ON THE NATURE OF DEPRESSIVE AND ANXIOUS STATES IN A FAMILY-PRACTICE SETTING - THE HIGH PREVALENCE OF BIPOLAR-II AND RELATED DISORDERS IN A COHORT FOLLOWED LONGITUDINALLY

Much of the scientific literature on affective states in primary care settings is derived from instrument-based diagnoses, typically without the benefit of clinical in-depth examination. in a naturalistic famil y practice setting, we prospectively evaluated 108 consecutive anxious and/or depressed patients. All diagnoses derived from semistructured interviews conducted by a family physician with enhanced training in m ood disorders. Nonbipolar depressions were found in 60 of 108 patients (55.6%), nearly half of whom were in the depression not otherwise spe cified (DNOS) category; yet on careful history, all but two of 28 DNOS cases had major depressive episodes in the past. Twenty-eight patient s (25.9%) were diagnosed with bipolar I, II, or III disorder or cyclot hymia. Panic disorder was found in 9%, and obsessive-compulsive disord er and active chemical dependency were each diagnosed in 3%, Bipolar s pectrum disorders were common (one in three within the depressive grou p) and at times were not recognized until several weeks or months into the treatment phase of the depressed or anxious state, Although the l argest percentage of patients had DNOS at the index episode, bipolar i llness (usually bipolar II) was also common. Our findings contrast wit h the nearly fetal unipolarity reported in the instrument-based (noncl inician) literature, If generalizable, our observations have significa nt implications for physician education and practice, since bipolar de pressions require different interventions, Further investigation to ex plore interview approaches and/or instruments sensitive for hypomania and other ''soft'' bipolar features seems warranted. Copyright (C) 199 7 by W.B. Saunders Company.