Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders

Akiskal, Hagop S.; Bourgeois, M; Angst, Jules; Post, Robert M.; Möller, Hans; Hirschfeld, Robert M. A.

doi:10.1016/s0165-0327(00)00203-2

Cited by 772 publications

(566 citation statements)

References 116 publications

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“…Since DSM-III R criteria are employed by the SCID, thereby not differentiating between euphoric and mixed manic episodes, we were unable to analyze the subset of patients with initially explicitly DSM-IV mixed manic states. However, the DSM-IV criteria are generally criticized as overly restrictive, and definitions similar to those employed here have been recommended (Swann et al, 1997;Akiskal et al, 2000). The design was an unbalanced one, with twice the proportion of patients treated with divalproex as with placebo or lithium.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Bowden

Collins

McElroy

et al. 2005

Neuropsychopharmacol

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Euphoric and mixed (dysphoric) manic symptoms have different response patterns to divalproex and lithium in acute mania treatment, but have not been studied in relationship to maintenance treatment outcomes. We examined the impact of initial euphoric or dysphoric manic symptomatology on maintenance outcome. Randomized maintenance treatment with divalproex, lithium, or placebo was provided for 372 bipolar I patients, who met improvement criteria during open phase treatment for an index manic episode. The current analysis grouped patients according to the index manic episode subtype (euphoric or dysphoric), and evaluated the impact on maintenance treatment outcome. The rate of early discontinuation due to intolerance during maintenance treatment was higher for initially dysphoric patients (N ¼ 249) than euphoric patients (N ¼ 123; 15.7 vs 7.3%, respectively; p ¼ 0.032). Both lithium (23.2%) and divalproex (17.1%) were associated with more premature discontinuations due to intolerance than placebo (4.8%; p ¼ 0.003 and 0.02, respectively) in the initially dysphoric patients. Among initially euphoric patients, treatment with lithium was associated with significantly more premature discontinuations due to intolerance compared to placebo (18.2 vs 0%; p ¼ 0.03), and divalproex was significantly (p ¼ 0.05) more effective than lithium, but not placebo in delaying time to a depressive episode. Initial euphoric mania appeared to predispose to better outcomes on indices of depression and overall function with divalproex maintenance than with either placebo or lithium. Dysphoric mania appeared to predispose patients to more side effects when treated with either divalproex or lithium during maintenance therapy.

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Section: Discussionmentioning

confidence: 99%

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Bowden

Collins

McElroy

et al. 2005

Neuropsychopharmacol

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“…Os resultados são coincidentes com os da literatura sobre sintomas e comportamentos de pacientes depressivos bipolares (Akiskal et al, 2000) relacionados com dificuldades afetivas (Leboyer, Henry, Martinot, & Bellivier, 2005); cognitivas (Rocca & Lafer, 2006;Singer & Brabender,1993); e interpessoais (Akiskal et al, 2000;Kaplan et al, 1997;Mattos, 2003).…”

Section: Discussionunclassified

“…Estudos mostram que nos EUA, na década de 1990, a freqüência do transtorno bipolar que era de 1,6% para o tipo I e 0,5% para o tipo II (Akiskal et al, 2000) aumentou para 2,6% para ambos os tipos (Kessler et al, 2006). No Brasil, mais especificamente em São Paulo, estudos constataram a prevalência de 1% na população (Andrade, Walters, Gentil, & Laurenti, 2002).…”

Section: Segundo O Manual Para Diagnóstico E Estatística Daunclassified

“…É de caráter crônico, causa incapacitação profissional e social e caracteriza-se pela ocorrência alternada de episódios agudos de mania com momentos ora de depressão, ora remissão (Akiskal, Bourgeois, Angst, Möller, & Hirschifild, 2000;Fleck et al, 2003;Kaplan, Sadock, & Grebb, 1997;Mattos, 2003). A evolução do quadro leva à diminuição dos intervalos livres entre depressão e mania, piorando as condições mentais, sociais e neuro-psicológicas do paciente (Akiskal et al, 2000;Kaplan et al, 1997;Mattos, 2003).…”

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Cognição, afeto e relacionamento interpessoal de mulheres com transtorno afetivo bipolar

Hisatugo¹,

Yázigi²,

Porto³

2009

Psicol. Reflex. Crit.

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Compreensivo. O objetivo foi analisar os aspectos afetivos, cognitivos e interpessoais das pacientes. Quatro pacientes foram estudadas. Foram atendidas em ambulatório público e préviamente diagnosticadas com depressão bipolar, segundo Entrevista Psiquiátrica (SCID-I/CV-DSM-IV). Resultados indicaram sentimentos depreciativos na autoimagem, conteúdos eufóricos e falta de insight sobre a auto-tolerância ao estresse. Aspectos emocionais e cognitivos influenciaram no contexto interpessoal, acentuando o sofrimento. Outros dados qualitativos clínicos foram observados e comentados. Palavras-chave: Transtorno depressivo bipolar; Afeto; Cognição; Estresse; Rorschach. AbstractThe bipolar affective disorder induces incapacitation and social isolation, and might lead to suicide. It was a clinical study of multiple cases using the following instruments: Beck Depression Inventory (BDI), Beck Suicide Inventory (BSI), Hamilton Scale of Depression (HAM-D) and the Rorschach, by Exner's Comprehensive System (CS). The objective was to analyze the affective, cognitive and interpersonal aspects of the patients. Four female out-patients who were previously diagnosed as bipolar depressive, by the Psychiatry Interview according to Diagnostic and Statistical Manual of Mental Disorders (SCID-I/CV-DSM-IV) criteria were studied. Results had indicated undervalued feelings about themselves, euphoric contents and lack of insight about the self-tolerance related to stress controls. Emotional and cognitive aspects have influenced the interpersonal context leading to increased suffering. Other qualitative and clinic data have been observed and commented.

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“…Prevalence rates of bipolar disorder are similar among African Americans, Hispanics, and non-Hispanic whites (1–3), ranging from 2% to 4% (3–5). Several studies have reported treatment differences for African Americans, such as fewer psychiatric medications and fewer classes of these medications (6,7), fewer outpatient visits (8), and higher psychiatric hospitalization rates than for whites (9).…”

mentioning

confidence: 99%

One-Year Treatment Outcomes of African-American and Hispanic Patients With Bipolar I or II Disorder in STEP-BD

Gonzalez¹,

Bowden²,

Berman³

et al. 2010

Psychiatric Services

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Objective Few studies have compared treatment outcomes of African-American, Hispanic, and non-Hispanic white patients with bipolar disorder. The U.S. Systematic Treatment Enhancement Program for Bipolar Disorder compared one-year outcomes for bipolar I or II disorder from each of these racial-ethnic groups. Methods African Americans (N=155) were retrospectively compared with a matched group of non-Hispanic whites (N=729), and Hispanics (N=152) were compared with a separate matched group of non-Hispanic whites (N=822). Response and recovery outcomes were examined. Survival analysis was used to compare time to treatment response for depression (Montgomery-Asberg Depression Rating Scale) and mania (Young Mania Rating Scale) as well as global assessment of functioning (Global Assessment of Functioning). Results For manic and depressive symptoms, time to response and proportion of responders were similar across groups. Over the study year the proportion of days well was similar across groups. A smaller proportion of African Americans met criteria for improved global functioning. Depression response among African Americans with psychotic symptoms was slower than the response among African Americans without psychotic symptoms and among non-Hispanic whites with or without psychotic symptoms. No differences between Hispanics and non-Hispanic whites in response times and recovery were observed. Conclusions Results are consistent with U.S. clinical trials for other psychiatric disorders, which have reported similar outcomes for ratings of primary symptoms. Baseline psychotic symptoms are likely a significant contributor when African Americans with bipolar disorder are slow to recover. These results may be less generalizable to uninsured patients.

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Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders

Cited by 772 publications

References 116 publications

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Cognição, afeto e relacionamento interpessoal de mulheres com transtorno afetivo bipolar

One-Year Treatment Outcomes of African-American and Hispanic Patients With Bipolar I or II Disorder in STEP-BD

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