J Clin Outcomes Manage
Bipolar disorder for the primary care physician
St. John-Larkin C, Allen MH
Abstract Objective: To review the diagnosis and treatment of bipolar disorder. Methods: Qualitative assessment of the literature. Results: Bipolar disorder is a major cause of morbidity and mortality. Due to the incidence and nature of the disorder, it is important to screen any patient presenting with depression for a history of mood swings and manic symptoms. The presence of psychosis or a family history of bipolar disorder can be helpful. First-line treatment for a depressive episode includes lithium or lamotrigine. The addition of an antipsychotic or an antidepressant may be necessary or useful in some cases. Evidence supports avoiding monotherapy with an antidepressant as this is likely to induce mania or rapid cycling. Treatment of severe manic or mixed episodes includes lithium or valproic acid with an atypical antipsychotic. Mild to moderate episodes may be managed with lithium, valproic acid, or an antipsychotic alone. Valproate may be more effective than lithium for some variants. An atypical antipsychotic may be the best choice for management of mild to moderate episodes in primary care settings. Conclusion: Appropriate diagnosis and treatment of bipolar disorder will help improve outcomes for patients with this potentially devastating but often manageable illness.
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