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Bipolar: Experts urge better initial care
Many people do not receive appropriate early care for bipolar disorder.
A new article in The Lancet Psychiatry has assessed existing evidence and argues that many people with bipolar disorder have a poor quality of life because they did not receive appropriate care at the right time.
The argument belongs to a team of specialists from several academic institutions:
- the Institute of Psychiatry, Psychology and Neuroscience at King’s College London in the United Kingdom
- Orygen, The National Centre of Excellence in Youth Mental Health in Parkville, Australia
- the University of British Columbia in Vancouver, Canada
- the Florey Institute for Neuroscience and Mental Health at the University of Melbourne, also in Parkville, Australia
Bipolar disorder affects around 60 million people around the world, according to the World Health Organization (WHO).
In the United States alone, about 2.8% of all adults held a diagnosis of bipolar disorder in the past year, according to the National Institute of Mental Health.
People with bipolar disorder can experience drastic mood shifts called periods of mania (dramatic states of “high”) and depression (equally intense “lows”).
For a person to receive a diagnosis of bipolar disorder, they must have experienced at least one manic episode. Mania might make a person feel as though they are on top of the world and capable of anything, which can fuel risk taking behavior.
However, many do not receive a diagnosis when their symptoms first begin to manifest, and they do not receive appropriate care following an initial manic episode.
‘We need long-term studies’
In their “Personal View” article, the specialists looked at data concerning the prevalence and health burden of bipolar disorder, as well as how it usually progresses, how healthcare providers typically treat it, and what international guidelines recommend.
They found that people with bipolar disorder have “a 50 times greater risk of self-harm” than those without the condition. They also have “at least a 12 times increased suicide risk,” according to the article.
The authors also note that “[d]ata from the WHO Global Burden of Disease study ranked bipolar disorder as the fourth leading cause of disability-adjusted life-years in people aged 10–24 years.”
They also cite studies that found that about half of people with bipolar disorder develop symptoms before the age of 21. However, other evidence shows that it can take almost 6 years after the first symptoms set in for a doctor to diagnose the condition and suggest treatment options.
In their article, the specialists show that people having their first manic episode do not receive the treatment they need. They also note that there is insufficient research regarding the appropriate intervention for first-time manic episodes, which, in turn, leads to incomplete care guidelines.
“Bipolar [disorder] can have serious effects on the health of a young person, their family, and society in general,” explains first author Sameer Jauhar, Ph.D.
“By identifying people who have had a first episode, and offering them appropriate treatment at an early stage,” he adds, “we can help them get on with their lives and prevent relapses.”
“As a consultant psychiatrist,” says Jauhar, “this is something I see again and again. People who are identified early and get effective treatment quickly are able to avoid further episodes and achieve extraordinary things, while others who the system doesn’t serve so well can get stuck for years.”
“Another really important factor is research — we need long-term studies to help guide future treatments and make sure we keep people well in the longer-term.”
Sameer Jauhar, Ph.D.
The specialists attach to their article the account of a man with bipolar disorder who reports not receiving the treatment he needed for early hypomania. In the account, the man describes how this affected his life. His case illustrates the importance of receiving an early diagnosis and treatment.
“My struggles with mental health began at age 14 when I started to experience some symptoms of depression,” he says. “However, it was when I started to develop episodes of hypomania at 16 that things really began getting out of hand.”
“These episodes came as a shock to everyone around me. […] I wasn’t sleeping, had a constant need to pace, and was very frustrated. My behavior began to alienate everyone around me. Further episodes followed and I began engaging in risky behavior.”
“The doctors failed to diagnose me properly at this point,” he adds, “because they failed to take a proper history of my mental health.”
It was only when doctors finally identified and provided the care he needed that his productivity and quality of life improved.
“All in all, it took 4 years from my first symptoms to the point when I started getting the treatment I really needed. Now, 3 years later, I am managing to study and work at the same time and am able to enjoy my life,” he concludes.