Ebmeier Klaus P
University of Oxford.
Practitioner. 2010 May;254(1729):19-22, 2.
Bipolar disorder is relatively common, at least twice as common as schizophrenia, and eminently treatable. It is also perfectly suited to the well established outpatient model practised in general practice and psychiatry. All GP practices should include people with a diagnosis of bipolar disorder on their case register of people with severe mental illness. It is not possible to exclude a bipolar diagnosis categorically if there are only symptoms of depression. Most patients will have had a (hypo)manic episode by their 30s. The lifetime prevalence of bipolar affective disorder proper is 1%, with a further 1.2% presenting with milder hypomanic symptoms (so-called bipolar II disorder). Relaxing diagnostic symptom criteria increases the frequency of depressed patients who develop symptoms of mania for any length of time to 50%. The lifetime course of the illness tends to be dominated by depressive episodes: half the time is estimated to be spent in the euthymic (well) state, 12% in a manic state and 38% in a depressed state. Any depressed patient should be asked about periods in the past when (s)he has been elated in mood, found it unnecessary to sleep, talked a lot, spent excessive amounts of money etc. Treatment for bipolar disorder has to be divided into: treatment of mania, treatment of bipolar depression and prophylaxis of mood swings in either direction. Antidepressant treatments are unlikely to help manic symptoms, at worst they can precipitate or aggravate them. Antimanic treatments are unlikely to help symptoms of depression but an exception to this rule would be a genuine mood stabiliser, such as lithium. Patients with bipolar disorder should have an annual physical health review. This will include monitoring for weight gain, lipid levels, plasma glucose levels, smoking status and alcohol use, as well as blood pressure.
双相情感障碍相对常见，至少是精神分裂症的两倍，而且完全可以治疗。它也非常适合在全科医疗和精神病学中实行的成熟门诊模式。所有全科医疗诊所都应将双相情感障碍诊断患者列入其严重精神疾病病例登记册。如果仅有抑郁症状，就不可能绝对排除双相情感障碍的诊断。大多数患者在30多岁时会经历一次（轻）躁狂发作。双相情感障碍的终生患病率为1%，另有1.2%表现为较轻的轻躁狂症状（所谓的双相II型障碍）。放宽诊断症状标准会使出现过任何时长躁狂症状的抑郁患者比例增至50%。该疾病的终生病程往往以抑郁发作为主：估计有一半时间处于心境正常（良好）状态，12%处于躁狂状态，38%处于抑郁状态。任何抑郁患者都应被问及过去是否有情绪高涨、觉得无需睡眠、话多、过度消费等情况。双相情感障碍的治疗必须分为：躁狂治疗、双相抑郁治疗以及双向心境波动的预防。抗抑郁治疗不太可能有助于缓解躁狂症状，最坏的情况是可能会引发或加重躁狂症状。抗躁狂治疗不太可能有助于缓解抑郁症状，但真正的心境稳定剂如锂盐是个例外。双相情感障碍患者应每年进行一次身体健康检查。这将包括监测体重增加、血脂水平、血糖水平、吸烟状况和饮酒情况以及血压。
