Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: The BRIDGE Study

The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Archives of general psychiatry (Impact Factor: 13.75). 08/2011; 68(8):791-8. DOI: 10.1001/archgenpsychiatry.2011.87
Source: PubMed

ABSTRACT Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability. Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers.
To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a major depressive episode.
Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE).
Community and hospital psychiatry departments.
Participants included 5635 adults with an ongoing major depressive episode.
The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression.
A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P < .001) with bipolarity were observed for family history of mania/hypomania and multiple past mood episodes. The bipolarity specifier additionally identified significant associations for manic/hypomanic states during antidepressant therapy, current mixed mood symptoms, and comorbid substance use disorder.
The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is recommended before deciding on treatment.

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Available from: Charles L Bowden, Aug 27, 2015
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    • "Depression is also a risk factor for somatic diseases such as cardiovascular disease (Lin et al., 2014), and maternal depression has been shown to affect child development (Ohoka et al., 2014). Approximately 16% of patients seeking treatment for a major depressive episode have bipolar disorder (Angst et al., 2011). Bipolar disorder is characterized by recurrent depressive and (hypo)manic episodes. "
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    ABSTRACT: Animal models of mental disorders should ideally have construct, face, and predictive validity, but current animal models do not always satisfy these validity criteria. Additionally, animal models of depression rely mainly on stress-induced behavioral changes. These stress-induced models have limited validity, because stress is not a risk factor specific to depression, and the models do not recapitulate the recurrent and spontaneous nature of depressive episodes. Although animal models exhibiting recurrent depressive episodes or bipolar depression have not yet been established, several researchers are trying to generate such animals by modeling clinical risk factors as well as by manipulating a specific neural circuit using emerging techniques. Copyright © 2015. Published by Elsevier Ltd.
    Neuroscience 08/2015; DOI:10.1016/j.neuroscience.2015.08.016 · 3.33 Impact Factor
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    • "There is also some evidence that MAO inhibitors may have a relatively low risk of inducing mood-switching (Himmelhoch et al., 1991 ; Tondo et al., 2010). The presence of unrecognized initial subsyndromal hypomanic symptoms may contribute to poor responses to antidepressant treatment, even in patients diagnosed with unipolar depression (Ghaemi et al., 2003 ; Post et al., 2003b ; Sharma et al., 2005 ; Calabrese et al., 2006 ; Goldberg et al., 2007 ; Sachs et al., 2007 ; O'Donovan et al., 2008 ; Phelps et al., 2008 ; Frye et al., 2009 ; Baldessarini et al., 2010d ; Correa et al., 2010 ; Angst et al., 2011 ; Pacchiarotti et al., 2011b ; Perlis et al., 2011 ; Rihmer and Gonda, 2011 ; Rybakowski, 2012). This hypothesis parallels the view that bipolar depression is less treatmentresponsive than unipolar depression – a conclusion that can be questioned based on the present findings (Table 2). "
    03/2015; 13(1):102-112. DOI:10.1176/appi.focus.130119
    • "An effective disorder-promotion strategy is to repeatedly claim that the disorder is being underdiagnosed and underrecognized. Multiple studies have been conducted with the goal of demonstrating that bipolar disorder is underrecognized and underdiagnosed in depressed patients (Angst et al., 2011; Benazzi and Akiskal, 2001; Ghaemi et al., 1999, 2000; Hantouche et al., 1998; Nasr et al., 2005). Complementing this empirical literature are the commentaries and review articles exhorting clinicians to improve their recognition of bipolar disorder (Bowden, 2001; Dunner, 2003; Hirschfeld, 2001, 2013; Hirschfeld and Vornik, 2004; Katzow et al., 2003; Yatham, 2005). "
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    ABSTRACT: Compared with bipolar disorder, borderline personality disorder (BPD) is as frequent (if not more frequent), as impairing (if not more impairing), and as lethal (if not more lethal). Yet, BPD has received less than one-tenth the funding from the National Institutes of Health than has bipolar disorder. More than other reviewers of the literature on the interface between bipolar disorder and BPD, Paris and Black (Paris J and Black DW (2015) Borderline Personality Disorder and Bipolar Disorder: What is the Difference and Why Does it Matter? J Nerv Ment Dis 203:3-7) emphasize the clinical importance of correctly diagnosing BPD and not overdiagnosing bipolar disorder, with a focus on the clinical feature of affective instability and how the failure to recognize the distinction between sustained and transient mood perturbations can result in misdiagnosing patients with BPD as having bipolar disorder. The review by Paris and Black, then, is more of an advocacy for BPD than other reviews in this area have been. In the present article, the author will illustrate how the bipolar disorder research community has done a superior job of advocating for and "marketing" their disorder compared with researchers of BPD. Specifically, researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, written commentaries about the problem with underdiagnosis, developed and promoted several screening scales to improve diagnostic recognition, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these issues and thus have been less successful in highlighting the public health significance of the disorder.
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