Long-term symptomatic status of bipolar I vs. bipolar II disorders

National Institute of Mental Health Collaborative Program on the Psychobiology of Depression Clinical Studies, San Diego, La Jolla, CA, USA.
The International Journal of Neuropsychopharmacology (Impact Factor: 4.01). 07/2003; 6(2):127-37. DOI: 10.1017/S1461145703003341
Source: PubMed


Weekly affective symptom severity and polarity were compared in 135 bipolar I (BP I) and 71 bipolar II (BP II) patients during up to 20 yr of prospective symptomatic follow-up. The course of BP I and BP II was chronic; patients were symptomatic approximately half of all follow-up weeks (BP I 46.6% and BP II 55.8% of weeks). Most bipolar disorder research has concentrated on episodes of MDD and mania and yet minor and subsyndromal symptoms are three times more common during the long-term course. Weeks with depressive symptoms predominated over manichypomanic symptoms in both disorders (31) in BP I and BP II at 371 in a largely depressive course (depressive symptoms=59.1% of weeks vs. hypomanic=1.9% of weeks). BP I patients had more weeks of cyclingmixed polarity, hypomanic and subsyndromal hypomanic symptoms. Weekly symptom severity and polarity fluctuated frequently within the same bipolar patient, in which the longitudinal symptomatic expression of BP I and BP II is dimensional in nature involving all levels of affective symptom severity of mania and depression. Although BP I is more severe, BP II with its intensely chronic depressive features is not simply the lesser of the bipolar disorders; it is also a serious illness, more so than previously thought (for instance, as described in DSM-IV and ICP-10). It is likely that this conventional view is the reason why BP II patients were prescribed pharmacological treatments significantly less often when acutely symptomatic and during intervals between episodes. Taken together with previous research by us on the long-term structure of unipolar depression, we submit that the thrust of our work during the past decade supports classic notions of a broader affective disorder spectrum, bringing bipolarity and recurrent unipolarity closer together. However the genetic variation underlying such a putative spectrum remains to be clarified.

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    • "Bipolar II Judd et al . , 2003 12 ."
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    ABSTRACT: BACKGROUND: Long-term symptomatic status in persons with major depressive and bipolar disorders treated clinically is not well established, although mood disorders are leading causes of disability worldwide. AIMS: To pool data on long-term morbidity, by type and as a proportion of time-at-risk, based on published studies and previously unreported data. METHODS: We carried out systematic, computerized literature searches for information on percentage of time in specific morbid states in persons treated clinically and diagnosed with recurrent major depressive or bipolar I or II disorders, and incorporated new data from one of our centers. RESULTS: We analyzed data from 25 samples involving 2479 unipolar depressive and 3936 bipolar disorder subjects (total N=6415) treated clinically for 9.4 years. Proportions of time ill were surprisingly and similarly high across diagnoses: unipolar depressive (46.0%), bipolar I (43.7%), and bipolar II (43.2%) disorders, and morbidity was predominantly depressive: unipolar (100%), bipolar-II (81.2%), bipolar-I (69.6%). Percent-time-ill did not differ between UP and BD subjects, but declined significantly with longer exposure times. CONCLUSIONS: The findings indicate that depressive components of all major affective disorders accounted for 86% of the 43-46% of time in affective morbidity that occurred despite availability of effective treatments. These results encourage redoubled efforts to improve treatments for depression and adherence to their long-term use
    Journal of Affective Disorders 03/2015; 3(178):71-78. DOI:10.1016/j.jad.2015.02.011. · 3.38 Impact Factor
    • "The clinical course of BD is typified by recurring major depressive episodes as well as (hypo) manic and mixed episodes (Phillips and Kupfer, 2013). The seminal studies carried out by Lewis Judd and coworkers at the National Institue of Mental health (NIMH) demonstrate that BD patients spend slightly more than half their lifetime suffering from affective symptoms, mostly depressive episodes/symptoms (Judd et al., 2003b). However, since Kraepelin, BD has been regarded as an illness whose symptomatic expression and long-term clinical evolution is characterized by significant inter-individual variation (Kraepelin, 1921; Roy-Byrne et al., 1985). "
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    ABSTRACT: Background Predominant polarity (PP) is a proposed course specifier for bipolar disorder, which was not incorporated in the DSM-5 as a descriptor for the nosology of bipolar disorder (BD). Here we perform a systematic review of original studies about PP. Methods A computerized search of MEDLINE/Pubmed, EMBASE and Web of Science databases from inception to October 6th, 2013 was performed with keywords, including ‘bipolar disorder’, ‘polarity’ and ‘predominant polarity’. Results A total of 19 studies met inclusion criteria. A unifying definition and conceptualization for PP is lacking. A PP is found in approximately half of BD patients. Most studies that included type I BD patients found the manic PP to be more prevalent, while studies that included type II BD participants found a higher prevalence of depressive PP. The depressive PP has been consistently associated with a depressive onset of illness, a delayed diagnosis of BD, type II BD and higher rates of suicidal acts. The manic PP is associated with a younger onset of illness, a first episode manic/psychotic and a higher rate of substance abuse. Evidence suggests that PP may influence responses to acute treatment for bipolar depression. Furthermore, evidences indicate that PP should be considered for the selection of maintenance treatments for BD. Limitations There are few prospective studies on PP. There were disparate definitions for PP across studies. Conclusions The concept of PP provides relevant information for clinicians. Future studies should investigate the genetic and biological underpinnings of PP.
    Journal of Affective Disorders 07/2014; 163:56–64. DOI:10.1016/j.jad.2014.03.035 · 3.38 Impact Factor
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    • "Degree of PD pathology (i.e., total number of PD symptoms that met subthreshold or threshold levels) predicted depressive symptoms at the end of the acute treatment phase (i.e., 4-month followup) as well as at the final (28-month) followup, over and above shared variance with baseline depressive symptoms and other clinically relevant variables; a higher number of PD symptoms were associated with higher depression scores at both timepoints, suggesting a “dose-response” relationship between these variables. Importantly, although follow-up depression scores were relatively low, research clearly indicates that residual depressive symptoms are both common [53] and disabling [54, 55] amongst individuals with BD. Cluster C (i.e., avoidant, dependent, and obsessive-compulsive) pathology emerged as particularly problematic in terms of 4-month depressive symptoms, whereas cluster A (i.e., paranoid, schizoid, and schizotypal) pathology was most problematic in terms of 28-month depressive symptoms. "
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    ABSTRACT: We conducted a secondary analysis of data from a clinical trial to explore the relationship between degree of personality disorder (PD) pathology (i.e., number of subthreshold and threshold PD symptoms) and mood and functioning outcomes in Bipolar I Disorder (BD-I). Ninety-two participants completed baseline mood and functioning assessments and then underwent 4 months of treatment for an index manic, mixed, or depressed phase acute episode. Additional assessments occurred over a 28-month follow-up period. PD pathology did not predict psychosocial functioning or manic symptoms at 4 or 28 months. However, it did predict depressive symptoms at both timepoints, as well as percent time symptomatic. Clusters A and C pathology were most strongly associated with depression. Our findings fit with the literature highlighting the negative repercussions of PD pathology on a range of outcomes in mood disorders. This study builds upon previous research, which has largely focused on major depression and which has primarily taken a categorical approach to examining PD pathology in BD.
    Depression research and treatment 01/2014; 2014:816524. DOI:10.1155/2014/816524
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