title: Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study.
abstract: BACKGROUND
  Bipolar disorder is not uncommon, is associated with high disability and risk of suicide, often presents with depression, and can go unrecognised.
  
  
  OBJECTIVE
  To determine the prevalence of unrecognised bipolar disorder among those prescribed antidepressants for depressive or anxiety disorder in UK primary care; whether those with unrecognised bipolar disorder have more severe depression than those who do not; and the accuracy of a screening questionnaire for bipolar disorder, the Mood Disorder Questionnaire (MDQ), in this setting.
  
  
  METHODS
  Observational primary care study of patients on the lists of 21 general practices in West Yorkshire aged 16-40 years and prescribed antidepressant medication.
  
  
  METHODS
  Participants were recruited using primary care databases, interviewed using a diagnostic interview, and completed the screening questionnaire and rating scales of symptoms and quality of life.
  
  
  RESULTS
  The prevalence of unrecognised bipolar disorder was 7.3%. Adjusting for differences between the sample and a national database gives a prevalence of 10.0%. Those with unrecognised bipolar disorder were younger and had greater lifetime depression. The predictive value of the MDQ was poor.
  
  
  CONCLUSIONS
  Among people aged 16-40 years prescribed antidepressants in primary care for depression or anxiety, there is a substantial proportion with unrecognised bipolar disorder. When seeing patients with depression or anxiety disorder, particularly when they are young or not doing well, clinicians should review the life history for evidence of unrecognised bipolar disorder. Some clinicians might find the MDQ to be a useful supplement to non-standardised questioning.
authors.affiliation: Leeds and York Partnership NHS Foundation Trust, Leeds.
authors.forename: Tom
authors.initials: T
authors.lastname: Hughes
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds.
authors.forename: Alastair
authors.initials: A
authors.lastname: Cardno
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds.
authors.forename: Federica
authors.initials: F
authors.lastname: Marino-Francis
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds.
authors.forename: Imogen
authors.initials: I
authors.lastname: Featherstone
authors.affiliation: Leeds and York Partnership NHS Foundation Trust, Leeds.
authors.forename: Keeley
authors.initials: K
authors.lastname: Rolling
authors.affiliation: Leeds and York Partnership NHS Foundation Trust, Leeds.
authors.forename: Alice
authors.initials: A
authors.lastname: Locker
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds.
authors.forename: Kate
authors.initials: K
authors.lastname: McLintock
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds.
authors.forename: Allan
authors.initials: A
authors.lastname: House
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: bipolar disorder; prevalence; primary care; sensitivity and specificity