Practical Clues to Early Recognition of Bipolar Disorder

Abstract

Early treatment can favorably impact the course of bipolar disorder, a lifelong illness. Because bipolar disorder can masquerade as various mental and physical illnesses-primarily major depressive disorder-patients with this condition frequently go unrecognized for years. During this recognition lag, such patients may present to their primary care physician on multiple occasions. Accordingly, primary care physicians would benefit from knowing the "clues" to early recognition of the disorder, because early recognition and management can reduce disability, improve social and employment stability, and result in improved functional outcomes. This review describes 3 pathways to the diagnosis of bipolar disorder relevant to the primary care setting: detection of mania or hypomania, differential diagnosis of recurrent depressive episodes, and identification of interepisode disorder and its comorbidities. We summarize these pathways in terms of a practical tool that a primary care physician can use to trigger further evaluation or referral.

Estructura de la sintomatología depresiva en una muestra de mujeres con menos de un año postparto.

“…Por todo lo mencionado, no existe mucha evidencia de que la hipersomnia y el aumento de apetito sean síntomas que pertenezcan al síndrome depresivo, aun cuando parecen ser relevantes como indicadores de bipolaridad (19)(20)(21)(22). Asimismo, la presencia de características atípicas en un episodio depresivo se asocia con comorbilidad psiquiátrica de diverso tipo incluyendo trastornos de ansiedad (especialmente fobia social), por uso de sustancias, de personalidad (exceptuando el tipo antisocial), psicosis e intentos suicidas (23).…”

MTHFD 1958G>A and MTR 2756A>G polymorphisms are associated with bipolar disorder and schizophrenia

“…BD is a mental disorder that is manifested by mood alterations, characterized by episodic mood swings (mania or depression) (Swann et al, 2005). Schizophrenia is a mental illness characterized by the so-called 'positive' symptoms, that include hallucinations and delusions and 'negative' symptoms contributing to the social and occupational dysfunction.…”

The Presentation, Recognition and Management of Bipolar Depression in Primary Care

“…[16][17][18] In one primary care practice, those with a lifetime history of bipolar disorder were significantly more likely than those without bipolar disorder to have current symptoms of anorexia or overeating, low self-esteem, suicidal ideation, alcohol use, and a history of hallucinations. 12 Mitchell et al 19,20 systematically reviewed the literature and found that the clinical symptoms of hypersomnia, hyperphagia, leaden paralysis, psychomotor retardation, psychotic features, pathological guilt, mood lability and longer speech latency occurred more often in bipolar depression than in unipolar depression ( Table 2).…”