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Bipolar disorders: Previous depression diagnosis in the primary care setting

1 August 2003


BACKGROUND: Previous studies have indicated that bipolar disorders are diagnosed as depression in the primary care setting. This can lead to treatment failure of depression and worsening of bipolar disorder symptoms.

OBJECTIVE: To determine if patients with a bipolar disorder have had a previous diagnosis of depression by their primary care provider.

METHOD: A retrospective chart review of outpatients with a new diagnosis of bipolar disorder during the period of September 1, 2001 thru April 30, 2003 was performed. Past diagnostic and treatment information was obtained looking for a previous diagnosis of depression.

RESULTS: 25 patients were identified with a bipolar disorder. 8 patients had a self reported and 2 had a confirmed diagnosis of depression prior to being diagnosed with a bipolar disorder. Of the 25 patients, 13 (52%) had a history of illicit drug use, 19 (76%) had been hospitalized for a manic episode and 12 (48% )had a suicide attempt. Of those patients previously diagnosed with depression (N=10), 7 had a history of illicit drug use, 7 had been hospitalized for a manic episode, and 4 had suicide attempts. Of these patients, alcohol abuse was the most common comorbid disorder (40%).

CONCLUSION: Close to half of this study population had been previously diagnosed with and treated for depression. This indicated that diagnosing a bipolar disorder can be difficult, especially in the primary care setting. In order for an accurate diagnosis and treatment, PCP's need to be aware of and keep the various types of bipolar disorders in their differential


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