Diagnosis and Treatment of Bipolar Illness in the Primary Care Office.

Bipolar Affective Disorder (BPAD) is frequently encountered in the primary care office and must be considered in the differential diagnosis of all patients with mood dysregulation. Appreciation for the range of bipolar illness has evolved in recent years, and the overlap of bipolar illness with trauma-based diagnosis such as Post-Traumatic Stress Disorder (PTSD) and Borderline Personality Disorder must be considered. Treatment of BPAD is divided into manic, depressive, and maintenance phases, each with different pharmacologic considerations. First line agents for the acute manic phase include lithium, valproic acid, and second generation antipsychotics (SGAs). First line agents for depressive phase include lamotrigine, lithium, and the SGAs lurasidone and quetiapine. For bipolar maintenance therapy, lamotrigine, valproic acid, and lithium are first line options. Finally, nonpharmacologic interventions including psychoeducation can be extremely helpful for patients and their families to successfully participate in the management of their disease.