User login
CHICAGO — Family physicians can close gaping holes in the safety net for individuals with bipolar disorder by following a few important guidelines, according to Dr. John R. Purvis.
“This is a very complicated illness with complicated treatment, and it's our job as family doctors to diagnose these patients,” Dr. Purvis said at the annual meeting of the American Academy of Family Physicians.
Research data suggest that two-thirds of bipolar patients are initially misdiagnosed. In addition, patients see a mean of four physicians before the correct diagnosis is made, and more than one-third wait 10 years or longer for the correct diagnosis (J. Clin. Psychiatry 2003;64:161–74).
“It's estimated that 3%–4% of the population has some sort of bipolar spectrum disorder, and roughly 20% of people who walk into your office with depression have bipolar disorder,” said Dr. Purvis, associated director of the family practice residency program at Tallahassee Memorial Healthcare in Florida.
Family physicians should use the Mood Disorder Questionnaire to screen all patients presenting with depression, panic disorder, or anxiety disorder, Dr. Purvis advised.
Because the questionnaire is designed for screening only, its results should be confirmed by the physician's evaluation, and “if you're unsure or uncomfortable managing the patient yourself, get a consultation with a psychiatrist,” he added.
A key question to ask patients is, “Do you have racing thoughts?” he said. “This is the most important question. In my experience, it is almost diagnostic, particularly when the racing thoughts keep the patient awake.”
Risk is increased in those with first-degree relatives who have bipolar illness or major depression. In addition, seasonal depression, postpartum depression, psychotic depression, and atypical depression should raise suspicion.
There's a common misconception that bipolar I (and II) disease involves regular intervals of mania (or hypomania) and depression separated by periods of euthymia, Dr. Purvis said.
“Even though the diagnosis rests with mania and hypomania, bipolar disease is primarily a disease of depression. Those who are bipolar I spend three times as much of their time depressed as they do manic, and for bipolar II illness the ratio is 1% of the time hypomanic and 50% of the time depressed,” he noted.
Comorbid conditions include attention-deficit/hyperactivity disorder, panic attacks, social phobia, and obsessive-compulsive phenomena.
“If you just make the diagnosis of bipolar disorder, you have done the patient a huge service,” Dr. Purvis said, explaining that bipolar patients often have chaotic lives, “so it's important to set boundaries, particularly regarding appointments and pain medications.”
The goals of treatment are to restore sleep, normalize mood, and maximize executive and cognitive functioning.
“The foundation of treatment of bipolar disorders is behavioral and medication therapy,” he said, adding that a good place for the treating physician to start is with the Texas Treatment Guidelines of 2005 (http://www.psycheducation.org/depression/APAguide.htm
Although some physicians believe that it's acceptable to use antidepressants with mood stabilizers, Dr. Purvis said he believes that mood stabilizers should be used to treat bipolar depression and that antidepressants should be used with caution and for only short periods of time.
“The one thing that is very clear is that antidepressant monotherapy in bipolar depressed patients is not acceptable,” he said in an interview.
Dr. Purvis noted that for some patients, bipolar illness can confer an advantage. “Bipolar illness is sort of like uranium, which can level a city or light a city. Some of the most creative people—including researchers, physicians, CEOs, and actors—are bipolar and can work on several levels at once when they're not in a depressed mood,” he said, adding that careful treatment is necessary to keep such patients from self-destructing.
CHICAGO — Family physicians can close gaping holes in the safety net for individuals with bipolar disorder by following a few important guidelines, according to Dr. John R. Purvis.
“This is a very complicated illness with complicated treatment, and it's our job as family doctors to diagnose these patients,” Dr. Purvis said at the annual meeting of the American Academy of Family Physicians.
Research data suggest that two-thirds of bipolar patients are initially misdiagnosed. In addition, patients see a mean of four physicians before the correct diagnosis is made, and more than one-third wait 10 years or longer for the correct diagnosis (J. Clin. Psychiatry 2003;64:161–74).
“It's estimated that 3%–4% of the population has some sort of bipolar spectrum disorder, and roughly 20% of people who walk into your office with depression have bipolar disorder,” said Dr. Purvis, associated director of the family practice residency program at Tallahassee Memorial Healthcare in Florida.
Family physicians should use the Mood Disorder Questionnaire to screen all patients presenting with depression, panic disorder, or anxiety disorder, Dr. Purvis advised.
Because the questionnaire is designed for screening only, its results should be confirmed by the physician's evaluation, and “if you're unsure or uncomfortable managing the patient yourself, get a consultation with a psychiatrist,” he added.
A key question to ask patients is, “Do you have racing thoughts?” he said. “This is the most important question. In my experience, it is almost diagnostic, particularly when the racing thoughts keep the patient awake.”
Risk is increased in those with first-degree relatives who have bipolar illness or major depression. In addition, seasonal depression, postpartum depression, psychotic depression, and atypical depression should raise suspicion.
There's a common misconception that bipolar I (and II) disease involves regular intervals of mania (or hypomania) and depression separated by periods of euthymia, Dr. Purvis said.
“Even though the diagnosis rests with mania and hypomania, bipolar disease is primarily a disease of depression. Those who are bipolar I spend three times as much of their time depressed as they do manic, and for bipolar II illness the ratio is 1% of the time hypomanic and 50% of the time depressed,” he noted.
Comorbid conditions include attention-deficit/hyperactivity disorder, panic attacks, social phobia, and obsessive-compulsive phenomena.
“If you just make the diagnosis of bipolar disorder, you have done the patient a huge service,” Dr. Purvis said, explaining that bipolar patients often have chaotic lives, “so it's important to set boundaries, particularly regarding appointments and pain medications.”
The goals of treatment are to restore sleep, normalize mood, and maximize executive and cognitive functioning.
“The foundation of treatment of bipolar disorders is behavioral and medication therapy,” he said, adding that a good place for the treating physician to start is with the Texas Treatment Guidelines of 2005 (http://www.psycheducation.org/depression/APAguide.htm
Although some physicians believe that it's acceptable to use antidepressants with mood stabilizers, Dr. Purvis said he believes that mood stabilizers should be used to treat bipolar depression and that antidepressants should be used with caution and for only short periods of time.
“The one thing that is very clear is that antidepressant monotherapy in bipolar depressed patients is not acceptable,” he said in an interview.
Dr. Purvis noted that for some patients, bipolar illness can confer an advantage. “Bipolar illness is sort of like uranium, which can level a city or light a city. Some of the most creative people—including researchers, physicians, CEOs, and actors—are bipolar and can work on several levels at once when they're not in a depressed mood,” he said, adding that careful treatment is necessary to keep such patients from self-destructing.
CHICAGO — Family physicians can close gaping holes in the safety net for individuals with bipolar disorder by following a few important guidelines, according to Dr. John R. Purvis.
“This is a very complicated illness with complicated treatment, and it's our job as family doctors to diagnose these patients,” Dr. Purvis said at the annual meeting of the American Academy of Family Physicians.
Research data suggest that two-thirds of bipolar patients are initially misdiagnosed. In addition, patients see a mean of four physicians before the correct diagnosis is made, and more than one-third wait 10 years or longer for the correct diagnosis (J. Clin. Psychiatry 2003;64:161–74).
“It's estimated that 3%–4% of the population has some sort of bipolar spectrum disorder, and roughly 20% of people who walk into your office with depression have bipolar disorder,” said Dr. Purvis, associated director of the family practice residency program at Tallahassee Memorial Healthcare in Florida.
Family physicians should use the Mood Disorder Questionnaire to screen all patients presenting with depression, panic disorder, or anxiety disorder, Dr. Purvis advised.
Because the questionnaire is designed for screening only, its results should be confirmed by the physician's evaluation, and “if you're unsure or uncomfortable managing the patient yourself, get a consultation with a psychiatrist,” he added.
A key question to ask patients is, “Do you have racing thoughts?” he said. “This is the most important question. In my experience, it is almost diagnostic, particularly when the racing thoughts keep the patient awake.”
Risk is increased in those with first-degree relatives who have bipolar illness or major depression. In addition, seasonal depression, postpartum depression, psychotic depression, and atypical depression should raise suspicion.
There's a common misconception that bipolar I (and II) disease involves regular intervals of mania (or hypomania) and depression separated by periods of euthymia, Dr. Purvis said.
“Even though the diagnosis rests with mania and hypomania, bipolar disease is primarily a disease of depression. Those who are bipolar I spend three times as much of their time depressed as they do manic, and for bipolar II illness the ratio is 1% of the time hypomanic and 50% of the time depressed,” he noted.
Comorbid conditions include attention-deficit/hyperactivity disorder, panic attacks, social phobia, and obsessive-compulsive phenomena.
“If you just make the diagnosis of bipolar disorder, you have done the patient a huge service,” Dr. Purvis said, explaining that bipolar patients often have chaotic lives, “so it's important to set boundaries, particularly regarding appointments and pain medications.”
The goals of treatment are to restore sleep, normalize mood, and maximize executive and cognitive functioning.
“The foundation of treatment of bipolar disorders is behavioral and medication therapy,” he said, adding that a good place for the treating physician to start is with the Texas Treatment Guidelines of 2005 (http://www.psycheducation.org/depression/APAguide.htm
Although some physicians believe that it's acceptable to use antidepressants with mood stabilizers, Dr. Purvis said he believes that mood stabilizers should be used to treat bipolar depression and that antidepressants should be used with caution and for only short periods of time.
“The one thing that is very clear is that antidepressant monotherapy in bipolar depressed patients is not acceptable,” he said in an interview.
Dr. Purvis noted that for some patients, bipolar illness can confer an advantage. “Bipolar illness is sort of like uranium, which can level a city or light a city. Some of the most creative people—including researchers, physicians, CEOs, and actors—are bipolar and can work on several levels at once when they're not in a depressed mood,” he said, adding that careful treatment is necessary to keep such patients from self-destructing.