New York, NY.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Quality of Care in a Medicaid Population With Bipolar I Disorder
Busch et al.
Psychiatr. Serv. 2007;58:848-854.
ABSTRACT
| FULL TEXT
The Role of Psychosocial Stress in the Onset and Progression of Bipolar Disorder and its Comorbidities: The Need for Earlier and Alternative Modes of Therapeutic Intervention
Post and Leverich
Focus 2007;5:73-97.
ABSTRACT
| FULL TEXT
Diagnosis and Management of Childhood Bipolar Disorder in the Primary Care Setting
Faust et al.
CLIN PEDIATR 2006;45:801-808.
ABSTRACT
Prevalence of bipolar symptoms in epilepsy vs other chronic health disorders
Ettinger et al.
Neurology 2005;65:535-540.
ABSTRACT
| FULL TEXT
The Increasing Medical Burden in Bipolar Disorder
Kupfer
JAMA 2005;293:2528-2530.
FULL TEXT
Bipolar Patients in Primary Care: Do They Receive the Care They Need?
JWatch Psychiatry 2005;2005:4-4.
FULL TEXT
Bipolar Disorder Is More Common Than Expected in Primary Care
JWatch General 2005;2005:3-3.
FULL TEXT
What's new in the other general journals
Tonks
BMJ 2005;330:501-502.
FULL TEXT
|
