The Clinical Side of Bipolar Disorders

 

 Buy Article Permissions and Reprints

Abstract

This article summarizes key facts on the epidemiology, diagnosis and clinical treatment of bipolar disorder. Bipolar disorder is a common mental disorder with a high disease burden, but still does not get the attention it deserves in research and clinical training. The nature of the disorder is complex, but it is apparent that biological factors are decisive. Thus, understanding the biological systems and cycles affected will become crucial for developing more targeted interventions. Currently, standard treatments seem to have a low specificity for Bipolar Disorder, and only few experimental interventions target directly potential underlying disturbances as HPA axis or circadian clock dysregulation. Systemic analysing and modelling of bipolar disorder is a novel approach which might open up new ways in developing more selective therapies.

References

• 1 Angst J. Do many patients with depression suffer from bipolar disorder?.  Can J Psychiatry. 2006;  51 3-5
  PubMedGoogle Scholar
• 2 American Psychiatric Association .Diagnostic and statistical manual of mental disorders.. 4th revised ed. Washington DC: American Psychiatric Press; 1994
  Google Scholar
• 3 Merikangas KR, Akiskal HS, Angst J. et al . Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication.  Arch Gen Psychiatry. 2007;  64 543-552
  Google Scholar
• 4 Judd LL, Akiskal HS. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases.  J Affect Disord. 2003;  73 123-131
  CrossrefPubMedGoogle Scholar
• 5 Phelps J, Angst J, Katzow J. et al . Validity and utility of bipolar spectrum models.  Bipolar Disord. 2008;  10 179-193
  CrossrefPubMedGoogle Scholar
• 6 Regeer EJ, ten HM, Rosso ML. et al . Prevalence of bipolar disorder in the general population: a Reappraisal Study of the Netherlands Mental Health Survey and Incidence Study.  Acta Psychiatr Scand. 2004;  110 374-382
  CrossrefPubMedGoogle Scholar
• 7 Angst J. The epidemiology of depressive disorders.  Eur Neuropsychopharmacol. 1995;  5 (Suppl) 95-98
  PubMedGoogle Scholar
• 8 Ghaemi SN, Sachs GS, Chiou AM. et al . Is bipolar disorder still underdiagnosed? Are antidepressants overutilized?.  J Affect Disord. 1999;  52 135-144
  CrossrefPubMedGoogle Scholar
• 9 Suppes T, Leverich GS, Keck PE. et al . The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients.  J Affect Disord. 2001;  67 45-59
  CrossrefPubMedGoogle Scholar
• 10 Gonzalez-Pinto A, Aldama A, Mosquera F. et al . Epidemiology, diagnosis and management of mixed mania.  CNS Drugs. 2007;  21 611-626
  CrossrefPubMedGoogle Scholar
• 11 Kilzieh N, Akiskal HS. Rapid-cycling bipolar disorder. An overview of research and clinical experience.  Psychiatr Clin North Am. 1999;  22 585-607
  CrossrefPubMedGoogle Scholar
• 12 Kraepelin E. Psychiatrie. Ein Lehrbuch für Studierende und Ärzte.. 6 ed. Leipzig: Barth; 1899
  Google Scholar
• 13 Swann AC, Bowden CL, Morris D. et al . Depression during mania. Treatment response to lithium or divalproex.  Arch Gen Psychiatry. 1997;  54 37-42
  CrossrefPubMedGoogle Scholar
• 14 McElroy SL, Keck PE, Pope HG. et al . Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania.  Am J Psychiatry. 1992;  149 1633-1644
  PubMedGoogle Scholar
• 15 Perugi G, Akiskal HS, Micheli C. et al . Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases.  J Affect Disord. 1997;  43 169-180
  CrossrefPubMedGoogle Scholar
• 16 Suppes T, Mintz J, McElroy SL. et al . Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon.  Arch Gen Psychiatry. 2005;  62 1089-1096
  CrossrefPubMedGoogle Scholar
• 17 Dunner DL, Fieve RR. Clinical factors in lithium carbonate prophylaxis failure.  Arch Gen Psychiatry. 1974;  30 229-233
  CrossrefPubMedGoogle Scholar
• 18 Kupka RW, Luckenbaugh DA, Post RM. et al . Comparison of rapid-cycling and non-rapid-cycling bipolar disorder based on prospective mood ratings in 539 outpatients.  Am J Psychiatry. 2005;  162 1273-1280
  CrossrefPubMedGoogle Scholar
• 19 Sjoholm LK, Backlund L, Cheteh EH. et al . CRY2 is associated with rapid cycling in bipolar disorder patients.  PLoS One. 2010;  5 e12632
  CrossrefPubMedGoogle Scholar
• 20 Daban C, Colom F, Sanchez-Moreno J. et al . Clinical correlates of first-episode polarity in bipolar disorder.  Compr Psychiatry. 2006;  47 433-437
  CrossrefPubMedGoogle Scholar
• 21 Angst J. Do many patients with depression suffer from bipolar disorder?.  Canadian journal of psychiatry. 2006;  51 3-5
  PubMedGoogle Scholar
• 22 World Health Organization .The ICD-10 Classification of Mental and behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines.. Geneva: WHO; 1992
  Google Scholar
• 23 Goldberg JF, Perlis RH, Bowden CL. et al . Manic symptoms during depressive episodes in 1 380 patients with bipolar disorder: findings from the STEP-BD.  Am J Psychiatry. 2009;  166 173-181
  CrossrefPubMedGoogle Scholar
• 24 Goodwin FK, Jamison KR. Manic -depressive illness.. 2 ed. New York: Oxford University Press; 2007
  Google Scholar
• 25 Akiskal HS, Walker P, Puzantian VR. et al . Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors.  J Affect Disord. 1983;  5 115-128
  CrossrefPubMedGoogle Scholar
• 26 Perlis RH, Brown E, Baker RW. et al . Clinical features of bipolar depression versus major depressive disorder in large multicenter trials.  Am J Psychiatry. 2006;  163 225-231
  CrossrefPubMedGoogle Scholar
• 27 Mitchell PB, Malhi GS. Bipolar depression: phenomenological overview and clinical characteristics.  Bipolar Disord. 2004;  6 530-539
  CrossrefPubMedGoogle Scholar
• 28 Winokur G, Coryell W, Endicott J. et al . Further distinctions between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression).  Am J Psychiatry. 1993;  150 1176-1181
  PubMedGoogle Scholar
• 29 Hegerl U, Bottner AC, Holtschmidt-Taschner B. et al . Onset of depressive episodes is faster in patients with bipolar versus unipolar depressive disorder: evidence from a retrospective comparative study.  J Clin Psychiatry. 2008;  69 1075-1080
  CrossrefPubMedGoogle Scholar
• 30 Mitchell PB, Goodwin GM, Johnson GF. et al . Diagnostic guidelines for bipolar depression: a probabilistic approach.  Bipolar Disord. 2008;  10 144-152
  CrossrefPubMedGoogle Scholar
• 31 Simpson SG, Jamison KR. The risk of suicide in patients with bipolar disorders.  J Clin Psychiatry. 1999;  60 (S 02) 53-56
  CrossrefPubMedGoogle Scholar
• 32 Morselli P, Elgie R, Cesana B. GAMIAN-Europe/BEAM survey II: cross-national analysis of unemployment, family history, treatment satisfaction and impact of the bipolar disorder on life style.  Bipolar Disord. 2004;  6 487-497
  CrossrefPubMedGoogle Scholar
• 33 Maina G, Albert U, Bellodi L. et al . Health-related quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes.  J Clin Psychiatry. 2007;  68 207-212
  CrossrefPubMedGoogle Scholar
• 34 Shi L, Thiebaud P, McCombs JS. The impact of unrecognized bipolar disorders for patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program.  J Affect Disord. 2004;  82 373-383
  PubMedGoogle Scholar
• 35 Woods SW. The economic burden of bipolar disease.  J Clin Psychiatry. 2000;  61 (Supp 13) 38-41
  PubMedGoogle Scholar
• 36 Angst J. Bipolar disorder – a seriously underestimated health burden.  Eur Arch Psychiatry Clin Neurosci. 2004;  254 59-60
  CrossrefPubMedGoogle Scholar
• 37 Hakkaart-van RL, Hoeijenbos MB, Regeer EJ. et al . The societal costs and quality of life of patients suffering from bipolar disorder in the Netherlands.  Acta Psychiatr Scand. 2004;  110 383-392
  CrossrefPubMedGoogle Scholar
• 38 Runge C, Grunze H. Jährliche Krankheitskosten bipolarer Störungen in Deutschland.  Nervenarzt. 2004;  75 896-903
  PubMedGoogle Scholar
• 39 The World Health Organisation . The World Health Report 2001, Mental Health: New understanding, new hope.  Chapter 2: Burden of mental and behavioural disorder. http://www.who.int/whr/2001/main/en/pdf/GGTSPU-1368-326547-DAT/chapter2.en.pdf 2002
  PubMedGoogle Scholar
• 40 Henry C, Sorbara F, Lacoste J. et al . Antidepressant-induced mania in bipolar patients: identification of risk factors.  J Clin Psychiatry. 2001;  62 249-255
  CrossrefPubMedGoogle Scholar
• 41 Rihmer Z, Szadoczky E, Furedi J. et al . Anxiety disorders comorbidity in bipolar I, bipolar II and unipolar major depression: results from a population-based study in Hungary.  J Affect Disord. 2001;  67 175-179
  CrossrefPubMedGoogle Scholar
• 42 Sherwood BE, Suppes T, Adinoff B. et al . Drug abuse and bipolar disorder: comorbidity or misdiagnosis?.  J Affect Disord. 2001;  65 105-115
  CrossrefPubMedGoogle Scholar
• 43 Rihmer Z, Kiss K. Bipolar disorders and suicide risk.  Clinical Approaches in Bipolar Disorders. 2002;  1 15-21
  PubMedGoogle Scholar
• 44 Oedegaard KJ, Fasmer OB. Is migraine in unipolar depressed patients a bipolar spectrum trait?.  J Affect Disord. 2005;  84 233-242
  CrossrefPubMedGoogle Scholar
• 45 Regenold WT, Thapar RK, Marano C. et al . Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use.  J Affect Disord. 2002;  70 19-26
  CrossrefPubMedGoogle Scholar
• 46 Kupka RW, Altshuler LL, Nolen WA. et al . Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder.  Bipolar Disord. 2007;  9 531-535
  CrossrefPubMedGoogle Scholar
• 47 Berk M, Dodd S. Bipolar II disorder: a review.  Bipolar Disord. 2005;  7 11-21
  CrossrefPubMedGoogle Scholar
• 48 Rihmer Z, Pestality P. Bipolar II disorder and suicidal behavior.  Psychiatr Clin North Am. 1999;  22 667-673
  CrossrefPubMedGoogle Scholar
• 49 Dittmann S, Hennig-Fast K, Gerber S. et al . Cognitive functioning in euthymic bipolar I and bipolar II patients.  Bipolar Disord. 2008;  10 877-887
  CrossrefPubMedGoogle Scholar
• 50 Dittmann S, Seemuller F, Grunze HC. et al . The impact of homocysteine levels on cognition in euthymic bipolar patients: a cross-sectional study.  J Clin Psychiatry. 2008;  69 899-906
  CrossrefPubMedGoogle Scholar
• 51 Robinson LJ, Thompson JM, Gallagher P. et al . A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder.  J Affect Disord. 2006;  93 105-115
  CrossrefPubMedGoogle Scholar
• 52 Berk M, Berk L. Mood stabilizers and treatment adherence in bipolar disorder: addressing adverse events.  Ann Clin Psychiatry. 2003;  15 217-224
  CrossrefPubMedGoogle Scholar
• 53 Angst F, Stassen HH, Clayton PJ. et al . Mortality of patients with mood disorders: follow-up over 34–38 years.  J Affect Disord. 2002;  68 167-181
  CrossrefPubMedGoogle Scholar
• 54 Sowden GL, Huffman JC. The impact of mental illness on cardiac outcomes: A review for the cardiologist.  Int J Cardiol. 2008; 
  PubMedGoogle Scholar
• 55 Grunze H, Vieta E, Goodwin GM. et al . The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania.  World J Biol Psychiatry. 2009;  10 85-116
  CrossrefPubMedGoogle Scholar
• 56 Grunze H, Vieta E, Goodwin GM. et al . The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression.  World J Biol Psychiatry. 2010;  11 81-109
  CrossrefPubMedGoogle Scholar
• 57 Grunze H, Vieta E, Goodwin GM. et al . WFSBP Task Force on Treatment Guidelines for Bipolar Disorders The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2011 on the Maintenance treatment of Bipolar Disorder.  World J Biol Psychiatry. 2011;  In Press
  PubMedGoogle Scholar
• 58 Tohen M, Zarate CA, Hennen J. et al . The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence.  Am J Psychiatry. 2003;  160 2099-2107
  CrossrefPubMedGoogle Scholar
• 59 Solomon DA, Leon AC, Coryell WH. et al . Longitudinal course of bipolar I disorder: duration of mood episodes.  Arch Gen Psychiatry. 2010;  67 339-347
  CrossrefPubMedGoogle Scholar
• 60 Newberg AR, Catapano LA, Zarate CA. et al . Neurobiology of bipolar disorder.  Expert Rev Neurother. 2008;  8 93-110
  CrossrefPubMedGoogle Scholar
• 61 Heuser I, Yassouridis A, Holsboer F. The combined dexamethasone/CRH test: a refined laboratory test for psychiatric disorders.  J Psychiatr Res. 1994;  28 341-356
  CrossrefPubMedGoogle Scholar
• 62 Rybakowski JK, Twardowska K. The dexamethasone/corticotropin-releasing hormone test in depression in bipolar and unipolar affective illness.  J Psychiatr Res. 1999;  33 363-370
  CrossrefPubMedGoogle Scholar
• 63 Schmider J, Lammers CH, Gotthardt U. et al . Combined dexamethasone/corticotropin-releasing hormone test in acute and remitted manic patients, in acute depression, and in normal controls: I.  Biol Psychiatry. 1995;  38 797-802
  CrossrefPubMedGoogle Scholar
• 64 Watson S, Del Estal D, Smith M. et al . The hypothalamic-pituitary-adrenal axis in euthymic bipolar patients.  J Psychopharmacol. 2001;  15 (suppl) B7
  PubMedGoogle Scholar
• 65 Lauer CJ, Schreiber W, Modell S. et al . The Munich vulnerability study on affective disorders: overview of the cross-sectional observations at index investigation.  J Psychiatr Res. 1998;  32 393-401
  CrossrefPubMedGoogle Scholar
• 66 Modell S, Lauer CJ, Schreiber W. et al . Hormonal response pattern in the combined DEX-CRH test is stable over time in subjects at high familial risk for affective disorders.  Neuropsychopharmacology. 1998;  18 253-262
  CrossrefPubMedGoogle Scholar
• 67 Harris TO, Borsanyi S, Messari S. et al . Morning cortisol as a risk factor for subsequent major depressive disorder in adult women.  Br J Psychiatry. 2000;  177 505-510
  CrossrefPubMedGoogle Scholar
• 68 Gallagher P, Malik N, Newham J. et al . Antiglucocorticoid treatments for mood disorders.  Cochrane Database Syst Rev. 2008;  CD005168
  PubMedGoogle Scholar
• 69 Young AH, Gallagher P, Watson S. et al . Improvements in neurocognitive function and mood following adjunctive treatment with mifepristone (RU-486) in bipolar disorder.  Neuropsychopharmacology. 2004;  29 1538-1545
  CrossrefPubMedGoogle Scholar
• 70 Sack DA, James SP, Rosenthal NE. et al . Deficient nocturnal surge of TSH secretion during sleep and sleep deprivation in rapid-cycling bipolar illness.  Psychiatry Res. 1988;  23 179-191
  CrossrefPubMedGoogle Scholar
• 71 Joffe RT, Sokolov STH. Hormones and Bipolar Affective Disorder.. In:, Young LT,, Joffe RT,, eds. Bipolar disorder – Biological models and their clinical application. New York: Marcel Dekker; 1997: 81-92
  Google Scholar
• 72 Bauer MS, Whybrow PC. Rapid cycling bipolar affective disorder. II. Treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study.  Arch Gen Psychiatry. 1990;  47 435-440
  CrossrefPubMedGoogle Scholar
• 73 Bauer M, London ED, Rasgon N. et al . Supraphysiological doses of levothyroxine alter regional cerebral metabolism and improve mood in bipolar depression.  Mol Psychiatry. 2005;  10 456-469
  CrossrefPubMedGoogle Scholar
• 74 Bauer M, Hellweg R, Graf KJ. et al . Treatment of refractory depression with high-dose thyroxine.  Neuropsychopharmacology. 1998;  18 444-455
  CrossrefPubMedGoogle Scholar
• 75 Kupka RW, Nolen WA, Post RM. et al . High rate of autoimmune thyroiditis in bipolar disorder: lack of association with lithium exposure.  Biol Psychiatry. 2002;  51 305-311
  CrossrefPubMedGoogle Scholar
• 76 Wirz-Justice A, Quinto C, Cajochen C. et al . A rapid-cycling bipolar patient treated with long nights, bedrest, and light.  Biol Psychiatry. 1999;  45 1075-1077
  CrossrefPubMedGoogle Scholar
• 77 Wirz-Justice A, Benedetti F, Berger M. et al . Chronotherapeutics (light and wake therapy) in affective disorders.  Psychological medicine. 2005;  35 939-944
  CrossrefPubMedGoogle Scholar
• 78 Wu JC, Kelsoe JR, Schachat C. et al . Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder.  Biol Psychiatry. 2009; 
  PubMedGoogle Scholar
• 79 Riemann D, Voderholzer U, Berger M. Sleep and sleep-wake manipulations in bipolar depression.  Neuropsychobiology. 2002;  45 (Suppl. 1) 13-19
  CrossrefPubMedGoogle Scholar
• 80 Colombo C, Benedetti F, Barbini B. et al . Rate of switch from depression into mania after therapeutic sleep deprivation in bipolar depression.  Psychiatry Res. 1999;  86 267-270
  CrossrefPubMedGoogle Scholar
• 81 Dolder CR, Nelson M, Snider M. Agomelatine treatment of major depressive disorder.  Ann Pharmacother. 2008;  42 1822-1831
  CrossrefPubMedGoogle Scholar
• 82 Calabrese JR, Guelfi JD, Perdrizet-Chevallier C. Agomelatine adjunctive therapy for acute bipolar depression: preliminary open data.  Bipolar Disord. 2007;  9 628-635
  CrossrefPubMedGoogle Scholar
• 83 Macedo-Soares MB, Moreno RA, Rigonatti SP. et al . Efficacy of electroconvulsive therapy in treatment-resistant bipolar disorder: a case series.  J ECT. 2005;  21 31-34
  CrossrefPubMedGoogle Scholar
• 84 Silverstone PH, Silverstone T. A review of acute treatments for bipolar depression.  Int Clin Psychopharmacol. 2004;  19 113-124
  CrossrefPubMedGoogle Scholar
• 85 Hallam KT, Smith DI, Berk M. Differences between subjective and objective assessments of the utility of Electroconvulsive therapy in patients with bipolar and unipolar depression.  J Affect Disord. 2009;  112 212-218
  CrossrefPubMedGoogle Scholar
• 86 Angst J. Switch from depression to mania–a record study over decades between 1920 and 1982.  Psychopathology. 1985;  18 140-154
  CrossrefPubMedGoogle Scholar
• 87 Nahas Z, Kozel FA, Li X. et al . Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy.  Bipolar Disord. 2003;  5 40-47
  CrossrefPubMedGoogle Scholar
• 88 Xia G, Gajwani P, Muzina DJ. et al . Treatment-emergent mania in unipolar and bipolar depression: focus on repetitive transcranial magnetic stimulation.  Int J Neuropsychopharmacol. 2008;  11 119-130
  PubMedGoogle Scholar

Correspondence

Prof. H. Grunze

Newcastle University

Institute of Neuroscience

Academic Psychiatry

Building 15, 1 st Floor

Newcastle General Hospital

Westgate Road

Newcastle upon Tyne NE4 6BE

United Kingdom

Phone: +44/0191/256 3219

Fax: +44/0191/256 3324

Email: heinz.grunze@ncl.ac.uk