Culpepper Larry
Department of Family Medicine, Boston University Medical Center, Boston, Massachusetts.
Prim Care Companion CNS Disord. 2014;16(3). doi: 10.4088/PCC.13r01609. Epub 2014 Jun 19.
Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring.
双相情感障碍是一种慢性发作性疾病，其特征为躁狂或抑郁症状反复发作。双相情感障碍患者通常首先就诊于基层医疗，但潜在症状的多样性以及医生的低怀疑指数可能导致许多患者被误诊。通常，同时存在的精神和躯体疾病会使鉴别诊断更加复杂。在临床访谈时进行全面的诊断评估，并结合辅助的病例发现工具，对于做出准确诊断至关重要。在治疗双相情感障碍患者时，基层医疗医生在协调多学科网络中起着不可或缺的作用。药物治疗是双相情感障碍短期和长期管理的基础。预防复发的维持治疗通常基于治疗急性症状有效的相同药物治疗方法。无论选择何种治疗方法，长期监测对于确保持续的症状缓解、功能、安全性、依从性以及总体身体健康至关重要。本文从基层医疗角度描述了双相情感障碍管理中的关键决策步骤：从最初的临床怀疑到诊断确认，再到急性和长期管理中的决策以及患者监测的重要性。
