Das Amar K, Olfson Mark, Gameroff Marc J, Pilowsky Daniel J, Blanco Carlos, Feder Adriana, Gross Raz, Neria Yuval, Lantigua Rafael, Shea Steven, Weissman Myrna M
Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York 10032, USA.
JAMA. 2005 Feb 23;293(8):956-63. doi: 10.1001/jama.293.8.956.
Bipolar disorder consists of episodes of manic and depressive symptoms. Efforts to screen for depression in a primary care setting without assessment of past manic symptoms can lead to incorrect diagnosis and treatment of bipolar disorder.
To screen for bipolar disorder in adult primary care patients and to examine its clinical presentation and effect on functioning.
DESIGN, SETTING, AND PARTICIPANTS: A systematic sample of 1157 patients between 18 and 70 years of age who were seeking primary care at an urban general medicine clinic serving a low-income population. The study was conducted between December 2001 and January 2003.
Prevalence of bipolar disorder, its treatment and patient functioning. Study measures included the Mood Disorder Questionnaire, the PRIME-MD Patient Health Questionnaire, the Medical Outcomes Study 12-Item Short Form health survey, the Sheehan Disability Scale, data on past mental health treatments, and a review of medical records and International Classification of Diseases, Ninth Revision codes for each visit dating from 6 months prior to the screening day.
The prevalence of receiving positive screening results for lifetime bipolar disorder was 9.8% (n = 112; 95% confidence interval, 8.0%-11.5%) and did not differ significantly by age, sex, or race/ethnicity. Eighty-one patients (72.3%) who screened positive for bipolar disorder sought professional help for their symptoms, but only 9 (8.4%) reported receiving a diagnosis of bipolar disorder. Seventy-five patients (68.2%) who screened positive for bipolar disorder had a current major depressive episode or an anxiety or substance use disorder. Of 112 patients, only 7 (6.5%) reported taking a mood-stabilizing agent in the past month. Primary care physicians recorded evidence of current depression in 47 patients (49.0%) who screened positive for bipolar disorder, but did not record a bipolar disorder diagnosis either in administrative billing or the medical record of any of these patients. Patients who screened positive for bipolar disorder reported worse health-related quality of life as well as increased social and family life impairment compared with those who screened negative.
In an urban general medicine clinic, a positive screen for bipolar disorder appears to be common, clinically significant, and underrecognized. Because of the risks associated with treating bipolar disorder with antidepressant monotherapy, efforts are needed to educate primary care physicians about the screening, management, and pharmacotherapy of bipolar disorders.
双相情感障碍由躁狂和抑郁症状发作组成。在初级保健环境中，在未评估既往躁狂症状的情况下筛查抑郁症可能会导致双相情感障碍的误诊和误治。
在成年初级保健患者中筛查双相情感障碍，并检查其临床表现及对功能的影响。
设计、场所和参与者：从一家为低收入人群服务的城市综合内科诊所中，系统抽取1157名年龄在18至70岁之间寻求初级保健的患者。该研究于2001年12月至2003年1月进行。
双相情感障碍的患病率、治疗情况及患者功能。研究指标包括心境障碍问卷、PRIME-MD患者健康问卷、医学结局研究12项简明健康调查、希恩残疾量表、既往心理健康治疗数据，以及对筛查日前6个月内每次就诊的病历和国际疾病分类第九版编码的回顾。
终生双相情感障碍筛查结果呈阳性的患病率为9.8%（n = 112；95%置信区间，8.0%-11.5%），在年龄、性别或种族/民族方面无显著差异。81名双相情感障碍筛查呈阳性的患者（72.3%）因症状寻求专业帮助，但只有9名（8.4%）报告被诊断为双相情感障碍。75名双相情感障碍筛查呈阳性的患者（68.2%）目前患有重度抑郁发作或焦虑或物质使用障碍。在112名患者中（6.5%），只有7名报告在过去一个月服用了心境稳定剂。初级保健医生在47名双相情感障碍筛查呈阳性的患者（49.0%）中记录了当前抑郁的证据，但在行政计费或这些患者的任何一份病历中均未记录双相情感障碍的诊断。与筛查呈阴性的患者相比，双相情感障碍筛查呈阳性的患者报告的健康相关生活质量较差，社会和家庭生活受损情况也有所增加。
在城市综合内科诊所中，双相情感障碍筛查呈阳性似乎很常见、具有临床意义且未得到充分认识。由于抗抑郁药单药治疗双相情感障碍存在风险，需要努力对初级保健医生进行双相情感障碍筛查、管理和药物治疗方面的教育。
