New research identifies prior signals of bipolar disorder

'Strong indicators' of bipolar

New research from the Universities of Keele and Manchester has found that psychiatric diagnoses, psychotropic prescriptions, and health service use patterns are strong indicators of bipolar disorder.

The findings - published in the British Journal of General Practice - will allow doctors to carry out quicker referral, assessment, and treatment of the devastating condition which used to be known as manic depression.

The early warning signs, identifiable for over 10 years before diagnosis, include previous depressive episodes, sleep disturbance, substance misuse, receipt of three or more different types of psychotropic medications in a year, escalating self-harm, frequent consultations and missing scheduled appointments.

The findings could help improve delays between the early manifestations of bipolar disease and its diagnosis and treatment, currently estimated to be around six years.

Major reforms required

The National Institute for Health and Care Research (NIHR) and the NIHR Greater Manchester Patient Safety Translational Research Centre funded research team analysed routinely collected electronic primary healthcare data from between January 2010 and July 2017

They identified 2,366 people with a bipolar disorder diagnosis and 47,138 people without bipolar disorder in England.

The work supports the remit of the recent Bipolar Commission Report 'Bipolar Minds Matter' which is calling for major reform of healthcare practice to develop a dedicated care pathway for specialist treatments and lifetime support for people with bipolar disorder.

Up to 3% of the UK population experience bipolar disorder at some point during their lives.

Many people who are undiagnosed experience adverse health outcomes including poor social adjustment, multiple hospital admissions, poor physical health, interpersonal violence and increased risk of self-harm and suicide.

Better referrals for patients

Professor Carolyn Chew-Graham OBE, Professor of General Practice Research at Keele University and member of the Bipolar UK Advisory group, said: "Better referral pathways from primary to specialist care are desperately needed both for patients and GPs, when a diagnosis of bipolar is suspected, if patient are to receive the timely help they need. 'Think bipolar' is a strong message to send out to GPs. The findings from our study support the recent call from the Bipolar Commission Report for dedicated care for people with bipolar disorder https://www.bipolaruk.org/bipolarcommission.

"There is evidence that a delay in diagnosis of bipolar can be up to 9 years, with a third of people who are eventually diagnosed with bipolar will have made an attempt on their lives because of the distress they feel and the delay in getting appropriate care."

Bipolar disorders are serious mental illnesses characterized by instability in mood. They can have devastating impacts on the lives of patients and their families.

Early treatment, however, can be crucial in averting years of hardship for patients; our study provides crucial information that could help GPs to consider a diagnosis of bipolar much earlier and refer on for specialist assessment."

Dr Catharine Morgan, Research Fellow, The University of Manchester