Primary care and bipolar disorder

The recent publication of the Bipolar Commission’s report, ‘Bipolar Minds Matter’, by Bipolar UK (BDUK) makes it timely to revisit the place of UK primary care in bipolar disorder (BD).¹ Bipolar disorder is a severe mood disorder that affects more than 1 million people in the UK; this is nearly one-third more than dementia and twice the number for schizophrenia.

This chronic disease is subclassified into distinct categories; for example, patients with BD1 have more severe manic episodes, whereas in BD2 the episodes of elation are less severe and shorter, often not coming to medical attention. Whatever the type of disease, the outcomes can be poor.² Without effective pharmacological and psychological interventions patients will suffer relapses. The aims of treatment are to prevent relapse and improve function. Most people with BD have a co-existing psychiatric illness, such as drug and alcohol misuse, eating disorders, anxiety disorders, or attention deficit hyperactivity disorder.²