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Early signs of bipolar disorder seen in GP records

Early signs of bipolar disorder seen in GP records

A new study has identified the early signs of bipolar disorder that can be recognised up to ten years prior to diagnosis, with symptoms such as sleep problems and depression.

Researchers at the Universities of Keele and Manchester found that patterns in which patients use health care services, previous psychiatric diagnoses and psychotropic prescriptions are strong indicators of bipolar disorder.

More frequent face-to-face consultations with healthcare workers, higher levels of depression and greater substance misuse were among several patterns that could be identified as early warning signs of bipolar disorder.

The study is published in the British Journal of General Practice, and the researchers hope that the findings will enable GPs to carry out quick referrals to assess and treat the condition, and ultimately reduce the delay between diagnosis and treatment.

Up to three per cent of the UK population experience bipolar disorder at some point during their lives. It currently takes an average of six years to get a diagnosis, and many people remain undiagnosed. This can lead to increased hospital admissions, general poor physical health, interpersonal violence, more self-harm incidents and an increased suicide risk.

The research team analysed routinely collected electronic primary healthcare data from the  UK Clinical Practice Research Datalink (CPRD) GOLD. The aim was to look for signals of undiagnosed bipolar disorder in the dataset. The team identified 2,366 people with bipolar disorder and 47,138 people without the disorder, the latter of which became the control group. All patients were based in England, and the data was collected between January 2010 and July 2017.

The analysis revealed that patients with bipolar disorder had a higher incidence of depression, had more psychotic episodes, and experienced higher levels of anxiety and personality disorders up to 10 years before diagnosis. This group were also much more likely to experience escalating levels of self-harm prior to diagnosis when compared with the control group.

Sleep disturbance, substance misuse and mood swings were more frequent among those with bipolar disorder than those without. Patients who went on to be diagnosed with bipolar disorder were found to have more frequent face-to-face consultations with healthcare workers and were more likely to miss multiple scheduled appointments than the control group. In addition, those diagnosed with bipolar were more likely to have been prescribed three different psychotropic medication classes in a given year.

Professor Carolyn Chew-Graham, from Keele University and a member of the Bipolar UK Advisory group, said: ‘Better referral pathways from primary to specialist care are desperately needed both for patients and GPs, when a diagnosis of bipolar is suspected, if patients are to receive the timely help they need.’

The researchers hope that their research will help activate healthcare reforms so that dedicated care pathways for specialist treatments and lifetime support for people with bipolar disorder can be put in place. They advised primary care services to ‘think bipolar’ and supported the recent call from the Bipolar Commission Report for dedicated care for people with bipolar disorder. 

Dr Catharine Morgan, from the University of Manchester, added: ‘Bipolar disorders can have devastating impacts on the lives of patients and their families. Early treatment, however, can be crucial in averting years of hardship for patients; our study provides crucial information that could help GPs to consider a diagnosis of bipolar much earlier and refer on for specialist assessment.’


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