title: Screening for bipolar disorder in a primary care practice.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To screen for bipolar disorder in adult primary care patients and to examine its clinical presentation and effect on functioning.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York 10032, USA.
authors.forename: Amar K
authors.initials: AK
authors.lastname: Das
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Gameroff
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pilowsky
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
authors.forename: Adriana
authors.initials: A
authors.lastname: Feder
authors.forename: Raz
authors.initials: R
authors.lastname: Gross
authors.forename: Yuval
authors.initials: Y
authors.lastname: Neria
authors.forename: Rafael
authors.initials: R
authors.lastname: Lantigua
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Myrna M
authors.initials: MM
authors.lastname: Weissman
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors