Bipolar disorders

Abstract

Bipolar disorders are chronic and recurrent disorders that affect >1% of the global population. Bipolar disorders are leading causes of disability in young people as they can lead to cognitive and functional impairment and increased mortality, particularly from suicide and cardiovascular disease. Psychiatric and nonpsychiatric medical comorbidities are common in patients and might also contribute to increased mortality. Bipolar disorders are some of the most heritable psychiatric disorders, although a model with gene-environment interactions is believed to best explain the aetiology. Early and accurate diagnosis is difficult in clinical practice as the onset of bipolar disorder is commonly characterized by nonspecific symptoms, mood lability or a depressive episode, which can be similar in presentation to unipolar depression. Moreover, patients and their families do not always understand the significance of their symptoms, especially with hypomanic or manic symptoms. As specific biomarkers for bipolar disorders are not yet available, careful clinical assessment remains the cornerstone of diagnosis. The detection of hypomanic symptoms and longtudinal clinical assessment are crucial to differentiate a bipolar disorder from other conditions. Optimal early treatment of patients with evidence-based medication (typically mood stabilizers and antipsychotics) and psychosocial strategies is necessary.

Polygenic scores for major depressive disorder and depressive symptoms predict response to lithium in patients with bipolar disorder

“…Our findings could form part of a genetic explanation for the previously described clinical observations in relation to mania, depression and lithium response in BD 6,7,[27][28][29][30][31][32][33][34] and supports the notion that lithium responsiveness could be associated with a 'core' bipolar phenotype in the Kraepelinian form of manic depression 34,44 . Such a concept is further supported by our previous finding of an inverse association of lithium response and schizophrenia PGS in BD 16 .…”

“…On the other hand, in BD, lithium is more effective in preventing manic than depressive episodes 27,28 , leading to the notion that better lithium responders might be more likely to experience manic predominant polarity, as opposed to depressive predominant polarity 29 . In support of this view, one study found that excellent lithium responders were characterized by a manic but not depressive polarity of the index episode 30 .…”

Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder—A systematic review

“…We know that treatment reduces recurrences, 79 and that when treatment is initiated early, the potential for positive outcomes is greater. 4…”

“…To do this, we selected longitudinal and cross-sectional studies of BD that evaluated the influence of factors that were present in childhood, on the frequency of mood episode recurrence. We chose to focus on factors present during childhood because the presence of risk or protective factors early in the illness has substantial influence on the course of BD across the lifespan 4 ; consequently, identifying and targeting these factors could have a greater impact on illness trajectory than factors present only in adulthood. There are undoubtedly factors that influence mood episode recurrence later in life (eg, substance use, stressful or traumatic events), but as the effects of the illness accumulate, it becomes harder to distinguish independent risk from those factors that share a bidirectional relation with mood symptoms.…”

Beyond evidence‐based treatment of bipolar disorder: Rational pragmatic approaches to management

“…Given the fact that a proportion of patients with bipolar disorder have cognitive impairment, cognitive and functional remediation may be necessary as well 52. Lastly, because of extensive comorbidity with personality disorders, approaches such as dialectical behavior therapy may be valuable for individual patients 53. A critical, if neglected element is the value of the therapeutic alliance and long term stable clinical care.…”