Sep 09, · A comprehensive review of the current literature was completed to investigate whether the effectiveness of treatment of bipolar disorder varies depending on the illness stage. In summary, the literature suggests that treatment earlier in the course of illness is more effective than in the later stages of bipolar blogger.com by: 62 Assignment: Assessing and Treating Patients With Bipolar DisorderBipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to This article reviews the research examining stigma towards bipolar disorder (BD) with a view to guiding the development of stigma reduction initiatives and ongoing research. Methods PsychInfo, Medline, and Embase databases were searched for peer-reviewed studies addressing stigma in BD. ResultsCited by:
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See free commentary by Singh. Objective: To evaluate the presence of affective signs and symptoms as precursors of bipolar disorder in prospective studies, including assessment of their prevalence, duration, and predictive value.
Hand searching of identified reports led to additional relevant references. Study Selection: We included only English-language articles containing 1 prospective, longitudinal studies with at least 2 structured clinical assessments intake and follow-up ; 2 no previous DSM-III or DSM-IV diagnoses of bipolar I or bipolar II; literature review bipolar disorder 3 diagnostic outcome of bipolar I or bipolar II.
Studies of subjects at familial risk of bipolar disorder were excluded, as these have been reviewed elsewhere. Data Extraction: We tabulated details of study design, outcomes, precursors, and predictive value. Only studies reporting a positive predictive association were included. Results: In 26 published reports meeting selection criteria, methods varied widely in terms of design, duration of follow-up, ages, and populations investigated. Despite such heterogeneity in methods, findings were notably consistent.
Precursors of bipolar disorder include mood lability, subsyndromal and major depression, literature review bipolar disorder, subsyndromal hypomanic symptoms with or without major depression, cyclothymia and bipolar not otherwise specified, major depression with psychotic features, and other psychotic disorders. Bipolar disorder was also literature review bipolar disorder by juvenile onset of major depression as well as frequency and loading of hypomanic or depressive symptoms.
Conclusions: Despite the limitations of published reports, prospectively identified precursors of bipolar disorder typically arose years prior to syndromal onset, literature review bipolar disorder, often with significant early morbidity and disability. Prospectively identified precursors of bipolar disorder are generally consistent with findings in retrospective and family-risk studies.
Combining precursors and other risk factors may increase predictive value, literature review bipolar disorder, support earlier diagnosis, improve treatment, and limit disability in bipolar disorder. J Clin Psychiatry ;76 5 Submitted: November 22, ; accepted July 14, doi Corresponding author: Gianni L.
Faedda, MD, East 50th St, literature review bipolar disorder, Ste 2A, New York, NY moodcenter gmail.
B ipolar disorder is a major psychiatric illness, with lifetime prevalence of approximately 1. The transition from normality to illness occurs gradually in most psychiatric syndromes 4 with the more or less subtle or gradual appearance of symptoms of varying degrees of severity, duration, co-occurrence, and associated disability.
Although episodes of hypomania or mania can onset suddenly with little preceding psychopathology, many retrospective and family risk studies have detected attenuated symptoms before the syndromal onset of bipolar disorder, literature review bipolar disorder, 3including mood-shifts, emotional lability, irritability, depressive and hypomanic symptoms, sleep disturbances, distractibility, hyperactivity, impulsivity, anxiety, and aggression; such symptoms have been identified 1. Little is known about the prevalence of acute versus gradual onset of mania, hypomania, mixed states, and depression.
Most studies of bipolar I and first-episode mania recruited inpatients and reported a sudden onset, more males, and a younger age at onset of mania compared to depression. The relative frequency of prodromal manifestations is also unknown, and few studies report the onset type ie, acute vs gradualand the proportion of bipolar I and bipolar II cases is not always specified.
The lack of accepted terms to define and study the onset of bipolar disorder has prompted the International Society for Bipolar Disorder literature review bipolar disorder convene a task force to improve timely diagnosis and early intervention, literature review bipolar disorder.
Among those clinical symptoms or syndromes that precede the syndromal onset of bipolar disorder, we define precursorsclinical risk factorsand environmental risk factors exposures as prospectively identified variables that increase the risk of later bipolar disorder Figure 1 ; also Supplementary eFigure 1 [available at Psychiatrist.
com]as suggested by Eaton 4 ; precursors and clinical and environmental risk factors are collectively referred to as clinical predictors. Risk factors can be environmental prenatal and perinatal exposures, traumatic events, substances of abuse, effects of medicines or personal ie, clinical risk factors and will be reviewed separately. This review focuses on precursors of bipolar disorder, their characteristics and timing based on available prospective studies in which outcomes are bipolar I or bipolar II.
Our emphasis on prospective studies reflects methodological concern to limit the effects of inaccurate or incomplete information recall bias and selection bias diagnosed cases associated with retrospective analyses. Research addressed the following questions: 1 Is there evidence of a prodromal phase of bipolar disorder in prospective studies?
and 5 Does the prodromal phase differ by bipolar subtype? Hand searching of references in identified reports led to additional relevant reports. Articles selected were published in the English language and met the following inclusion criteria: 1 prospective, longitudinal studies with at least 2 structured clinical assessments intake and follow-up ; 2 diagnoses at intake that included DSM-III or DSM-IV major depressive episode MDE and major depressive disorder MDDdysthymia, cyclothymia, or bipolar NOS as well as subjects with subsyndromal affective disorders or symptoms; 3 diagnostic outcome at follow-up of bipolar I or bipolar II.
Exclusion criteria are detailed in Figure 2. We identified a total of 26 reports meeting inclusion criteria. org guidelines, and for each article selected, we extracted the following information: number of subjects, initial diagnosis, age at intake, study design and assessment tool, duration of follow-up, percentage of subjects diagnosed as bipolar I or bipolar II during follow-up, and clinical features predicting later bipolar diagnosis and their statistical power odds ratio [OR] or adjusted odds ratio, hazard ratio, likelihood ratio, or Bayesian sensitivity, specificity, and positive or negative predictive value.
Only studies reporting a positive predictive value were included in this review. This suggests that there may be sporadic or nonfamilial forms of illness. Furthermore, most family risk studies focus on offspring of adults or siblings of subjects with bipolar I, 2 although there are exceptions. Figure 2 shows a flowchart of the number of articles identified and their disposition; Table 1 summarizes the findings obtained. Sample characteristics.
All studies included subjects of both sexes. The group sample sizes for the studies varied widely, with groups as small as 32 to as large as 5, Six studies included subjects with intake diagnosis of MDD or depression, 6 studies literature review bipolar disorder samples with MDD with psychotic features, 3 studies included psychotic non-MDD patients, 3 studies included subjects diagnosed with cyclothymic disorder or bipolar NOS, literature review bipolar disorder studies had subjects with subsyndromal depressive or hypomanic symptoms, and 6 community studies included subjects at risk see Table 1, literature review bipolar disorder.
Diagnoses were obtained with structured interviews using DSM-IIIliterature review bipolar disorder, DSM-III — Ror DSM-IV criteria in all studies selected except for Akiskal et al.
We refer the reader to the original reports for details about the psychometric properties of instruments used, literature review bipolar disorder. All studies included were longitudinal and prospective: 11 studies included inpatients, 5 studies followed outpatients, and 10 studies included a community sample. The duration of follow-up varied markedly, ranging from 6 months to 31 years.
Mood lability. We found that mood lability predicted bipolar II but not bipolar I in adult inpatients with MDD, 24 whereas it predicted bipolar II and bipolar spectrum disorders MDD and subsyndromal hypomania in young adults in a community risk set. Subsyndromal depression. Subsyndromal hypomanic symptoms. Elevated scores on the Hypomanic Personality Scale significantly predicted later bipolar disorder, especially bipolar II, 29 in a cohort of college students compared to healthy controls.
Also, lifetime subsyndromal hypomanic symptoms predicted bipolar I, bipolar NOS, and a major depressive episode in a Dutch community sample of adults, 28 and the combination of subclinical mania with subclinical psychosis at baseline predicted 3 times more new diagnoses of bipolar disorder as compared to those with subclinical mania only, literature review bipolar disorder. Major depression. We recently reviewed studies both prospective and retrospective on rates of conversion from MDD to bipolar I or bipolar II, differentiating cases of spontaneous conversion from those emerging with antidepressant use.
Subsyndromal hypomanic symptoms in major depression. In adults with current MDD, 24 the presence of the hypomanic symptom hyperenergetic involvement in activities predicted diagnostic switch to bipolar disorder, with more cases involving later hypomanic than manic episodes; however, more than one-third of those diagnosed with bipolar II later developed mania, suggesting a progression of intensity of mood elevation.
In literature review bipolar disorder same cohort, but with longer follow-up, 34 the sum of ratings of 5 hypomanic symptoms moderately but significantly predicted bipolar disorder, with a similar relationship to later mania or hypomania; in bivariate analyses, decreased need for sleep, unusually high energy, and increased goal-directed activity significantly predicted both hypomania and mania, literature review bipolar disorder, whereas grandiosity predicted only mania, literature review bipolar disorder.
The presence of at least 3 hypomanic symptoms was fairly specific in predicting bipolar disorder. Cyclothymic disorder and bipolar NOS. Among youths with hypomania but without a lifetime history of major depression, A similar pattern of results in adults with bipolar NOS or cyclothymic disorder were reported by Alloy, 38 who found that more than half developed bipolar disorder over 4.
Psychotic symptoms in major depression. Psychotic features predicted conversion to bipolar disorder in a cohort of adolescents hospitalized for MDD compared to those without psychotic features17 a finding replicated by Kochman 18 : depressed youths with psychotic features and cyclothymic temperament were 9.
Several prospective studies reported further evidence of diagnostic instability of psychotic MDD and its conversion to bipolar disorder, both in adolescents and adults. Psychotic disorders. Age at onset of major depression. Frequency and loading of affective symptoms. The risk of bipolar disorder increased with the number of lifetime depressive episodes and with the number of hypomanic symptoms.
We found evidence of a prodromal phase of bipolar disorder, characterized by several precursors. Precursors of bipolar disorder had significant time depth, anticipating syndromal onset by years. Manic and depressive symptoms appeared early and increased in number, duration, and secondary impairment, following a chronic rather than episodic course over several years.
Hypomanic and depressive symptoms increased the risk of their own recurrence literature review bipolar disorder of the occurrence of episodes of opposite polarity. Monotonically increasing rates of progression to bipolar disorder were found in cohorts and community samples with isolated hypomanic symptoms,323436 cyclothymic disorder, 182138 and bipolar NOS as well as those prospectively diagnosed with bipolar II and bipolar I.
Some precursors were selective for bipolar I or bipolar II, but data literature review bipolar disorder phenomenological differences by subtype in the prodromal features observed are insufficient.
While acute onset of mania or depression is often reported in retrospective studies, 3512 the literature review bipolar disorder of chronic and gradually worsening symptoms literature review bipolar disorder found in most cases.
We also found a good deal of consistency between the present findings and those identified with retrospective studies. A depressive onset is common in all subtypes of bipolar and cyclothymic disorder both in retrospective 35681250 and prospective studies 1718242734as well as family risk studies.
Such outcome has been described in a substantial proportion of patients, especially in youth and early adulthood 5literature review bipolar disorder, 6810141527 and often in response to antidepressant treatment, literature review bipolar disorder.
High scores in ratings of hypomanic personality traits and hypomanic symptoms in young depressed patients as well as early onset hypomania have predicted bipolar disorder in only a minority of subjects over relatively short periods of follow-up. These findings suggest that the predictive power and diagnostic specificity of hypomanic symptoms and attenuated syndromes cyclothymic disorder and bipolar NOS for mania may be limited or that these syndromes themselves might represent stable outcomes.
It is also clear, however, that in some adolescents, literature review bipolar disorder rather than the sole presence of hypomanic or manic symptoms increases the risk of a progression to diagnosable bipolar disorder. Consistent with the EDSP findings, 2756 hypomanic or literature review bipolar disorder symptoms might increase the risk of bipolar disorder only if recurrent, persistent or both, and especially when associated with other precursors depressive symptoms 3136 and risk factors.
From a prevention-early identification perspective, the predictive value of precursors is lower than it is for risk factors, as the definition of the outcome includes such signs and symptoms. To increase predictive power and accurately identify populations with different types and levels of risk, it is often necessary to combine different, literature review bipolar disorder, ideally independent risk markers. In a prevention model, a different threshold besides the syndromal one can be useful.
Limitations of this review are literature review bipolar disorder. Heterogeneity of studies and samples precluded pooling of data that might clarify the timing and duration of such precursors. Similarly, only few studies provided data on sensitivity, specificity, literature review bipolar disorder, and predictive value of reported precursors.
Notably, the prevalence, sequence, and timing of psychopathology predictive of bipolar disorder remain understudied, lacking sensitivity and specificity. The assessment tools, their validity, reliability, or predictive value could not be operationalized in a review of published reports, literature review bipolar disorder.
While these are objective and not methodological limitations, a cautious interpretation of the findings as to their generalizability is necessary. Specifically, it prevents the use of the data summarized in efforts to define stages of illness other than the obvious presyndromal and postsyndromal phases, literature review bipolar disorder.
Family risk studies were not reviewed here, as they have been reviewed elsewhere. Drug names: lithium Lithobid and others. Disclosure of off-label usage: The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration-approved labeling has been presented in this article.
Case study clinical example: Session with a client with Bipolar Disorder (fluctuations in mood)
, time: 14:51Bipolar Disorder - Literature Review Centre
Objectives: Functional impairment is an important driver of disability in patients with bipolar disorder (BD) and can persist even when symptomatic remission has been achieved. The objectives of this systematic literature review were to identify studies that assessed functioning in patients with BD and describe the functional scales used and their blogger.com by: 20 Bipolar Disorder Bipolar Disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks. Symptoms of Bipolar Disorder can be severe. They are different from the normal ups and downs that everyone goes through from time to time Bipolar spectrum disorders are a major public health problem, with estimates of lifetime prevalence in the general population of the United States at percent, 1 with a range from to percent. 2 Bipolar disorder is also associated with significant mortality risk, with approximately 25 percent of patients attempting suicide and 11 percent of patients completing. 3 Furthermore, inadequate treatment and Cited by: 28
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