The Bipolar Spectrum: A Review of Current Concepts and Implications for the Management of Depression in Primary Care

J. S. Manning

doi:10.1001/archfami.7.1.63

Trauma exposure and posttraumatic stress disorder among primary care patients with bipolar spectrum disorder

Bipolar Disorders ◽

10.1111/j.1399-5618.2008.00589.x ◽

2008 ◽

Vol 10 (4) ◽

pp. 503-510 ◽

Cited By ~ 29

Author(s):

Yuval Neria ◽

Mark Olfson ◽

Marc J Gameroff ◽

Priya Wickramaratne ◽

Daniel Pilowsky ◽

...

Keyword(s):

Primary Care ◽

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Trauma Exposure ◽

Spectrum Disorder ◽

Bipolar Spectrum ◽

Bipolar Spectrum Disorder ◽

Primary Care Patients

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The Bipolar Spectrum; Do we Need a Single Algorithm for Affective Disorders?

European Psychiatry ◽

10.1016/s0924-9338(09)70839-9 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

M. Agius ◽

G. Tavormina

Keyword(s):

Primary Care ◽

Bipolar Disorder ◽

Affective Disorders ◽

Stepped Care ◽

Rapid Cycling ◽

Bipolar Spectrum ◽

Mixed States ◽

Bipolar Ii Disorder ◽

Bipolar Illness ◽

Bipolar Ii

Increasing understanding of the bipolar spectrum of disorders has led to an increasing integration of concepts regarding the aetiology and treatment of affective disorders.Thus, for example, we now understand that an illness, previously believed to be recurrent depressive disorder, may develop over time into a bipolar illness, and bipolar II illnesses may develop into bipolar I.Agitated depression may in fact be a mixed affective state, and injudicious use of powerful antidepressants in patients with undiagnosed bipolar disorder may lead to the development of mixed states or rapid cycling illness, as well as a complete switch from depression to mania.Mixed states and rapid cycling states are linked with increased suicidality.Meanwhile bipolar disorder, especially bipolar II disorder, remains a condition which is underdiagnosed and often inappropriately treated.Unfortunately, NICE guidelines are separate for Unipolar Depression and Bipolar Illness; those for Unipolar illness advocate a 'stepped care’ model, centred round primary care, while bipolar guidelines warn against injudicious use of antidepressants and the use of mood stabilisers to prevent ‘switching’ to mania.Primary care physicians are not warned to take a full longitudinal history in depressed patients, to identify bipolar illness, nor are they trained to use mood stabilisers in patients with bipolar II disorder, and in the risks of injudicious use of antidepressants.We need a single algorithm for identifying and treating affective disorders.The symposium will consider these issues as a prelude to a Europe Wide meeting planned for later in 2009, to develop guidelines about these issues.

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Bipolar spectrum disorders in primary care: optimising diagnosis and treatment

British Journal of General Practice ◽

10.3399/bjgp10x484165 ◽

2010 ◽

Vol 60 (574) ◽

pp. 322-324 ◽

Cited By ~ 8

Author(s):

Daniel J Smith ◽

Ajay Thapar ◽

Sharon Simpson

Keyword(s):

Primary Care ◽

Diagnosis And Treatment ◽

Bipolar Spectrum ◽

Bipolar Spectrum Disorders ◽

Spectrum Disorders

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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