Clinical implications of predominant polarity and the polarity index in bipolar disorder: A naturalistic study

Bipolar Disorders Program, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 07/2013; 129(5). DOI: 10.1111/acps.12179
Source: PubMed


Predominant polarity (PP) is an important variable in maintenance treatment of bipolar disorder (BD). This study aimed at determining the role of polarity index (PI), a metric indicating antimanic versus antidepressive prophylactic potential of drugs, in clinical decision-making.
Two hundred and fifty-seven of 604 (43%) of patients with BD-I or II fulfilled criteria for manic (MPP) or depressive PP (DPP). The PI, representing the ratio of number needed to treat (NNT) for depression prevention to NNT for mania prevention, was calculated for patients' current treatment. MPP and DPP groups were compared regarding sociodemographic, clinical and therapeutic characteristics.
One hundred and forty-three patients (55.6%) fulfilled criteria for DPP and 114 (44.4%) for MPP. Total PI, Antipsychotics' PI, and mood stabilizers PI were higher, indicating a stronger antimanic action, in MPP. MPP presented higher prevalence of BD-I, male gender, younger age, age at onset and at first hospitalization, more hospitalizations, primary substance misuse, and psychotic symptoms. DP correlated with BD-II, depressive onset, primary life events, melancholia, and suicide attempts.
The results confirm the usefulness of the PI. In this large sample, clinical differences among these groups justify differential treatment approach. The PI appears to be a useful operationalization of what clinicians do for maintenance therapy in BD.

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    • "There were no studies of the relationship between polarity of first episode and suicide deaths. The presence of a depressive predominant polarity has been consistently associated with greater likelihood of lifetime suicide attempts than a manic predominant polarity (Baldessarini et al., 2012; Carvalho et al., 2014; Colom et al., 2006; Popovic et al., 2014). "
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    ABSTRACT: Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors. A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords 'bipolar disorder' and 'suicide attempts or suicide'. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables. We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants. There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder. © The Royal Australian and New Zealand College of Psychiatrists 2015.
    Australian and New Zealand Journal of Psychiatry 07/2015; DOI:10.1177/0004867415594428 · 3.41 Impact Factor
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    • "Approximately one-half of BD patients were reported to have a predominant polarity [54] [57], and various studies have detected clinical differences between predominantly manic and predominantly depressed patients [54] [58] [59]. In a naturalistic study by Popovic and colleagues [60], several clinical differences were detected between the two groups: manic predominant polarity was characterized by higher prevalence of BD I, male gender, younger age, younger age at illness onset and at first hospitalization, higher hospitalization rate, more manic and hypomanic episodes, primary substance abuse and psychotic symptoms; depressive predominant polarity was characterized by higher rates of BD II, depressive onset, more depressive episodes, stressful events preceding illness onset, melancholia and more suicide attempts. Another example of intraindividual differentiation of patients with BD pertains to the rapid cycling subgroup with a minimum of four episodes per year, i.e., mania/hypomania and major depression [61]. "
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    Clinica Chimica Acta 02/2015; 449. DOI:10.1016/j.cca.2015.02.029 · 2.82 Impact Factor
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    • "Even sub-syndromal forms of bipolar disorder, such as hypomania, are associated with a wide range of substance use and misuse outcomes (D'Mello et al., 1995; Do and Mezuk, 2013). A history of substance abuse preceding first episode has been reported to correlate with a manic predominant polarity (Carvalho et al., 2014; Colom and Vieta, 2009; Popovic et al., 2014). More than one third of individuals with hypomania had a comorbid SUD, and these associations were seen across a range of psychoactive substances (Albanese et al., 2006; D'Mello et al., 1995; Do and Mezuk, 2013). "
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    ABSTRACT: Homeless individuals are an extremely vulnerable and underserved population characterized by overlapping problems of mental illness and substance use. Given the fact that mood disorders are frequently associated with substance use disorders, we wanted to further highlight the role of excitement in substance abuse. Patterns of substance abuse among homeless suffering from unipolar and bipolar depression were compared. The "self-medication hypothesis" which would predict no-differences in substance preference by unipolar (UP) and bipolar (BP) depressed homeless was tested. Homeless individuals from the Vancouver At Home/Chez Soi study were selected for lifetime UP and lifetime BP depression and patterns of substances abused in the previous 12 months were identified with the Mini-International Neuropsychiatric Interview. Differences in substance use between BP-depressed homeless and UP-depressed homeless were tested using Chi-square and logistic regression techniques. No significant differences were observed between UP and BP homeless demographics. The bipolar depressed homeless (BDH) group displayed a higher percentage of Central Nervous System (CNS) Stimulants (χ 8.66, p=0.004) and Opiates (χ 6.41, p=0.013) as compared to the unipolar depressed homeless (UDH) group. CSN Stimulant was the only predictor within the BDH Group (χ(2) 8.74 df 1 p<0.003). Data collected are self-reported and no urinalyses were performed. The results support the hypothesis that beyond the self-medication hypothesis, bipolarity is strictly correlated to substance use; this correlation is also verified in a homeless population. Copyright © 2015 Elsevier B.V. All rights reserved.
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