Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

National Institute of Mental Health, Bethesda, MD 20892, USA.
Archives of general psychiatry (Impact Factor: 14.48). 03/2011; 68(3):241-51. DOI: 10.1001/archgenpsychiatry.2011.12
Source: PubMed


There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods.
To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative.
Cross-sectional, face-to-face, household surveys of 61,392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview.
Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment.
The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system.
Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.

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Available from: Elie Georges Karam, Apr 18, 2014
    • "Bipolar disorder (BD), characterised by episodes of mania and depression, is estimated to have a lifetime prevalence of 1.4 % (Merikangas et al. 2011). This disorder has a strong genetic basis with an estimated heritability of 85 % (McGuffin et al. 2003) and first degree relatives of an affected individual at a significantly higher risk to develop BD (Lichtenstein et al. 2009; Müller-Oerlinghausen et al. 2002). "
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    ABSTRACT: Glutamatergic neurotransmission has been shown to be dysregulated in bipolar disorder (BD), alcohol use disorder (AUD) and substance use disorder (SUD). Similarly, disruption in the hypothalamic-pituitary-adrenal (HPA)-axis has also been observed in these conditions. BD is often comorbid with AUD and SUD. The effects of the glutamatergic and HPA systems have not been extensively examined in individuals with BD-AUD and BD-SUD comorbidity. The aim of this investigation was to determine whether variants in the glutamatergic pathway and HPA-axis are associated with BD-AUD and BD-SUD comorbidity. The research cohort consisted of 498 individuals with BD type I from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). A subset of the cohort had comorbid current AUD and current SUD. A total of 1935 SNPs from both the glutamatergic and HPA pathways were selected from the STEP-BD genome-wide dataset. To identify population stratification, IBS clustering was performed using the program Plink 1.07. Single SNP association and gene-based association testing were conducted using logistic regression. A pathway analysis of glutamatergic and HPA genes was performed, after imputation using IMPUTE2. No single SNP was associated with BD-AUD or BD-SUD comorbidity after correction for multiple testing. However, from the gene-based analysis, the gene PRKCI was significantly associated with BD-AUD. The pathway analysis provided overall negative findings, although several genes including GRIN2B showed high percentage of associated SNPs for BD-AUD. Even though the glutamatergic and HPA pathways may not be involved in BD-AUD and BD-SUD comorbidity, PRKCI deserves further investigation in BD-AUD.
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    • "Cognitive-behavioural therapy for BPSD has shown mixed outcomes so far (Thase et al., 2014), with some evidence that assumptions and beliefs about the self may moderate response to treatment (Lam et al., 2005). Onset of BPSD is typically in early adulthood (Merikangas et al., 2011), which represents an important period for development of the self (Fitzgerald, 1988; Rathbone et al., 2008, Burnett Heyes et al., 2013). Psychopathology research can contribute to treatment innovation by focusing on aspects of psychopathology that remain insufficiently explored yet (Di Simplicio et al., 2012). "
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    ABSTRACT: Bipolar Spectrum Disorder (BPSD) is associated with changes in self-related processing and affect, yet the relationship between self-image and affect in the BPSD phenotype is unclear. 47 young adults were assessed for hypomanic experiences (BPSD phenotype) using the Mood Disorders Questionnaire. Current and future self-images (e.g. I am… I will be…) were generated and rated for emotional valence, stability, and (for future self-images only) certainty. The relationship between self-image ratings and measures of affect (depression, anxiety and mania) were analysed in relation to the BPSD phenotype. The presence of the BPSD phenotype significantly moderated the relationship between (1) affect and stability ratings for negative self-images, and (2) affect and certainty ratings for positive future self-images. Higher positivity ratings for current self-images were associated with lower depression and anxiety scores. This was a non-clinical group of young adults sampled for hypomanic experiences, which limits the extension of the work to clinical levels of psychopathology. This study cannot address the causal relationships between affect, self-images, and BPSD. Future work should use clinical samples and experimental mood manipulation designs. BPSD phenotype can shape the relationship between affect and current and future self-images. This finding will guide future clinical research to elucidate BPSD vulnerability mechanisms and, consequently, the development of early interventions. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
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    • "Bipolar disorder (BD) is a highly prevalent (Catalá-López et al., 2013; Merikangas et al., 2011) and disabling disease (Huxley and Baldessarini, 2007; Judd et al., 2005; Rosa et al., 2008, 2009). "
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