Evaluation of the 13-item Hypomania Checklist and a brief 3-item manic features questionnaire in primary care

Aims and methodThe mean delay for bipolar disorder diagnosis is 10 years. Identification of patients with previous hypomania is challenging, sometimes resulting in misdiagnosis. The aims of this study were: (a) to estimate the proportion of primary care patients with depression currently taking antidepressants who have undiagnosed bipolar disorder and (b) to compare a brief 3-item manic features questionnaire with the Hypomania Checklist (HCL-13). The sample comprised patients with a recorded diagnosis of depression, either on long-term antidepressant therapy or with previous multiple courses of antidepressants.ResultsOf 149 participants assessed, 24 (16.1%) satisfied criteria for bipolar disorder. Areas under the curve (AUC) for the 3-item questionnaire and the HCL-13 were similar (0.79 and 0.72, respectively) but positive predictive values (PPV) were low.Clinical implicationsBipolar disorder may be underdiagnosed in primary care. A 3-item questionnaire could be used by general practitioners to screen for bipolar disorder in their patients with depression.

Download Full-text

Reassessing Carbamazepine in the Treatment of Bipolar Disorder Clinical Implications of New Data

CNS Spectrums ◽

10.1017/s1092852900023063 ◽

2005 ◽

Vol 10 (6) ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Terence A. Ketter ◽

David L. Ginsberg ◽

Hagop S. Akiskal ◽

Paul E. Keck ◽

Richard H. Weisler ◽

...

Keyword(s):

Bipolar Disorder ◽

Weight Gain ◽

Drug Interactions ◽

Bipolar Depression ◽

Panel Discussion ◽

Current Data ◽

Clinical Implications ◽

Good Tolerability ◽

Long Term Treatment

AbstractThis monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions.Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on weight.) Thus, carbamazepine may be a good option for patients who are concerned about weight gain or who are intolerant of or respond poorly to other medications. Further efforts are needed to update physicians on the use of carbamazepine relative to other medications in the treatment of bipolar disorder.

Download Full-text

Clinical trial: long-term use of proton pump inhibitors in primary care patients - a cross sectional analysis of 901 patients

Alimentary Pharmacology & Therapeutics ◽

10.1111/j.1365-2036.2009.04092.x ◽

2009 ◽

Vol 30 (7) ◽

pp. 725-732 ◽

Cited By ~ 20

Author(s):

C. REIMER ◽

P. BYTZER

Keyword(s):

Primary Care ◽

Clinical Trial ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Primary Care Patients ◽

Sectional Analysis

Download Full-text

Bipolar Disorder is Common in Depressed Primary Care Patients

Postgraduate Medicine ◽

10.3810/pgm.2011.09.2468 ◽

2011 ◽

Vol 123 (5) ◽

pp. 129-133 ◽

Cited By ~ 9

Author(s):

Steven L. Dubovsky ◽

Kenneth Leonard ◽

Kim Griswold ◽

Elsa Daurignac ◽

Burlleen Hewitt ◽

...

Keyword(s):

Primary Care ◽

Bipolar Disorder ◽

Primary Care Patients

Download Full-text

Reassessing Carbamazepine in the Treatment of Bipolar Disorder Clinical Implications of New Data

CNS Spectrums ◽

10.1017/s1092852900024494 ◽

2005 ◽

Vol 10 (S1) ◽

pp. 1-2 ◽

Cited By ~ 1

Keyword(s):

Bipolar Disorder ◽

Weight Gain ◽

Drug Interactions ◽

Bipolar Depression ◽

Panel Discussion ◽

Current Data ◽

Clinical Implications ◽

Good Tolerability ◽

Long Term Treatment

ABSTRACTThis monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions.Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on weight. *) Thus, carbamazepine may be a good option for patients who are concerned about weight gain or who are intolerant of or respond poorly to other medications. Further efforts are needed to update physicians on the use of carbamazepine relative to other medications in the treatment of bipolar disorder.

Download Full-text

Obesity management by general practitioners: the unavoidable necessity

Australian Journal of Primary Health ◽

10.1071/py15018 ◽

2015 ◽

Vol 21 (4) ◽

pp. 366 ◽

Cited By ~ 13

Author(s):

Sarah Jansen ◽

Ben Desbrow ◽

Lauren Ball

Keyword(s):

Primary Care ◽

Weight Management ◽

National Health ◽

Public Health Issue ◽

Management Support ◽

Obesity Management ◽

Management Interventions ◽

Primary Care Patients ◽

Insufficient Time

Nearly 62% of primary care patients are overweight or obese, and obesity is now a National Health Priority Area. Weight management interventions in primary care currently generate little more than 1 kg of weight loss per patient over a 2-year period. Consequently, further strategies are required to improve the effectiveness of weight management in primary care. The National Health and Medical Research Council (NHMRC) have released updated guidelines for the management of overweight and obese patients in primary care. However, there is some disconnect between establishment of guidelines and their implementation in practice. Barriers to GPs using guidelines for the management of obesity include low self-efficacy, perceived insufficient time in consultations and the challenge of raising the topic of a patient’s weight. Nonetheless, patients prefer to receive weight management support from GPs rather than other health professionals, suggesting that the demand on GPs to support patients in weight management will continue. GPs cannot afford to side-line obesity management, as obesity is likely to be the most prevalent modifiable risk factor associated with patients’ long-term health. Without further strategies to support GPs in their management of patients’ weight, obesity will continue to be an expensive and long-term public health issue.

Download Full-text