Onset polarity and illness course in bipolar I and II disorders: The predictive role of broadly defined mixed states

Tundo, Antonio; Musetti, Laura; Benedetti, Alessandra; Berti, Benedetta; Massimetti, Gabriele; Dell’Osso, Liliana

doi:10.1016/j.comppsych.2015.07.018

Cited by 23 publications

(20 citation statements)

References 32 publications

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“…The second diagnostic specifier that we analyzed was polarity of the first episode. We found that depressive onset was notably the quite high in our sample (76 out of 108 patients, 70.4%), in line with other studies reporting onset with a depressive episode in two thirds of BD patients (27,46,47), although this proportion can be different if mixed episodes are considered (48). In consistency with previous studies (47,48), we found that depressive onset was associated with type II BD, being one of the factors contributing to a worse perceived quality of life in these patients compared to patients diagnosed with type I BD (49).…”

Section: Discussionsupporting

confidence: 92%

“…We found that depressive onset was notably the quite high in our sample (76 out of 108 patients, 70.4%), in line with other studies reporting onset with a depressive episode in two thirds of BD patients (27,46,47), although this proportion can be different if mixed episodes are considered (48). In consistency with previous studies (47,48), we found that depressive onset was associated with type II BD, being one of the factors contributing to a worse perceived quality of life in these patients compared to patients diagnosed with type I BD (49). In addition to the variables showed in the table, the variables initially included in the logistic regression backward selection procedure were educational level, subtype of bipolar disorder, work disability, family disability and social disability, family history of psychiatric illness, predominant polarity, polarity of the first episode and Clinical Global Impression score, alcohol misuse, nicotine dependence, ever hospitalization and suicide attempts.…”

Section: Discussionsupporting

confidence: 92%

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Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder

et al. 2020

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Objective: The aim of this study is to determine the prevalence of three possible diagnostic specifiers, namely predominant polarity (PP) throughout illness, polarity of the first episode and early age at onset, in a sample of bipolar disorder (BD) patients and their association with important socio-demographic, clinical and course-of-illness variables. Methods: A retrospective and naturalistic study on 108 BD outpatients, who were classified according to the PP, polarity of the first episode and early age at onset (≤ 20 years) [vs. late (>20 years)] and were characterized by their demographics, clinical data, functionality and social support, among others features. After bivariate analyses, those variables showing certain association ( P value < 0.25) with the three dependent variables were entered in logistic regression backward selection procedures to identify the variables independently associated with the PP, polarity of the first episode and early age at onset. Results: The sample consisted of 75 women ad 33 men, 74% with type I BD and 26% with type II. Around 70% had depressive PP, onset with a depressive episode and onset after age 20. Depressive PP was independently associated with depressive onset, higher score on the CGI severity scale and work disability. Onset with depressive episode was associated with type II BD, longer diagnostic delay and higher score on family disability. Early age at onset (≤ 20 years) was associate with younger age, longer diagnostic delay, presence of ever psychotic symptoms, current use of antipsychotic drugs and higher social support score. Conclusions: The results of this study show that BD patients with depressive PP, onset with depression and early age at onset may represent greater severity, because they are frequently associated with variables that worsen the prognosis. Our findings match up with the conclusions of two systematic reviews and we also include a disability factor (at family and work) that has not been previously reported. This work contributes to the use of polarity and age at onset in BD patients, as it can become a useful instrument in the prognostic and therapeutic applications.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder

et al. 2020

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“…The study sample includes outpatients with BD‐I and BD‐II diagnosis according to DSM‐IV criteria, consecutively recruited during a period of 4 years (from January 2002 to January 2006) at the Psychiatric Unit of the Department of Clinical and Experimental Medicine, University of Pisa, Italy, and at the Istituto di Psicopatologia in Rome, Italy (Tundo et al, ). Inclusion criteria were as follows: (a) age 18–65 years, (b) on prophylactic treatment with Li and/or anticonvulsants (VA or CBZ), and (c) with a follow‐up of at least 18 months.…”

Section: Methodsmentioning

confidence: 99%

Lithium, valproate, and carbamazepine prescribing patterns for long‐term treatment of bipolar I and II disorders: A prospective study

Musetti

Tundo

Benedetti

et al. 2018

Human Psychopharmacology

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Objective This study aims to describe the prescription patterns of the mood stabilizers most commonly used for the treatment of bipolar I and II disorders (lithium, valproate, and carbamazepine) and to analyze the treatment outcomes. Methods Two hundred and thirty‐four outpatients with bipolar disorders receiving prophylactic treatment with lithium, valproate, carbamazepine, or their combination were followed up for at least 18 months in two Italian psychiatric centers specialized in mood disorders. Results The combination of lithium and valproate or carbamazepine was the most common prophylactic treatment (54.3%), followed by valproate or carbamazepine (24%) and lithium monotherapy (22%). Polytherapy was prescribed mainly to patients with bipolar I disorder, a high number of previous episodes and lifetime psychotic symptoms, whereas valproate or carbamazepine monotherapy was prescribed to patients with anxiety comorbidity. The annual frequency of recurrences decreased significantly after entering the study in the overall sample, and the reduction was significantly higher in patients on lithium plus valproate or carbamazepine compared with the valproate or carbamazepine group, but not with the lithium monotherapy group. The number of mixed recurrences during the follow‐up was significantly higher in patients on lithium plus valproate or carbamazepine. Conclusions Our findings may help clinicians to personalize long‐term treatment to prevent relapses of bipolar disorder according to clinical presentation.

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“…Furthermore, due to the presence of depressive phenomena in activated states, these patients are also at greater risk of completed suicide. 7 Another factor negatively influencing the prognosis is susceptibility to rapid cycling, in which patients have brief if any euthymic periods and a persistent symptomatic state is evident throughout the course of the illness. These facts allude to the pernicious nature of mixed symptoms, so that the treating physician must be alert to their presence and be prepared to institute therapeutic strategies which are effective, well tolerated, and have a good safety profile.…”

Section: Mixed Symptoms In Bipolar Disordermentioning

confidence: 99%

Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment

Muneer

2017

Chonnam Med J

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Many bipolar disorder patients exhibit mixed affective states, which portend a generally more severe illness course and treatment resistance. In the previous renditions of Diagnostic and Statistical Manual mixed states were narrowly defined in the context of bipolar I disorder, but with the advent of DSM-5 the term “mixed episode” was dropped and replaced by “mixed features” specifier which could be broadly applied to manic, hypomanic and depressive episodes in both the bipolar spectrum and major depressive disorders. This paradigm shift reflected their significance in the prognosis and overall management of mood disorders, so that the clinicians should thoroughly familiarize themselves with the contemporary notions surrounding these conditions. The purpose of this manuscript is to bring to light the current conceptualizations regarding the etiology, pathogenesis and treatment of mixed states. To achieve this goal, in June 2016 an extensive literature search was undertaken using the PubMed database. Some exploratory terms utilized included “mixed states”, “mixed episodes”, “switching”, “rapid cycling” cross referenced with “bipolar disorder”. Focusing on the most relevant and up to date studies, it was revealed that mixed states result from genetic susceptibility in the circadian and dopamine neurotransmission apparatuses and disturbance in the intricate catecholamine-acetylcholine neurotransmission balance which leads to mood fluctuations. The management of mixed states is challenging with atypical antipsychotics, newer anticonvulsants and electroconvulsive therapy emerging as the foremost treatment options. In conclusion, while progress has been made in the neurobiological understanding of mixed states, the currently available therapeutic modalities have only shown limited effectiveness.

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Onset polarity and illness course in bipolar I and II disorders: The predictive role of broadly defined mixed states

Cited by 23 publications

References 32 publications

Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder

Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder

Lithium, valproate, and carbamazepine prescribing patterns for long‐term treatment of bipolar I and II disorders: A prospective study

Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment

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