Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania

Angst, Jules; Gamma, Alex; Benazzi, Franco; Ajdacic, Vladeta; Eich, Dominique; Rössler, Wulf

doi:10.1016/s0165-0327(02)00322-1

Cited by 796 publications

(627 citation statements)

References 24 publications

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“…In recent years, several authors have argued that BD is more common, that symptoms of (hypo)mania are continually distributed among mood-disorder cases, 24 and that the criteria separating BDII from 'softer' conditions are essentially arbitrary. 25 These changes in conceptualization of mood disorders, if accepted, are critical for future research of BD. They also raise legitimate concerns about increasing heterogeneity and diminishing the chance of consistent findings in neurobiological or genetic studies.…”

Section: Diagnosis Of Bdmentioning

confidence: 99%

The phenotypes of bipolar disorder: relevance for genetic investigations

2005

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The search for susceptibility genes for bipolar disorder (BD) depends on appropriate definitions of the phenotype. In this paper, we review data on diagnosis and clinical features of BD that could be used in genetic studies to better characterize patients or to define homogeneous subgroups. Clinical symptoms, long-term course, comorbid conditions, and response to prophylactic treatment may define groups associated with more or less specific loci. One such group is characterized by symptoms of psychosis and linkage to 13q and 22q. A second group includes mainly bipolar II patients with comorbid panic disorder, rapid mood switching, and evidence of chromosome 18 linkage. A third group comprises typical BD with an episodic course and favourable response to lithium prophylaxis. Reproducibility of cognitive deficits across studies raises the possibility of using cognitive profiles as endophenotypes of BD, with deficits in verbal explicit memory and executive function commonly reported. Brain imaging provides a more ambiguous data set consistent with heterogeneity of the illness. Keywords: bipolar disorder; genetics; endophenotype; neurocognitive function; brain imaging Bipolar disorder (BD) has a genetic basis with heritability of at least 80%. 1 A number of studies have attempted to map the susceptibility loci giving evidence of linkage in multiple genomic regions. In particular, findings in 4p, 4q, 8q, 10p, 12q24, 13q, 18p, 18q, 21q, and 22q have been supported by more than one study. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, these studies have not identified any specific genes, and a recent metaanalysis of available genome scans showed no regions with a conclusive evidence of linkage. 20 The relatively slow progress of gene-mapping efforts is often explained by the 'complex' nature of the illness and of the genotype-phenotype relation. The complexity most likely includes heterogeneity, interactions of multiple loci, incomplete penetrance, as well as phenotypes resulting from environmental effects-either alone or in interaction with the genetic predisposition. The goal of psychiatric genetic research is identification of (heritable) variations in DNA sequence or function that influence behaviour or give rise to mental illness. By definition, in complex (multifactorial) traits, this link is not unique and specific. That is, a particular change in gene sequence does not necessarily lead to a specific behaviour, and similar behaviours (symptoms) may be due to distinct (sets of) genes. Moreover, we must consider the possibility that the path between the genotype and behaviour is not unidirectional. Emerging examples point not only to general effects of environment, for instance stress, on behaviour, but also to specific behaviours influencing gene function that can be transmitted onto the next generation. 21 No single method is considered clearly superior in identifying susceptibility genes for complex traits such as BD. Most researchers agree that a combination of strategies is most lik...

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Section: Diagnosis Of Bdmentioning

confidence: 99%

The phenotypes of bipolar disorder: relevance for genetic investigations

2005

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“…The most compelling clinic-based data on the significance of short-duration episodes of mania-like symptoms comes from the Course and Outcome in Bipolar Youth (COBY) study 23 . Children with manic symptoms and associated impairment were diagnosed as having Bipolar Disorder Not Otherwise specified if these symptoms lasted for a period of 4 hours within a 24-hour period, and at least 4 cumulative lifetime days 24 .…”

Section: Short-lived Episodes Of Mania Like Symptomsmentioning

confidence: 99%

Mood regulation in youth

Leigh

Smith

Milavić

et al. 2012

Current Opinion in Psychiatry

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Purpose of review-Mood regulation problems, such as severe chronic irritability or short episodes of mania like symptoms are common, impairing and a topic of intense recent interest to clinicians, researchers and the DSM-5 process. Here we review the most recent findings about these two presentations and discuss approaches to their treatment.Recent findings-Longitudinal and genetic findings suggest that chronic irritability should be regarded as a mood problem that is distinct from bipolar disorder.A proportion of children with short (less than 4 days) episodes of mania like symptoms seem to progress to classical (Type I or II) bipolar disorder over time in US clinic samples. In a UK sample, such episodes were independently associated with psychosocial impairment.The evidence base for the treatment of either irritability or short-lived episodes to mania-like symptoms is still small. Clinicians should be cautious with extrapolating treatments from classical bipolar disorder to these mood regulation problems. CBT-based approaches targeting general mood regulation processes may be effective for cases with severe irritability or short episodes of mania like symptoms.Summary-There is increasing research evidence for the importance of mood regulation problems in the form of either irritability or short episodes of mania like symptoms in youth. The evidence base for their drug treatment has yet to be developed. CBT-based interventions to modify processes of mood regulation may be a useful and safe intervention for patients with these presentations.

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“…Outra área de estudo envolve a relação da distimia com o espectro bipolar 9,[40][41][42][43] . A esse respeito, a distimia se insere na atual discussão nosológica entre a classificação da depressão como dimensional versus categorial de um lado e a dicotomia unipolar-bipolar do outro.…”

Section: Aspectos Nosológicosunclassified

“…Angst et al 42 sugerem o termo "transtorno bipolar menor", o qual pode incluir distimia associada a sintomas hipomaníacos 42 . A chamada "distimia bipolar" seria caracterizada por tendência a estados de elação e história familiar de transtorno bipolar 43 .…”

Section: Aspectos Nosológicosunclassified

“…A chamada "distimia bipolar" seria caracterizada por tendência a estados de elação e história familiar de transtorno bipolar 43 . No espectro bipolar, tal qual descreveu Kraepelin no início do século 20, estariam incluídas formas atenuadas e também grande parte do domínio do TDM, sendo que a nosologia atual (CID-10 e DSM-IV) é insuficiente para refletir adequadamente esse espectro 41,42 .…”

Section: Aspectos Nosológicosunclassified

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Distimia: características históricas e nosológicas e sua relação com transtorno depressivo maior

Spanemberg

Juruena

2004

Rev. psiquiatr. Rio Gd. Sul

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Transtorno distímico é uma forma crônica e incapacitante de depressão, ocorrendo em uma parcela substancial da população (3 a 6%) e aumentando os riscos de transtorno depressivo maior. Ela é associada a consideráveis incapacitações e elevada comorbidade. O status nosológico da distimia tem despertado consideráveis controvérsias ao longo das décadas passadas, sendo que algumas investigações a consideraram como um transtorno do humor e outras como um transtorno de personalidade. Classificada na nosografia atual entre os transtornos de humor, a distimia é hoje uma entidade tratável e que precisa receber maior atenção em virtude de sua morbidade. Este artigo revisa os principais aspectos históricos da distimia, suas características nosológicas, subtipos e sua relação com transtorno depressivo maior. Ao final, concluímos que novos estudos são necessários para a validação do conceito de distimia e do espectro de depressões crônicas, para uma melhor compreensão etiológica e para uma terapêutica baseada em evidências.

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Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania

Cited by 796 publications

References 24 publications

The phenotypes of bipolar disorder: relevance for genetic investigations

The phenotypes of bipolar disorder: relevance for genetic investigations

Mood regulation in youth

Distimia: características históricas e nosológicas e sua relação com transtorno depressivo maior

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