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Canadian Journal of Psychiatry. Revue... Apr 2017To evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD).
METHOD
We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches located studies reporting estimates of the age of onset (AOO) and indicators of the age at initial management of BD. We calculated a pooled estimate of the interval between AOO and age at management. Factors influencing between-study heterogeneity were investigated using sensitivity analyses, meta-regression, and multiple meta-regression.
RESULTS
Twenty-seven studies, reporting 51 samples and a total of 9415 patients, met the inclusion criteria. The pooled estimate for the interval between the onset of BD and its management was 5.8 years (standardized difference, .53; 95% confidence interval, .45 to .62). There was very high between-sample heterogeneity ( I = 92.6; Q = 672). A longer interval was found in studies that defined the onset according to the first episode (compared to onset of symptoms or illness) and defined management as age at diagnosis (rather than first treatment or first hospitalization). A longer interval was reported among more recently published studies, among studies that used a systematic method to establish the chronology of illness, among studies with a smaller proportion of bipolar I patients, and among studies with an earlier mean AOO.
CONCLUSIONS
There is currently little consistency in the way researchers report the AOO and initial management of BD. However, the large interval between onset and management of BD presents an opportunity for earlier intervention.
Topics: Bipolar Disorder; Early Medical Intervention; Humans
PubMed: 27462036
DOI: 10.1177/0706743716656607 -
Biological Psychiatry Nov 2004Substance use disorders are overrepresented in individuals with bipolar and bipolar spectrum disorders. Although awareness of this phenomenon has increased over the past... (Review)
Review
Substance use disorders are overrepresented in individuals with bipolar and bipolar spectrum disorders. Although awareness of this phenomenon has increased over the past 20 years, few empirically based treatment strategies have been developed for this challenging patient population. This review examines the relationship between bipolar and substance use disorders and treatment options that have been studied in this patient population. First, we examine the high prevalence rates of substance use disorders in individuals diagnosed with bipolar disorder, the common problems associated with establishing a bipolar disorder diagnosis in individuals who abuse substances, the possible explanations for the frequent coexistence of bipolar and substance use disorders, and the negative effect of substance abuse on the course of and treatment outcomes for bipolar disorder. The review then focuses on treatment approaches for this patient population, including integrated group therapy for co-occurring bipolar and substance use disorders and pharmacotherapies that target both disorders. Finally, we present suggestions for medications that might be tested for their efficacy in treating both disorders in specific subgroups of patients with bipolar and substance use disorders.
Topics: Bipolar Disorder; Diagnosis, Dual (Psychiatry); Humans; Substance-Related Disorders
PubMed: 15556118
DOI: 10.1016/j.biopsych.2004.05.008 -
Annals of Clinical Psychiatry :... Feb 2011There has been considerable interest in the elevated risk of cardiovascular disease associated with serious mental illness. Although the contemporary literature has paid... (Review)
Review
BACKGROUND
There has been considerable interest in the elevated risk of cardiovascular disease associated with serious mental illness. Although the contemporary literature has paid much attention to major depression and schizophrenia, focus on the risk of cardiovascular mortality for patients with bipolar disorder has been more limited, despite some interest in the historical literature.
METHODS
We reviewed the historical and contemporary literature related to cardiovascular morbidity and mortality in bipolar disorder.
RESULTS
In studies that specifically assess cardiovascular mortality, bipolar disorder has been associated with a near doubling of risk when compared with general population estimates. This may be explained by the elevated burden of cardiovascular risk factors found in this population. These findings predate modern treatments for bipolar disorder, which may further influence cardiovascular risk.
CONCLUSIONS
Given the substantial risk of cardiovascular disease, rigorous assessment of cardiovascular risk is warranted for patients with bipolar disorder. Modifiable risk factors should be treated when identified. Further research is warranted to study mechanisms by which this elevated risk for cardiovascular disease are mediated and to identify systems for effective delivery of integrated medical and psychiatric care for individuals with bipolar disorder.
Topics: Behavior Control; Bipolar Disorder; Cardiovascular Agents; Cardiovascular Diseases; Cause of Death; Comorbidity; Early Diagnosis; Humans; Life Style; Psychotherapy; Psychotropic Drugs; Risk Assessment
PubMed: 21318195
DOI: No ID Found -
The American Journal of Managed Care Jun 2005Bipolar disorder is a chronic, severe, recurrent mood disorder. Traditional estimates of the prevalence of the disorder may underestimate the actual total disease... (Review)
Review
Bipolar disorder is a chronic, severe, recurrent mood disorder. Traditional estimates of the prevalence of the disorder may underestimate the actual total disease burden. The condition can occur across a wide spectrum of ages, but the most common age of onset appears to be between the ages of 15 and 19. Bipolar disorder is often underdiagnosed or misdiagnosed, with profound negative clinical and economic consequences. Medical and psychiatric comorbidity is common in patients with bipolar disorder. Functional disability because of bipolar disorder is comparable with that of many chronic medical conditions. It has been estimated that the total annual societal cost of bipolar disorder may be as high as 45 billion dollars.
Topics: Bipolar Disorder; Comorbidity; Cost of Illness; Diagnostic Errors; Humans; Recurrence; Suicide; United States
PubMed: 16097718
DOI: No ID Found -
Psychiatria Danubina Jun 2014Suicide is a leading cause of death in patients with bipolar disorder. Risk factors and prevention of suicide in this illness are the focus of considerable current... (Review)
Review
BACKGROUND
Suicide is a leading cause of death in patients with bipolar disorder. Risk factors and prevention of suicide in this illness are the focus of considerable current research.
METHODS
MEDLINE data base was searched for the key words "bipolar disorder" with "suicide", "lithium" with "suicide", "anticonvulsants" with "bipolar disorder", and "anticonvulsants" with "bipolar disorder" and with "suicide". No language or time constraints were applied. The lists of references were searched manually to find additional articles.
RESULTS
It is estimated that 25% to 50% of patients with bipolar disorder will attempt suicide at least once over their lifetime, and that 8% to 19% will complete suicide. Mortality rates from cardiovascular diseases are elevated in bipolar disorder. Risk factors for suicide include younger age of onset of the illness, history of past suicidal behavior, family history of suicide acts, comorbid borderline personality disorder and substance use disorders, and hopelessness. The warning signs calling for immediate action include the patients threatening to harm themselves, or looking for ways to kill themselves (seeking access to pills or weapons), or the patient talking or writing about death. Robust evidence supports the effects of lithium treatment in reducing suicidal attempts and completions in bipolar disorder. The evidence for antisuicidal effects of anticonvulsants is weaker. Nevertheless, valproate and other anticonvulsants are frequently prescribed as mood stabilizers. There have been controversial suggestions that this treatment may elevate the risk of suicide, but the data supporting this are not convincing. Psychoeducation can reduce the number of suicide attempts and completions.
CONCLUSIONS
Suicide in bipolar disorder is a major public health problem. Recent research has expanded our knowledge of risk factors and warning signs. Nevertheless, it appears that the introduction of lithium treatment in the 1970s was the most recent important breakthrough in the prevention of suicide in this illness.
Topics: Antipsychotic Agents; Bipolar Disorder; Humans; Lithium; Suicide; Suicide Prevention
PubMed: 24909246
DOI: No ID Found -
BMJ Open Dec 2022The Swedish National Quality Register for bipolar affective disorder, BipoläR, was established in 2004 to provide nationwide indicators for quality assessment and...
PURPOSE
The Swedish National Quality Register for bipolar affective disorder, BipoläR, was established in 2004 to provide nationwide indicators for quality assessment and development in the clinical care of individuals with bipolar spectrum disorder. An ancillary aim was to provide data for bipolar disorder research.
PARTICIPANTS
Inclusion criteria for registration in BipoläR is a diagnosis of bipolar spectrum disorder (ICD codes: F25.0, F30.1-F30.2, F30.8-F31.9, F34.0) and treatment at an outpatient clinic in Sweden. BipoläR collects data from baseline and annual follow-up visits throughout Sweden. Data is collected using questionnaires administered by healthcare staff. The questions cover sociodemographic, diagnostic, treatment, outcomes and patient reported outcome variables. The register currently includes 39 583 individual patients with a total of 75 423 baseline and follow-up records.
FINDINGS TO DATE
Data from BipoläR has been used in several peer-reviewed publications. Studies have provided knowledge on effectiveness, side effects and use of pharmacological and psychological treatment in bipolar disorder. In addition, findings on the diagnosis of bipolar disorder, risk factors for attempted and completed suicide and health economics have been reported. The Swedish Bipolar Collection project has contributed to a large number of published studies and provides important information on the genetic architecture of bipolar disorder, the impact of genetic variation on disease characteristics and treatment outcome.
FUTURE PLANS
Data collection is ongoing with no fixed end date. Currently, approximately 5000 new registrations are added each year. Cohort data are available via a formalised request procedure from Centre of Registers Västra Götaland (e-mail: [email protected]). Data requests for research purposes require an entity responsible for the research and an ethical approval.
Topics: Humans; Bipolar Disorder; Sweden; Longitudinal Studies; Risk Factors; Treatment Outcome
PubMed: 36600380
DOI: 10.1136/bmjopen-2022-064385 -
Ugeskrift For Laeger Aug 2022Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a global prevalence of approximately 1%. This review summarises new evidence of association between... (Review)
Review
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a global prevalence of approximately 1%. This review summarises new evidence of association between bipolar disorder (BD) and ASD. The mood episodes of BD can present atypically in people with ASD, potentially leading to misdiagnosis. Anamnesis regarding family history of affective disorders as well as previous mood episode is important among people with ASD to capture the BD diagnosis. Precaution with SSRI-treatment among people with ASD is crucial as the treatment can potentially trigger a mood episode of an underlying BD.
Topics: Autism Spectrum Disorder; Bipolar Disorder; Humans; Mood Disorders
PubMed: 36065878
DOI: No ID Found -
The American Journal of Managed Care Nov 2007Bipolar disorder is a recurrent and sometimes chronic illness involving episodes of depression and mania or hypomania. The most frequent presentation is depression: more... (Review)
Review
Bipolar disorder is a recurrent and sometimes chronic illness involving episodes of depression and mania or hypomania. The most frequent presentation is depression: more than 1 of 5 primary care patients with depression have bipolar disorder. The symptoms of bipolar depression often differ from those of unipolar depression. Age of onset for bipolar disorder is usually the late teens; slightly older for bipolar II subtype. Nearly all patients with bipolar disorder suffer from a comorbid psychiatric disorder, most frequently an anxiety disorder. Although the most dramatic presentation of bipolar disorder is the acutely manic patient who presents to the emergency department, this presentation is much less frequently encountered in physicians' offices, both primary care and psychiatric. Bipolarity is often missed in these situations. About half of bipolar patients have consulted 3 or more professionals before receiving a correct diagnosis, and the average time to first treatment is 10 years. It is imperative that clinicians carefully assess patients for bipolar disorder, especially those presenting with depression. In addition to patient and family history, administration of a screening instrument can be very helpful. The most widely used screening tool is the Mood Disorder Questionnaire. This screening tool will be discussed in this article regarding its use in outpatient clinics and the community.
Topics: Adolescent; Adult; Bipolar Disorder; Depressive Disorder; Diagnosis, Differential; Humans; Medical History Taking; Surveys and Questionnaires
PubMed: 18041877
DOI: No ID Found -
Journal of Affective Disorders Nov 2023Bipolar disorder (BD) is a severe psychiatric illness with an increasing prevalence worldwide. Although the pathological mechanism of and pharmacological interventions... (Review)
Review
Bipolar disorder (BD) is a severe psychiatric illness with an increasing prevalence worldwide. Although the pathological mechanism of and pharmacological interventions for BD have been extensively investigated in preclinical and clinical studies, a scientometric analysis of the developmental trends, interdisciplinary frontiers, and research hotspots in this field has not yet been conducted. Therefore, we performed a comprehensive scientometric review of 55,358 published studies on BD over the past two decades (2002-2021) to identify the most frequently used keywords and explore research hotspots and trajectories. The present findings revealed the main distribution, knowledge structure, topic evolution, and emerging topics of BD research. Analysing the risk factors, pathogenesis, key brain regions, comorbid conditions, and treatment strategies for BD contributed to understanding of the aetiology, progression, and treatment of this disorder. These findings provided substantial support for continued research in this area.
Topics: Humans; Bipolar Disorder; Risk Factors
PubMed: 37595897
DOI: 10.1016/j.jad.2023.08.069 -
The Journal of Clinical Psychiatry Dec 2010High rates of misdiagnosis, delayed diagnosis, and lack of recognition and treatment of comorbid conditions often lead patients with bipolar illness to have a chronic... (Review)
Review
OBJECTIVE
High rates of misdiagnosis, delayed diagnosis, and lack of recognition and treatment of comorbid conditions often lead patients with bipolar illness to have a chronic course with high disability, unemployment rates, and mortality. Despite the recognition that long-term outcome of bipolar disorder depends on systematic assessment of both interepisodic dysfunctional domains and comorbid psychiatric and medical conditions, treatment of bipolar disorder still focuses primarily on alleviation of acute symptoms and prevention of future recurrences. We propose here to review the evidence offering a modern view of bipolar disorder defined as a chronic and progressive multisystem disorder, taking into account characteristics of each patient as well as biosignatures in order to help design personalized treatments.
DATA SOURCES
We conducted a systematic PubMed search of all English-language articles, published between 2000 and 2010, focusing on the English and French literature with bipolar disorder cross-referenced with the following search terms: emotional dysregulation, sleep and circadian rhythm disturbances, cognitive impairment, age at onset, comorbid medical and psychiatric conditions, psychosocial and medical interventions, outcome, remission, and personalized medicine. The search was conducted between July 2009 and July 2010. The literature on bipolar disorder was reviewed to provide supporting evidence that the assessment of various symptom domains that are dysfunctional between episodes should all be considered as core dimensions of the disorder.
STUDY SELECTION
Forty-one articles were identified through the PubMed search described above and selected on the basis of addressing any combination of the search terms in conjunction with bipolar disorder.
DATA SYNTHESIS
Current guidelines advocate the use of more or less similar treatment algorithms for all patients, ignoring the clinical, pathophysiological, and lifetime heterogeneity of bipolar disorder. Systematic assessment of interepisodic dimensions, along with comorbid medical and psychiatric risk factors, should be performed along the life cycle in order to plan specific and personalized pharmacologic, medical, and psychosocial interventions tailored to the needs of each patient and ready-to-test biosignatures to serve as risk factors or diagnostic or prognostic tools.
CONCLUSIONS
Medical and research findings, along with health economic data, support a more modern view of bipolar disorder as a chronic, progressive, multisystem disorder. This new comprehensive framework should guide the search to identify biomarkers and etiologic factors and should help design a new policy for health care, including prevention, diagnosis, treatment, and training.
Topics: Age of Onset; Bipolar Disorder; Chronic Disease; Cognition; Comorbidity; Delivery of Health Care; Disease Progression; Humans; Precision Medicine; Risk Factors; Sleep; Treatment Outcome
PubMed: 21190640
DOI: 10.4088/JCP.10m06347yel