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Feature Article

The ups and downs of bipolar disorder in general practice

John WG Tiller

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Abstract

GPs are uniquely placed to identify patients with bipolar disorder and to contribute to their management, including addressing physical health problems and encouraging a stable balanced life and sleep/wake cycle. Treatment is generally with mood stabilisers rather than antidepressants, in collaboration with a psychiatrist.

Key Points

  • Patients with bipolar disorder present mostly with depression; the bipolar diagnosis is easily missed unless a history of mood elevation is sought.
  • Although up to 15% of patients with the disorder die by suicide, the major mortality is from cardiovascular disease and cancer (linked to obesity, smoking and alcohol), with about 10 to 20 years’ reduction in life span.
  • Pharmacotherapy with mood-stabilisers is essential, with antidepressants as second-line therapy or not used at all.
  • Electroconvulsive therapy can help both severe mania and depression.
  • Managing concurrent physical illness, especially obesity and substance abuse, is essential. General health measures and a balanced lifestyle with a regular sleep/wake cycle improve outcomes.
  • Most patients are best treated by GPs in conjunction with a psychiatrist.

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