Diagnosis and Treatment of Bipolar Disorder

Abstract

ImportanceBipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide.ObservationsBipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide.Conclusions and RelevanceBipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.

Lithium use and bone health in women with bipolar disorder: A cross‐sectional study

“…Lithium is the gold standard treatment for bipolar disorder with demonstrated mood stabilizing effects 6–8 . Besides its effects on mood, lithium has many off‐target properties 9 .…”

“…These include its potential to reduce cardiovascular and all‐cause mortality 11,12 . Accumulating data show that lithium may also present neuroprotective, osteoprotective and potentially anti‐cancer properties, thus shifting the balance around its potential deleterious effects 6–9 …”

Machine Learning Models for the Prediction of Early-Onset Bipolar Using Electronic Health Records

“…Bipolar disorder (BD) is a serious mental illness typically characterized by recurrent episodes of mania (or hypomania) and depression 1 . A recent analysis of data from 29 countries revealed a lifetime prevalence of 2.3% (among females) - 2.5% (among males) and a median age of onset of approximately 20 years 2 .…”

Competitive Influence of Alkali Metals in the Ion Atmosphere on Nucleic Acid Duplex Stability

“…66 The sodium−potassium pump controls the cellular concentrations of the two ions and is a well-characterized system that is tightly regulated. Lithium is used in some antipsychotic and hypertension medications, 67,68 and sodium−lithium exchange and sodium−proton exchange are mediated by the same transport system. 69 Rubidium helps in the stimulation of metabolism, 70,71 treats severe heart diseases, 72,73 and is found in muscles.…”

“…The sodium–potassium pump controls the cellular concentrations of the two ions and is a well-characterized system that is tightly regulated. Lithium is used in some antipsychotic and hypertension medications, , and sodium–lithium exchange and sodium–proton exchange are mediated by the same transport system . Rubidium helps in the stimulation of metabolism, , treats severe heart diseases, , and is found in muscles. , Some DNA extraction kits and DNA cloning methods utilize RbCl as a means for enhancing efficacy. − Cesium shares chemical properties of potassium and can replace potassium in biological systems. , Although Rb + and Cs + are less biologically relevant, studying the effects of all five monovalent ions on RNA secondary structure stability can assist in understanding the basic trends across the alkali metal ions.…”