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Feature Article

Improving recognition and management of bipolar disorder

Josephine Anderson, Philip B Mitchell

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Abstract

More than 200,000 people in Australia live with bipolar disorder throughout their adult lives, and poor management of this episodic illness significantly impairs social, emotional and economic wellbeing, to the detriment of both the patient and the community. GPs are key to an integrated biopsychosocial approach to bipolar disorder. This article describes the core components of early detection and effective management in the light of recent evidence.

Key Points

  • Bipolar disorder is more common than schizophrenia and associated with considerable morbidity and economic cost to affected individuals and their families.
  • Pharmacotherapy and psychological management, aimed at reducing the frequency and intensity of episodes of illness, can make a major difference to the wellbeing of those living with bipolar disorder.
  • There are as yet no diagnostic tests for bipolar disorder so the clinical evaluation of mood swings and associated symptoms of the two ‘poles’ of mood elevation and depression is crucial.
  • Doctors should be alert to the features more commonly associated with bipolar (rather than unipolar) depression, enquire about episodes of hypomania in patients with difficult to treat depression, and be mindful of the possibilities of overdiagnosis of bipolar disorder in some patients.
  • Doctors should also be aware that episodes of predominantly hypomania/mania or depression can occur with mixed features of the opposite ‘pole’.
  • Appropriate investigation and physical examination is crucial
as many physical illnesses may first present with severe secondary disturbances of mood and the unwanted effects of some medications used to treat patients with bipolar disorder can cause physical problems.
  • Although pharmacotherapy is necessary for acute and maintenance management of affected patients, specific adjunctive psychological therapies have also been found to promote better mood stability and reduce the frequency of hospitalisation.

    
Picture credit: © Hristo Shindov/Getty Images

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