BOCA RATON, Fla. – Many family physicians do not feel adequately prepared to diagnose and treat bipolar disorder, based on a survey of 77 family physicians.
Purvi Kobawala Smith
“When these mentally ill patients ... present in a primary care setting, it is a critical opportunity to intervene,” according to Purvi Kobawala Smith.
Diagnosis and management of bipolar disorder can be complex, given that patients can present with severe depression, severe mania, mixed mood states, rapid cycling, and/or comorbidities. This might explain in part the results of previous studies suggesting that bipolar disorder often can be misunderstood or misdiagnosed in primary care settings (JAMA 2005; 293;956-63; J. Clin. Psychiatry 2003;64:53-9).
“Many [patients] get misdiagnosed with depression and get sent down an entirely wrong treatment path,” Ms. Smith said in an interview at her poster during the New Clinical Drug Evaluation Unit meeting sponsored by the National Institute of Mental Health.
To evaluate family physicians’ educational needs regarding this disorder, Ms. Smith and her colleagues mailed surveys to 900 family physicians in January 2009. The 77 respondents (a 9% response rate) rated their own preparedness regarding screening for bipolar disorder, discussion of comorbidities, evaluation of the phase of bipolar disorder based on symptoms, discussion of psychotherapy and pharmacologic options, and development of a treatment plan.
“By and large, the majority rated themselves as ‘not very prepared’ or ‘somewhat prepared,’” said Ms. Smith, scientific director for a medical education company in Ramsey, N.J.
More than half felt this way, for example, when asked about their ability to assess for bipolar disorder using a screening tool or interviewing techniques (36 of 69 respondents, or 52%). Another 36% felt prepared and 12%, very prepared.
Regarding discussion of comorbidities, 53% of 68 felt they were not very prepared or were only somewhat prepared, 41% were prepared, and 6% were very prepared.
Regarding diagnosis of the phase of the disorder based on symptoms, 51% of 69 physicians felt not very or somewhat prepared, 39% felt prepared, and 10% felt very prepared.
Respondents rated themselves as less prepared to discuss psychotherapy options. For example, 64% of 67 physicians said they were not very prepared or were only somewhat prepared. Another 30% said they were prepared and only 6% were very prepared.
More family physicians said they were prepared or very prepared to discuss pharmacologic treatments: In all, 58% were not very prepared or only somewhat prepared, 33% were prepared, and 9% were very prepared.
Mood symptoms are common in primary care practices, Ms. Smith said. About 23% of their patients regularly complain of mood symptoms, according to 59 family physicians who answered this question.
Primary care physicians play an integral role in the initiation of treatment, especially when there are no psychiatrists in the local community for referral, Ms. Smith said. But she acknowledged that learning more about bipolar disorder may not be easy: “This is a challenge for primary care physicians, given their [time] constraints.”
Along with Dr. Jennifer Payne of the department of psychiatry and behavioral sciences at Johns Hopkins University in Baltimore, who was the lead investigator of the study, Ms. Smith and others developed a free online course. Dr. Payne is the course director.
The survey and online course are supported by a grant from Eli Lilly and Co. Ms. Smith said she had no relevant disclosures. Dr. Payne is a consultant for AstraZeneca and Wyeth and receives honoraria from Wyeth.