Bipolar disorder in primary care
Approximately 25 to 50 per cent of all individuals with depression in primary care settings have a bipolar spectrum disorder, one of the subtypes of bipolar disorder (Das et al., 2005).
Bipolar disorder is under-recognized and the amount of time between the onset of symptoms and the establishment of the bipolar diagnosis is protracted.
Most individuals with bipolar spectrum disorders presenting to both primary and specialty health care settings are mistakenly diagnosed as having a unipolar disorder. This means that they do not receive guideline-concordant care and, worse, receive inappropriate and possibly hazardous forms of treatment, such as antidepressant monotherapy (McIntyre & Konarski, 2004).
Recent comorbidity studies indicate that most individuals with bipolar disorder are differentially affected by psychiatric and medical comorbidities. For example, anxiety disorders and substance use disorders are common co-occurring syndromes that frequently obscure the underlying mood disorder.
The most common comorbid medical condition in bipolar disorder is overweight/obesity that often co-presents with other features of the metabolic syndrome (McIntyre et al., 2006). Comorbidity is associated with a greater illness severity, decreased response to treatment and, in the case of cardiovascular disease, premature mortality.
Bipolar disorder: Assessment and management (NICE guideline CG185, 2014)