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.
"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). "
"Approximately one-half of BD patients were reported to have a predominant polarity  , and various studies have detected clinical differences between predominantly manic and predominantly depressed patients   . In a naturalistic study by Popovic and colleagues , 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 . "
"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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