Predominant polarity in bipolar I and II disorders: A five-year follow-up study

Abstract

Background: Patients with bipolar disorder (BD) differ in their relative predominance of types of episodes, yielding predominant polarity, which has important treatment implications. However, few prospective studies of predominant polarity exist. Methods: In the Jorvi Bipolar Study (JoBS), a regionally representative cohort of 191 BD I and BD II in-and outpatients was followed for five years using life-chart methodology. Differences between depressive (DP), manic (MP), and no predominant polarity (NP) groups were examined regarding time ill, incidence of suicide attempts, and comorbidity. Results: At baseline, 16% of patients had MP, 36% DP, and 48% NP. During the follow-up the MP group spent significantly more time euthymic, less time in major depressive episodes, and more time in manic states than the DP and NP groups. The MP group had significantly lower incidence of suicide attempts than the DP and NP group, lower prevalence of comorbid anxiety disorders but more psychotic symptoms lifetime and more often (hypo)manic first phase of the illness than the DP group. Classification of predominant polarity was influenced by the timeframe used. Limitations: The retrospective counting of former phases is vulnerable to recall bias. Assignment of dominant polarity may necessitate a sufficient number of illness phases. Conclusions: Predominant polarity has predictive value in predicting group differences in course of illness, but individual patients' classification may change over time. Patients with manic polarity may represent a more distinct subgroup than the two others regarding illness course, suicide attempts, and psychiatric comorbidity.

Predominant polarity and hippocampal subfield volumes in Bipolar disorders

“…Second, despite the large number of recruited patients, the sample size of patients presenting with PP was relatively small. According to previous studies, the prevalence of PP in samples of BD patients ranged between 42.4% and 71.8% (median value: 52.7%) . Here, we found that only 37% of BD patients presented with PP.…”

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

“…Finally, we should mention the findings of a recently published 5-year prospective study (54), which develops the idea of time ill, according to which not only the number of episodes is important but also the total time that each patient remains in each one of the phases of the disease would determine the prognosis. The mentioned study showed that patients with manic PP spend more time in the manic phase than depressive PP and undetermined PP patients, but it is worth noting that manic PP patients also remained euthymic for longer periods and, therefore, compensated.…”

Physical health in affective disorders: a narrative review of the literature

“…26 Regarding BD, the prevalence of obesity is also increased, especially in patients with higher rates of depressive episodes. [27][28][29] Meta-analytical data show that the proportion of patients with abdominal obesity according to the National Cholesterol Education Program Adult Treatment Panel III (ATP-III) or ATP-III-A criteria was 48.7% (95%CI 46.2-51.2), and it was 61% (95%CI 51.9-63.4) according to International Diabetes Federation criteria, especially in patients with higher rates of depressive episodes. 29 BD and MDD are affective disorders that impair appetite, energy, and motivation.…”