Culpepper Larry
From the Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
J Clin Psychiatry. 2014 Mar;75(3):e05. doi: 10.4088/JCP.13019tx1c.
Misdiagnosis of bipolar disorder is too frequent in primary care practices. Early diagnosis of the disease is crucial for appropriate treatment and optimal outcomes, yet patients may go years without a proper diagnosis. Misdiagnosis of unipolar depression may occur when patients with depressive symptomatology report no manic or hypomanic episodes. Furthermore, bipolar disease may begin as depression and develop into bipolar disorder. Primary care physicians can watch for several red flags in patients with depressive episodes, such as poor functioning in social and work arenas, risky behaviors, and legal issues. Other warning signs include a family history of bipolar disorder, psychosis at the index depressive episode, young age at onset of depression, and either antidepressant resistance or antidepressant-induced mania or hypomania. Correct and timely recognition of bipolar disorder by primary care physicians can provide long-lasting benefits for the patient.
在基层医疗实践中，双相情感障碍的误诊情况极为常见。该疾病的早期诊断对于恰当治疗及实现最佳疗效至关重要，然而患者可能多年都无法得到正确诊断。当有抑郁症状的患者报告无躁狂或轻躁狂发作时，可能会发生单相抑郁症的误诊。此外，双相情感障碍可能始于抑郁症，并发展为双相情感障碍。基层医疗医生可以留意抑郁发作患者的几个危险信号，比如在社交和工作领域功能不佳、危险行为以及法律问题。其他警示信号包括双相情感障碍家族史、首发抑郁发作时伴有精神病性症状、抑郁症发病年龄较轻，以及抗抑郁药抵抗或抗抑郁药诱发的躁狂或轻躁狂。基层医疗医生正确且及时地识别双相情感障碍可为患者带来长期益处。
