Family Medicine Update

Diagnosis and monitoring of bipolar disorder in general practice.

Med J Aust. 2010 Aug 16;193(4):S10-3

Authors: Mitchell PB, Loo CK, Gould BM

General practitioners are often consulted for first presentations of bipolar disorder and are well placed to coordinate patient care. They can assist with early identification of bipolar disorder and monitoring for manic and depressive episodes. Delayed and incorrect diagnoses are common in bipolar disorder, and unipolar depression is a frequent misdiagnosis. Characteristics that can be used to distinguish bipolar I depression from unipolar depression (when no clear prior manic episodes are evident) include the course of illness, symptoms, mental state signs and family history. Manic episodes can be caused by poor adherence to medication, substance misuse, antidepressants and stressful events, and are often preceded by early warning signs. Early warning signs are less commonly observed for depressive episodes. Daily mood charts are useful for providing an overview of patient progress and for identifying and managing early warning signs. Families and carers can also play an active role in supporting patients with bipolar disorder.

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– Diagnosis and monitoring of bipolar disorder in general practice.

Misdiagnosis of patients receiving inhaled therapies in primary care.

Int J Chron Obstruct Pulmon Dis. 2010;5:241-9

Authors: Izquierdo JL, Martín A, de Lucas P, Rodríguez-González-Moro JM, Almonacid C, Paravisini A

AIM: To analyze the accuracy of diagnosis in a population receiving inhaled therapies due to respiratory diseases in a primary care setting. METHOD: Noninterventional, multicenter, cross-sectional, observational epidemiologic study methodology. RESULTS: A total of 9752 subjects were evaluated. Of these, 4188 (42.9%) patients were diagnosed with asthma, 4175 (42.8%) with chronic obstructive pulmonary disease (COPD), and 1389 had a diagnosis of disease of unknown origin. Of those over the age of 40 years, 4079 (50.9%) had COPD and 2877 (35.9%) had asthma. Sixty percent of the subjects were men, and the proportion of men was higher in patients with COPD (83.2%) than in the group with asthma (39.8%, P < 0.0001). Of subjects with COPD, 17.3% had mild, 55.3% had moderate, 24.1% had severe, and 3.2% had very severe disease. With regard to the level of severity of asthma, 34.9% of subjects had intermittent, 34.6% had mild persistent, 27.1% had moderate persistent, and 3.5% had severe persistent disease. Only 13.9% of patients in the COPD group had all the characteristics of COPD based on the Global Initiative for Chronic Obstructive Lung Disease criteria and an absence of the characteristics of asthma. CONCLUSIONS: The majority of patients receiving inhaled therapy in primary care did not have an accurate diagnosis according to current international guidelines for COPD and asthma. More initiatives for improving diagnostic accuracy in respiratory diseases must be implemented in primary care.

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– Misdiagnosis of patients receiving inhaled therapies in primary care.

Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care.

J Affect Disord. 2010 Aug 5;

Authors: Ruiz MA, Zamorano E, García-Campayo J, Pardo A, Freire O, Rejas J

OBJECTIVE: To explore the validity of the GAD-7 scale as an outcome measure of disability in primary care. METHODS: A random sample of 212 subjects was recruited in primary care clinics; 50% diagnosed with generalized anxiety disorder (GAD) by DSM-IV criteria and 50% concurrent matched controls. The GAD-7, the Hamilton Anxiety Scale (HAM-A), and the abridged 12-item version of World Health Organization Disability Scale (WHO-DAS-II) were administered. The number of visits to primary care and specialty clinics was also recorded. RESULTS: Strong and significant (p<0.001) correlations were found between GAD-7 and HAM-A (r=0.852) and WHO-DAS-II (r=0.704) scores, particularly for Participation in Society (r=0.741), Understanding and Communication (r=0.679), and Life Activities (0.638) dimensions. Moderate but significant correlations were also found between GAD-7 score and the number of visits to Primary Care (r=0.393) and Specialty clinics (r=0.373). In all cases, an overall relation was observed between GAD-7 severity levels and disability scores [F (3,208)=25.4, p<0.001] as assessed by the WHO-DAS II, with higher mean disability values related to higher severity levels. CONCLUSIONS: The GAD-7 scale has been shown to highly correlate not only with specific anxiety but also with disability measures. It has been shown that more severe GAD levels correlate with higher disability states and tend to demand more health care attention. As the GAD-7 is self-administered and is not time consuming, this instrument could be a good choice to explore the level of patient disability in subjects with GAD in primary care settings.

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– Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary…