Bipolar affective disorder―left out in the cold

摘要

The national strategic framework for mental health states that "one person in 250 will have a psychotic illness such as schizophrenia or bipolar affective disorder." It goes on to cite bipolar affective disorder as one of the 10 leading causes of disability worldwide in adults aged 15-44. How surprising then that the service needs of people with bipolar affective disorder receive no specific consideration in this major policy document. There are four reasons why the national service framework should have given special consideration to the needs of people with bipolar affective disorder. Firstly, most patients with bipolar affective disorder have the potential, with optimal treatment, to return to normal function and contribute to the economy. With suboptimal treatment, however, many will have a poor long term outcome and needlessly become a burden to families and society. Yet there is evidence that treatment is generally suboptimal. For example, a survey (n=1004) of members of the Manic Depression Fellowship, a British organisation for people with bipolar affective disorder, found that only 19% were in full time work, although 40% were graduates and 69% wanted to work. Longitudinal observational studies suggest that the very high lifetime prevalence of suicide attempts in people with bipolar affective disorder (50%) could be reduced by maintenance drug treatment and adequate treatment of depression and comorbid alcohol and drug abuse.