Das AK, Olfson M, Gameroff MJ, et al: Screening for bipolar disorder in a primary care practice. JAMA 2005;293(8):956-63.
Routine screening for depression is advised in primary care settings, but little attention has been focused on screening for past episodes of hypomania or mania, a history that may indicate bipolar disorder and a need for specialized therapy. The researchers identified 1,157 patients between the ages of 18 and 70 years who were scheduled to see a primary care clinician on a return visit to an urban general medicine clinic. Study participants received clinical assessment and chart review. The prevalence of positive screening results for lifetime bipolar disorder was 9.8% (n = 112) and did not differ by age, sex, or race. Patients who screened positive for bipolar disorder reported significantly worse health-related quality of life and increased social and family life impairment compared to those who screened negative (p <.001). Only seven of the 112 patients reported taking a mood-stabilizing agent in the past month. Primary care clinicians recorded evidence of current depression in 47 of the 112 patients, but did not record a bipolar disorder diagnosis in any of these patients. Current guidelines for bipolar disorders caution against monotherapy with antidepressants because this may induce hypomania, mania, or a mixed depressive/manic episode. Clinicians need to recognize and screen for bipolar disorder along with depression in primary care settings in order to appropriately diagnose and manage this common and underrecognized problem.