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Practical Clues to Early Recognition of Bipolar Disorder: A Primary Care Approach.

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  • 1Department of Psychiatry, University of Texas Health Science Center at Houston, Houston ; Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Mo. ; private practice, Chevy Chase, Md. ; the Department of Psychiatry & Biobehavioral Sciences, School of Medicine, University of California at Los Angeles, and the VA Greater Los Angeles Healthcare System, Los Angeles, Calif. ; the Department of Psychiatry & Behavioral Sciences, Division of Child & Adolescent Psychiatry & Child Development, and Department of Psychiatry, Stanford University School of Medicine, Stanford, Calif. ; the Departments of Psychiatry and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio ; the Department of Psychiatry and Human Behavior, University of California, Irvine ; and Outcomes Management, Active Health Management, Inc., New York, N.Y.


Early treatment can favorably impact the course of bipolar disorder, a lifelong illness. Because bipolar disorder can masquerade as various mental and physical illnesses-primarily major depressive disorder-patients with this condition frequently go unrecognized for years. During this recognition lag, such patients may present to their primary care physician on multiple occasions. Accordingly, primary care physicians would benefit from knowing the "clues" to early recognition of the disorder, because early recognition and management can reduce disability, improve social and employment stability, and result in improved functional outcomes. This review describes 3 pathways to the diagnosis of bipolar disorder relevant to the primary care setting: detection of mania or hypomania, differential diagnosis of recurrent depressive episodes, and identification of interepisode disorder and its comorbidities. We summarize these pathways in terms of a practical tool that a primary care physician can use to trigger further evaluation or referral.

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