title: Diagnosis of mental illness in primary and secondary care with a focus on bipolar disorder.
abstract: BACKGROUND
  While most of the management of mental health in the UK is conducted in primary care, the diagnosis by GPs has been shown to deficient in some areas. Bipolar disorder in particular is known to under-diagnosed but there is confusion as to whether this is due to poor recognition or conversion from unipolar depression
  
  
  METHODS
  In April and May 2012 an audit was conducted in secondary psychiatric services in Bedford, UK among 146 representative patients and 112 bipolar patients, examining the course of their illness and diagnosis
  
  
  RESULTS
  Bipolar disorder is under-diagnosed in the community and in secondary care. First manic or hypomanic symptoms usually follow first depressive symptoms by several years (μ=7.3, σ=7.9). A diagnosis of bipolar also commonly follows manic or hypomanic symptoms by years (μ=7.6, σ=8.3).
  
  
  CONCLUSIONS
  Both psychiatrists and GPs under-diagnose bipolar, but this study shows it may be due to two factors: poor recognition by doctors and conversion from major depressive disorder.
  
  
  CONCLUSIONS
  GPs and psychiatrists must be more aware of the under-diagnosis of bipolar and its tendency to convert from pure depressive symptoms.
authors.affiliation: School of Clinical Medicine University of Cambridge, Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rogers
authors.forename: Mark
authors.initials: M
authors.lastname: Agius
authors.forename: Rashid
authors.initials: R
authors.lastname: Zaman
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003951:Diagnostic Errors; D006801:Humans; D008485:Medical Audit; D011320:Primary Health Care; D012017:Referral and Consultation; D063127:Secondary Health Care; D013222:State Medicine; D006113:United Kingdom