On the nature of depressive and anxious states in a family practice setting: The high prevalence of bipolar II and related disorders in a cohort followed longitudinally

Screening for Bipolar Disorder in Patients Treated for Depression in a Family Medicine Clinic

“…A notable exception has been the work of J. Sloan Manning in Tennessee, who reported that 26% of patients presenting with depression in his family practice setting had bipolar disorder. 1 This prevalence is similar to that reported in the psychiatric specialty care settings. In a study conducted in France by Hantouche et al, 2 the rate of bipolar disorder in a population of patients presenting with a major depressive episode was 28%.…”

Retrospective Study of Olanzapine in Depressive and Anxious States in Primary Care

“…12 Direct observation of an increased prevalence of bipolar II and related disorders in primary care also exists. 9,13,14 Patients in the treatment arm gained an average of 3.9 kg (8.7 lb), or 5.6% of body weight-an amount that, though not trivial, is below the 7% of body weight defined by the U.S. Food and Drug Administration as being "clinically significant" weight gain during treatment with psychotropics. 15 Neither behavioral nor pharmacologic [16][17][18] interventions were systematically instituted, and it is unknown what effects such interventions might have had on weight gain.…”

Would Broadening the Diagnostic Criteria for Bipolar Disorder Do More Harm Than Good? Implications From Longitudinal Studies of Subthreshold Conditions

“…[13][14][15][16][17][18][19][20][21][22] For patients diagnosed with bipolar disorder, the lag between initial treatment-seeking and the correct diagnosis is often more than 10 years. 23,24 The treatment and clinical implications of the failure to recognize bipolar disorder in depressed patients include the underprescription of mood stabilizing medications, an increased risk of rapid cycling, and increased costs of care.…”

“…A number of studies have found that the rate of missed diagnoses of bipolar disorder is fairly high, especially when a broader definition of hypomania is used than the one specified in DSM-IV. 15,16,21,[28][29][30] As a clinician, it is often the case that early in the course of treatment I am not sure if a currently depressed patient has bipolar disorder. This uncertainty occurs despite an extensive evaluation that includes the administration of a semistructured interview, a review of prior records, and an interview with an informant.…”