Expert Commentary

Bipolar Disorder, a Public Health Issue in the United Kingdom

Dr Nicholas Stafford

Consultant Psychiatrist and Clinical Research Investigator
Leicestershire Partnership NHS Trust
Leicestershire, UK

Vice Chairman, Bipolar UK

Adult Bipolar Disorder (BPD) is a lifelong episodic illness with prevalence of 1% to 5% in the general population. Prevalence varies little internationally.  BPD is characterized by severe mood swings ranging from elation to depression; it is also associated with the highest suicide rate of all psychiatric illnesses. Because patients will usually report only symptoms of depression, diagnosis may be compromised if the general practice physician does not establish if hypomania may also be present.  Because of the importance of early recognition of BPD as a public health issue, education in BPD and awareness of the use of screening tools is critical.  In one key study which reviewed 6000 patients in 11 countries given a diagnosis of Major Depression 16% fulfilled the criteria for BPD given in DSM III.  The figure jumped to 50% using DSM IV criteria.  The consequences of missing a BPD diagnosis can be catastrophic.  Data shows that BPD can be missed for a decade and may require 4-5 clinicians before a proper diagnosis is obtained. Mistreatment with antidepressants can at best be wasted and at worst will exacerbate the illness or trigger its rapid cycling phase. In addition to synergistically improved mental and physical health benefits of early and appropriate BPD treatment, its economic benefits are profound since both direct and indirect costs are notably reduced.  In England a new software screening tool is currently under clinical evaluation which will alert GPs to the possibility of BPD in the normal course of assessment of putatively depressed patients.

Dr Stafford acknowledged support and advice from Dr Arek Hassy, a GP in the West Berkshire PCT, UK. In addition, AstraZeneca’s financial assistance to help establish and manage the program in its early stages was also acknowledged.

References

  1. http://www.rcpsych.ac.uk/members/nccmh/niceclinicalguidelines.aspx
  2. Angst, J. et al (2011) Prevalence and Characteristics of Undiagnosed Bipolar Disorders in Patients With a Major Depressive Episode Arch Gen Psychiatry. 2011;68(8):791-799.
  3. Smith DJ, et al (2011) Unrecognised bipolar disorder in primary care patients with depression. Br J Psychiatry. Jul;199(1):49-56.
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