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Bipolar disorder

17th May 2007

Few patients with true bipolar disorder receive appropriate treatment and many suffer severe impairment, according to new research released in May.

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The same study found that nearly 4% of the general population suffers from some variation of bipolar disorder.

Lead author Dr Kathleen Merikangas, and her team from the National Institute of Mental Health in the US, evaluated the rates and treatment patterns of bipolar spectrum disorder in a representative sample of the US population that included 9,282 subjects. Bipolar disorder was diagnosed based on responses to the Composite International Diagnostic Interview.

Their study, published in the May 2007 Archives of General Psychiatry, found that when researchers consider all variations of bipolar disorder or the entire “bipolar spectrum disorder," the estimated lifetime prevalence in the general population is approximately 4%.

The Archives of General Psychiatry analyzed data from the National Comorbidity Survey Replication (NCS-R), a nationwide survey of mental disorders among 9,282 Americans aged 18 and older. The NCS-R was funded by the National Institutes of Health's National Institute of Mental Health (NIMH).

Merikangas identified prevalence rates of three subtypes of bipolar spectrum disorder among adults. Bipolar I is considered the classic form of the illness, in which a person experiences recurrent episodes of mania and depression. People with bipolar II experience a milder form of mania called hypomania that alternates with depressive episodes.

The results indicate that two types of the disorder, bipolar I and bipolar II, each occur in about 1% of the population. A third type, BD-NOS, occurs in about 2.4% of the population. The findings support international studies suggesting that, given its multi-dimensional nature, bipolar disorder may be better characterised as a spectrum disorder.

Most respondents with bipolar disorder reported receiving treatment. Nearly everyone who had bipolar I or II (89 to 95%) received some type of treatment, while 69% of those with BD-NOS were getting treatment.

Those with bipolar I or II were more commonly treated by psychiatric specialists, while those with BD-NOS were more commonly treated by general medical professionals.

But not everyone received treatment considered optimal for bipolar disorder. Up to 97% of those who had some type of bipolar illness said they had coexisting psychiatric conditions, such as anxiety, depression, or substance abuse disorders, and many were in treatment for those conditions rather than bipolar disorder.

The researchers found that many were receiving medication treatment considered “inappropriate,? such as antidepressants or other psychotropic medication in the absence of a mood-stabilising medication such as lithium, valproate, or carbamazepine.

Only about 40% were receiving appropriate medication, considered a mood stabiliser, anticonvulsant or antipsychotic medication.

Merikangas’s team hypothesizes that as people seek treatment for anxiety, depression, or substance abuse disorders, their doctors may be failing to detect signs of underlying bipolar disorder.

"Inappropriate treatment of [bipolar disorder] is a serious problem in the US population," the study concludes.

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