(Feb. 21,2017) The average time between the onset of bipolar disorder (BP) symptoms and diagnosis is six to eight years in the United States. For a chronic disease that is treatable but not curable, this delay deprives patients of medical interventions that could reduce their psychiatric symptoms and the consequences that often ensue when symptoms go untreated. Faster detection ultimately could improve long-term outcomes.
"Bipolar disorder remains a leading cause of disability in the United States," Joseph M. Cerimele and colleagues write in a new paper in Psychiatric Services. "A significant need exists to improve the health of the population - or entire group - of individuals with bipolar disorder." In "Bipolar disorder and population health," the authors argue for improving BP treatment in primary care settings as one approach.
Better Treatment for Bipolar
At least nine out of 10 individuals with BP receive treatment for the disorder at some point in their lifetimes, and about two-thirds have a lifetime experience of seeing a psychiatrist. But most BP patients are not seen by a psychiatrist in any given year, and large numbers are treated by primary care physicians, where "few receive effective medication treatment," according to the authors.
"These patients have high symptom severity and functional impairment but are less likely to receive mood-stabilizing medications," the authors report. "Not receiving effective medication treatment is a significant problem, because individuals with bipolar disorder often experience chronic but treatable symptoms." For individuals with bipolar disorder who do not receive treatment or receive ineffective medication treatment, "opportunities may have been missed for adjusting or intensifying treatment to manage recurrent or chronic symptoms."
One approach for improving this situation, the authors conclude, is improving the quality and intensity of mental health care in the general medical setting, where there are "numerous barriers that prevent primary care clinicians from prescribing mood-stabilizing medications." Removing those barriers requires equipping general medical physicians with screening tools to make accurate diagnosis in general medical settings and providing increased professional support so they can confidently prescribe mood-stabilizing medications and psychotherapies.
Collaborative Models
"The collaborative care approach, originally developed for treating patients with depression in primary care, may need to be strengthened or adapted for treating patients with bipolar disorder," the authors write. "Strategies such as telehealth or enhanced collaborative care that also addresses psychosocial needs may be needed to effectively treat patients with bipolar disorder seeking treatment in primary care."
Psychiatrists could either collaborate as consultants, weighing in expertly in the initial states of treatment, or by directly managing medication aspects of treatment, perhaps via telemedicine, Cereimele and colleagues concluded.
With a severe shortage of psychiatrists in the United States and more than half of US counties without a single mental health professional within their limits, reliance on primary care and other general practitioners for diagnosis and treatment of bipolar and other psychiatric disorders is inevitable, making the quest for improved care outside of psychiatry urgent.
Doris A. Fuller
Chief of Research and Public Affairs
References:
• Cerimele, J.M. et al. (February 2017). Bipolar disorder and population health. Psychiatric Services.
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