Cribado para el trastorno bipolar en pacientes de atención primaria que presentan síntomas psicológicos / Screening for bipolar disorder in Primary Care patients with psychological symptoms

OBJETIVO: Estimar la proporción de resultados positivos en el cribado del trastorno bipolar (TB) entre los pacientes de atención primaria que consultan por problemas de naturaleza psicológica, y analizar sus características. DISEÑO: Estudio descriptivo transversal multicéntrico. Emplazamiento: Diecinueve consultas de atención primaria en diferentes comunidades autónomas. PACIENTES: La muestra estuvo formada por 360 pacientes consecutivos de atención primaria con edades entre 18 y 70 años visitados por síntomas psicológicos. Mediciones: El cribado para TB se realizó mediante el Mood Disorders Questionnaire. Se obtuvieron datos sobre calidad de vida (EuroQol-5D), impacto funcional (Sheehan Disability Inventory) y, mediante revisión de historias clínicas, datos sobre comorbilidad psiquiátrica y consumo de psicofármacos. RESULTADOS: Se obtuvo una proporción de cribados positivos del 11,9% (IC 95%: 8,8-15,7%). Solo en 2 de estos pacientes estaba registrado el diagnóstico de TB, y aunque más de la mitad recibían tratamiento con antidepresivos, solo 2 recibían tratamiento con estabilizadores del estado de ánimo. El cribado positivo se asocia a peor calidad de vida, a disfunción laboral, social y familiar, y a mayor estrés percibido. CONCLUSIONES: El cribado del TB en pacientes de atención primaria con otros problemas psicológicos da lugar a una notable proporción de resultados positivos, lo que indica que puede haber una prevalencia relevante de pacientes con TB, la mayor parte de ellos no diagnosticados y no tratados adecuadamente. Es necesario profundizar en la investigación para determinar el eventual papel que puede o debe asumir la atención primaria en la detección, el diagnóstico o el manejo de este trastorno

OBJECTIVE: To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. DESIGN: Multicenter cross-sectional study. Settings: Nineteen Primary Care clinics in different Spanish regions. PATIENTS: A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. Measurements: Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. RESULTS: Of the patients screened, 11.9% were positive (95% CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. CONCLUSIONS: BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder

[Screening for bipolar disorder in primary care patients with psychological symptoms]. / Cribado para el trastorno bipolar en pacientes de atención primaria que presentan síntomas psicológicos.

OBJECTIVE: To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. DESIGN: Multicenter cross-sectional study. SETTINGS: Nineteen Primary Care clinics in different Spanish regions. PATIENTS: A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. MEASUREMENTS: Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. RESULTS: Of the patients screened, 11.9% were positive (95%CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. CONCLUSIONS: BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder.