Article

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

ABSTRACT

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.

Full-text preview

Available from: ijnp.oxfordjournals.org
  • Source
    • "4.4. Emotional lability (EL) EL is associated with both ADHD (Skirrow and Asherson, 2013) and euthymic BD (Judd et al., 2003). Our study supports the view of EL as a largely non-specific set of symptoms that are seen across different disorders, with high EL scores seen in both the ADHD and BD groups compared to controls. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Overlapping symptoms can make the diagnostic differentiation of attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) challenging in adults using current clinical assessments. This study sought to determine if current clinical measures delineate ADHD from BD in adults, comparing relative levels of ADHD, BD and emotional lability (EL) symptoms. Methods: Sixty adult women with ADHD, BD or controls were compared on self-report and interview measures for ADHD symptoms, mania, depression, EL, and impairment. Results: ADHD interview measures and self-ratings of ADHD symptoms best discriminated between ADHD and BD. Self-report measures of EL and depression showed non-specific enhancement in both clinical groups. BD-specific items may distinguish BD from ADHD if a retrospective time-frame is adopted. Conclusions: Using measures which capture specific symptoms of ADHD and chronicity/episodicity of symptoms facilitates the delineation of ADHD from BD in adult women.
    Full-text · Article · Mar 2016 · Journal of Affective Disorders
  • Source
    • "Bipolar II Judd et al . , 2003 12 ."
    [Show abstract] [Hide abstract]
    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
    Full-text · Article · Mar 2015 · Journal of Affective Disorders
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jul 2014 · Journal of Affective Disorders
Show more