Defining the challenge: recognizing and treating bipolar disorder wherever patients present.(PART 1)(Disease/Disorder overview)

Bipolar disorder often goes unrecognized by primary care providers (PCPs) because patients typically present with what appears to be a major depressive episode and PCPs think it unlikely that they will see bipolar illness. (1-3) In psychiatric settings, too, bipolar disorder may be undetected or may be recognized only after a long delay, possibly because of evolving criteria for diagnosing the disorder. (3,5-7)

There is increasing recognition that bipolar disorder has a spectrum of symptom expression from subthreshold to meeting full criteria, indicating that bipolar I disorder, at least, may be more common than the 1% prevalence usually cited in population surveys. (1-3,8,9) Further, there is evidence that mixed episodes are not uncommon in bipolar I and II disorders. (4,6,10) In considering the whole spectrum of bipolar illnesses (bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder not otherwise specified), some authors have, controversially, suggested that the…