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Feature Article

Bipolar disorder: what the GP needs to know

Philip B Mitchell, Bronwyn Gould

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Abstract

Most GPs will have some involvement in the care of patients with bipolar disorder – either on an ongoing basis or during crises such as mania or suicidal depression. This article focuses on the diagnosis and common comorbidities of the illness and management of its various phases.

Key Points

  • Patients with bipolar disorder may have episodes of mania, hypomania or bipolar depression, or mixed episodes. Interepisodic features, such as mild depression and anxiety, are common.
  • Pharmacotherapy is the centrepiece of management.
  • Psychological therapies shown to be effective for bipolar disorder in randomised controlled trials include psychoeducation and cognitive behavioural therapy.
  • Effective management of patients with bipolar disorder must address comorbidities, such as anxiety disorders and substance abuse.
  • It is important to remember that a patient’s behaviour inside the surgery during an episode of mania or hypomania might appear more normal than his or her behaviour occurring outside.
  • For patients who are prone to spending large amounts of money during manic episodes, consideration should be given to strategies for reducing access to large sums.
  • Poor adherence to medications is common in bipolar disorder, with nonadherence rates of up to 50% frequently reported. Substance abuse may be a related issue.

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