Why GPs need to know about bipolar disorder

[Little Hussy]

It is well known that bipolar disorder carries with it high mortality and morbidity rates. The lifetime risk for suicide for people with bipolar disorder is 15% - this represents 12% of all Australian suicides, with around one quarter of patients with bipolar disorder making a suicide attempt at some point in their lifetime. The impact on quality of life, principally during depressive episodes, is quite substantive - impairing the capacity to get to work and, if at work, to function well. Of importance, the suicide risk and the level of impairment during the depressed phases are similar in bipolar I and bipolar II, underlining the importance of recognising and detecting both expressions. It has also been found that people with bipolar disorder have high rates of cardiovascular disease and this too contributes to the high mortality rate.

The burden of living with bipolar disorder is immense, not just to the individual and to their families but also to communities in general. This is reflected by data from the World Health Organisation that puts bipolar disorder as the sixth leading cause of disability world wide (when measured in DALYs - disability adjusted life years).

However, the real 'disability' data may well have been underestimated, as milder versions have a high chance of being undetected, or assigned as 'unipolar depression'. What's more, we know that for many people with bipolar disorder it can take over 10 years from the onset of symptoms for a correct diagnosis to be made. This delay in treatment contributes to the mortality figures. Finally, we now know that inappropriate treatment can have a negative impact on the course and severity of the disorder.