School of Clinical Medicine University of Cambridge, Cambridge, UK.
Psychiatr Danub. 2012 Sep;24 Suppl 1:S86-90.
While most of the management of mental health in the UK is conducted in primary care, the diagnosis by GPs has been shown to deficient in some areas. Bipolar disorder in particular is known to under-diagnosed but there is confusion as to whether this is due to poor recognition or conversion from unipolar depression
In April and May 2012 an audit was conducted in secondary psychiatric services in Bedford, UK among 146 representative patients and 112 bipolar patients, examining the course of their illness and diagnosis
Bipolar disorder is under-diagnosed in the community and in secondary care. First manic or hypomanic symptoms usually follow first depressive symptoms by several years (μ=7.3, σ=7.9). A diagnosis of bipolar also commonly follows manic or hypomanic symptoms by years (μ=7.6, σ=8.3).
Both psychiatrists and GPs under-diagnose bipolar, but this study shows it may be due to two factors: poor recognition by doctors and conversion from major depressive disorder.
GPs and psychiatrists must be more aware of the under-diagnosis of bipolar and its tendency to convert from pure depressive symptoms.
尽管英国大部分精神健康管理工作都是在初级保健机构进行的，但全科医生的诊断在某些方面被证明存在不足。双相情感障碍尤其容易被漏诊，但目前尚不清楚这是由于识别能力差还是从单相抑郁转化而来。
2012 年 4 月至 5 月，在英国贝德福德的二级精神科服务机构中，对 146 名有代表性的患者和 112 名双相情感障碍患者进行了一项审计，以检查他们的疾病过程和诊断情况。
双相情感障碍在社区和二级护理中都被漏诊。首发躁狂或轻躁狂症状通常比首发抑郁症状晚数年（μ=7.3，σ=7.9）。双相情感障碍的诊断也通常在躁狂或轻躁狂症状后数年（μ=7.6，σ=8.3）出现。
精神科医生和全科医生都对双相情感障碍的诊断不足，但本研究表明，这可能是由于两个因素：医生的识别能力差和从重度抑郁障碍转化而来。
全科医生和精神科医生必须更加意识到双相情感障碍的漏诊和从单纯抑郁症状转化的倾向。
