title: Bipolar disorder is common in depressed primary care patients.
abstract: OBJECTIVE
  To examine the prevalence and treatment of typical and subsyndromal bipolar disorder (BD) in depressed primary care patients.
  
  
  METHODS
  Patients with a diagnosis of a mood disorder being treated with antidepressants in 2 academic family practice clinics underwent a structured diagnostic interview (Mini International Neuropsychiatric Inventory) for manic and hypomanic symptoms.
  
  
  RESULTS
  Of 58 patients evaluated, 19% met full criteria for bipolar I disorder and 8.6% for bipolar II disorder; 31% had subsyndromal BD (ie, persistent elation or irritability accompanied by additional symptoms of hypomania but not enough symptoms to meet full criteria for bipolar I or II disorder). Only 5 patients with BD were receiving mood stabilizers, which had not been instituted in any patient by the primary care physician.
  
  
  CONCLUSIONS
  The high prevalence of patients meeting full criteria for BD and the low rate of identification of BD in primary care patients are consistent with estimates using self-administered questionnaires, but the interview revealed a substantial additional population that could be considered to have subsyndromal BD. Because subsyndromal forms of BD are associated with significant impairment and comorbidity as well as progression to frank BD, recognition of both full and subthreshold BD in primary care practice should be improved.
authors: Department of Psychiatry, University at Buffalo, Buffalo, NY, USA. dubovsky@buffalo.edu
authors: Steven L
authors: SL
authors: Dubovsky
authors: Kenneth
authors: K
authors: Leonard
authors: Kim
authors: K
authors: Griswold
authors: Elsa
authors: E
authors: Daurignac
authors: Burlleen
authors: B
authors: Hewitt
authors: Chester
authors: C
authors: Fox
authors: Deborah
authors: D
authors: Seymour
authors: Amelia N
authors: AN
authors: Dubovsky
authors: Frank
authors: F
authors: DeGruy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents