Bipolar (Spectrum) Disorder and Mood Stabilization: Standing at the Crossroads?

Department of Psychiatry, General Hospital Sint-Jan AV, Brugge, Belgium.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 02/2007; 76(2):77-88. DOI: 10.1159/000097966
Source: PubMed


Diagnosis and treatment of bipolar disorder has long been a neglected discipline. Recent years have shown an upsurge in bipolar research. When compared to major depressive disorder, bipolar research still remains limited and more expert based than evidence based. In bipolar diagnosis the focus is shifting from classic mania to bipolar depression and hypomania. There is a search for bipolar signatures in symptoms and course of major depressive episodes. The criteria for hypomania are softened, leading to a bipolar prevalence that now equals that of major depressive disorder. Anti-epileptics and atypical antipsychotics have joined lithium in the treatment of bipolar disorder. Fortunately, mood stabilization has become the core issue in bipolar disorder treatment. In contrast with recent trends in the diagnosis of bipolar disorder, treatment research remains more focused on classic mania than depression or hypomania. This leaves the clinician with the difficult task of diagnosing 'new bipolar patients' for whom no definite evidence-based treatment is available. An important efficacy-effectiveness gap further compromises the translation of the evidence base on bipolar disorder treatment into clinical practice. The recent upsurge of research on bipolar disorder is to be applauded, but further research is needed: for bipolar disorder in general, and for bipolar depression and the long-term treatment specifically. Given the complexity of the disorder and the many clinical uncertainties, effectiveness studies should be installed.

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Available from: Jürgen De Fruyt, Nov 25, 2014
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    • "). Moreover, the predictive clinical features identified here, including family history of BP, antidepressant-induced mania/hypomania, brief major depressive episodes, early age at onset, antidepressant wear-off, and antidepressant resistance, are in agreement with the findings of previous studies (Neuman et al., 1997; Ghaemi et al., 2002; Hirschfeld et al., 2003; De Fruyt and Demyttenaere, 2007; Benazzi, 2009). However, although these factors were predictive in Table 2 Comparisons of characteristics and 10 proposed bipolar features in the bipolar spectrum disorder diagnostic criteria except postpartum depression between unipolar group and conversion group. "
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    ABSTRACT: The major aims of this study were to identify factors that may predict the diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BP) and to evaluate the predictive performance of the bipolar spectrum disorder (BPSD) diagnostic criteria. The medical records of 250 patients with a diagnosis of MDD for at least 5 years were retrospectively reviewed for this study. The diagnostic conversion from MDD to BP was observed in 18.4% of 250 MDD patients, and the diagnostic criteria for BPSD predicted this conversion with high sensitivity (0.870) and specificity (0.917). A family history of BP, antidepressant-induced mania/hypomania, brief major depressive episodes, early age of onset, antidepressant wear-off, and antidepressant resistance were also independent predictors of this conversion. This study was conducted using a retrospective design and did not include structured diagnostic interviews. The diagnostic criteria for BPSD were highly predictive of the conversion from MDD to BP, and conversion was associated with several clinical features of BPSD. Thus, the BPSD diagnostic criteria may be useful for the prediction of bipolar diathesis in MDD patients. Copyright © 2014 Elsevier B.V. All rights reserved.
    Full-text · Article · Nov 2014 · Journal of Affective Disorders
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    • "The complexity of the BP clinical picture (with manic and depressive symptoms commonly intermixed) as well as the complexity of its treatment (with polypharmacy being more a rule than an exception) is now being explored with an upmost interest in diagnosis and treatment research. Past research has mainly focused on BP type I (BP-I), with mania as its hallmark, while BP type II (BP-II), cyclothymia, and not otherwise specified BP (BP- NOS) have been relatively neglected [3]. However, the reintroduction of the bipolar spectrum disorder (BPS) concept has extended the boundaries. "
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    ABSTRACT: The threshold chosen by categorical mental health classifications like DSM-IV-TR or ICD-10 for the diagnosis of bipolar disorders (BP) is too high, elevating the risk of misdiagnosing cases that closely resemble BP under several clinical variables like “major depressive disorder”. Acknowledging and providing the necessary weight to the BP subthreshold forms may improve the clinical practice and reduce the number of patients with misdiagnosis, creating opportunities for better treatment. Increasing evidence support the bipolar spectrum disorder (BPS) concept and factors such us earlier onset age of the first major depressive episode (MDE), brief duration of MDEs, rapid onset of MDEs, more than five previous MDEs, family history of BP, treatment-resistant depression, suicidal behavior, postpartum depression, atypical features, psychotic traits, irritability, overactivity, comorbidity with anxiety disorders, substance abuse, borderline personality disorder, migraine, and irritable temperament are well validated differentiators between unipolar and bipolar depressive disorders. Identifying those factors could increase the lifetime prevalence of BPS to at least 4.8%. New studies on the diagnosis and management of BP should focus on the development of diagnostics dimensional models with categorical benchmarks to recognize BP sub-threshold forms, on the selection of biomarkers for early identification of patients with BPS, especially those with BP family history, and on the promotion of joint efforts between academia, industry, government, and community to search new interventions in BPS management.
    Full-text · Article · Feb 2013 · Current Psychiatry Reviews
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    ABSTRACT: The aim of this review was to consider the literature concerned with a sequential use of pharmacotherapy and psychotherapy in mood disorders. Review of the clinical trials where treatment components were used in a sequential order were identified by using MEDLINE, a manual search of the literature and the Index Medicus. In unipolar recurrent depression, the sequential use of pharmacotherapy and psychotherapy was found to improve relapse rate. In bipolar disorder, the use of psychotherapeutic strategies in patients who were already assuming mood stabilizers was also found to yield clinical benefits. The sequential model has the potential for improving the logic and timing of interventions. A conceptual shift in current assessment methods (staging) is needed.
    No preview · Article · Jun 2008 · Journal of Contemporary Psychotherapy
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