Better Care Urged for Bipolar Patients’ 1st Manic Episode

’An international team of experts argues that better care for people experiencing their first manic episode is urgently needed and that more research needs to go into treatment solutions for bipolar disorder.

In a new paper, published in The Lancet Psychiatry journal, the authors describe patchy and inconsistent care, widespread failure to detect bipolar disorder early enough, and a lack of guidance on how to treat people experiencing mania for the first time.…’

Via PsychCentral

As a practicing psychiatrist, I’d like to suggest that the approach of this ‘international team of experts’ may be faulty. This may have something to do with the divide between clinicians and the academic psychiatric pundits, who I would venture to say see far fewer real-world patients.

Bipolar disorder is a condition that can only be properly diagnosed by observing and understanding the longitudinal course of the patient’s presentation over time. Thinking you know what is going on when you take the snapshot view at a moment in time is immensely problematic. It may be clear at the time of a ‘first manic episode’ that a person’s condition declares itself as bipolar disorder but not necessarily. It is often not clear even when faced with the patient in front of you in the moment that what they are experiencing is a manic episode. The symptoms they might display, possibly suggestive of mania — increased energy, decreased sleep, loquaciousness, ambition and confidence, brightening of mood, irritability, agitation and raciness, perhaps some telltale psychotic symptoms — could also be indicative of a number of other illnesses or temperaments when taken in isolation.

‘Better care for people experiencing their first manic episode’ is often not possible precisely because it is not prudent or sometimes not even possible to diagnose it as mania. The mindset of the rapid rush to judgment embodied in the article has arguably played a large part in the epidemic over\diagnosis of bipolar disorder and concomitant rush to overtreatment, to the detriment of our patients.