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Articles   |    
Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder
Joseph M. Cerimele, M.D.; Ya-Fen Chan, Ph.D.; Lydia A. Chwastiak, M.D.; Marc Avery, M.D.; Wayne Katon, M.D.; Jürgen Unützer, M.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300374
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With the exception of Dr. Chwastiak, the authors are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: cerimele@uw.edu). Dr. Chwastiak is with the Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, Seattle.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study aimed to describe the characteristics of primary care patients with bipolar disorder enrolled in a statewide mental health integration program (MHIP).

Methods  With the Composite International Diagnostic Interview (Version 3.0) and clinician diagnosis, 740 primary care patients with bipolar disorder were identified in Washington State between January 2008 and December 2011. Clinical rating scales were administered to patients at the time of enrollment and during treatment. Quality-of-care outcomes were obtained from a systematic review of the patient disease registry and compared with a previous study of patients with depressive symptoms in an MHIP. Descriptive analysis techniques were used to describe patients’ clinical characteristics.

Results  Primary care patients with bipolar disorder had high symptom severity on depression and anxiety measures: Patient Health Questionaire–9 (mean±SD score of 18.1±5.9 out of 27) and the seven-item Generalized Anxiety Disorder scale (15.7±4.7 out of 21). Psychosocial problems were common, with approximately 53% reporting concerns about housing, 15% reporting homelessness, and 22% reporting lack of a support person. Only 26% of patients were referred to specialty mental health treatment. Patients with bipolar disorder had a greater amount of contact with clinicians during treatment compared with patients with depressive symptoms from a prior study.

Conclusions  Primary care patients with bipolar disorder enrolled in MHIP had severe depression, symptoms of comorbid psychiatric illnesses, and multiple psychosocial problems. Patients with bipolar disorder received more intensive care compared with patients with depressive symptoms from a prior study. Referral to a community mental health center occurred infrequently even though most patients had persistent symptoms.

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Table 1Baseline demographic and clinical characteristics of 740 primary care patients with bipolar disordera
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a Mean±SD age was 38.9±10.6.

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b Self-reported by patients

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Table 2Baseline standardized examination findings for primary care patients with bipolar disorder
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a PHQ-9, Patient Health Questionnaire–9; GAD-7, seven-item Generalized Anxiety Disorder scale; GAIN-SS, Global Appraisal of Individual Needs–Short Screener; PCL, PTSD Checklist

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b Possible scores range from 0 to 27, with higher scores indicating greater depressive symptom severity.

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c Item 9 assesses suicidal ideation.

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d Possible scores range from 0 to 21, with higher scores indicating greater anxiety symptom severity.

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e Possible scores range from 0 to 5, with higher scores indicating greater likelihood of current substance use problems.

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f Possible scores range from 17 to 85, with higher scores indicating greater symptom severity.

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Table 3Quality-of-care outcomes for 740 primary care patients with bipolar disorder
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a Follow-up contacts with care manager include in-clinic, by phone, in group, and meeting with care manager in other location.

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Table 4Quality-of-care outcomes for mental health integration program (MHIP) populations from this study and previous study
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a Unützer et al., 2012 (26)

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b No Ns were provided in the study for the variables shown.

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