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  • Cited by 46
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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.
    Cerimele, Joseph M Fortney, John C Pyne, Jeffrey M and Curran, Geoffrey M 2018. Bipolar disorder in primary care: a qualitative study of clinician and patient experiences with diagnosis and treatment. Family Practice,
    McElroy, Susan L. and Keck, Paul E. 2017. Dysphoric mania, mixed states, and mania with mixed features specifier: are we mixing things up?. CNS Spectrums, Vol. 22, Issue. 02, p. 170.
    Fountoulakis, Konstantinos N. Young, Allan Yatham, Lakshmi Grunze, Heinz Vieta, Eduard Blier, Pierre Moeller, Hans Jurgen and Kasper, Siegfried 2016. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines. International Journal of Neuropsychopharmacology, p. pyw091.
    El-Mallakh, Rif S. and Bauer, Mark S. 2015. Psychiatry. p. 857.
    Pavlickova, Hana Turnbull, Oliver H. Myin-Germeys, Inez and Bentall, Richard P. 2015. The inter-relationship between mood, self-esteem and response styles in adolescent offspring of bipolar parents: An experience sampling study. Psychiatry Research, Vol. 225, Issue. 3, p. 563.
    Perugi, Giulio Quaranta, Giuseppe and Dell’Osso, Liliana 2014. The Significance of Mixed States in Depression and Mania. Current Psychiatry Reports, Vol. 16, Issue. 10,
    Tohen, Mauricio McIntyre, Roger S. Kanba, Shigenobu Fujikoshi, Shinji and Katagiri, Hideaki 2014. Efficacy of olanzapine in the treatment of bipolar mania with mixed features defined by DSM-5. Journal of Affective Disorders, Vol. 168, Issue. , p. 136.
    Bullock, Ben and Murray, Greg 2014. Reduced Amplitude of the 24 Hour Activity Rhythm. Clinical Psychological Science, Vol. 2, Issue. 1, p. 86.
    Tohen, Mauricio Kanba, Shigenobu McIntyre, Roger S. Fujikoshi, Shinji and Katagiri, Hideaki 2014. Efficacy of olanzapine monotherapy in the treatment of bipolar depression with mixed features. Journal of Affective Disorders, Vol. 164, Issue. , p. 57.
    Pavlickova, Hana Varese, Filippo Smith, Angela Myin-Germeys, Inez Turnbull, Oliver H. Emsley, Richard Bentall, Richard P. and Zhang, Xiang Yang 2013. The Dynamics of Mood and Coping in Bipolar Disorder: Longitudinal Investigations of the Inter-Relationship between Affect, Self-Esteem and Response Styles. PLoS ONE, Vol. 8, Issue. 4, p. e62514.
    Hu, Ming-Chuan Lee, Sheng-Yu Wang, Tzu-Yun Chen, Shiou-Lan Chang, Yun-Hsuan Chen, Shih-Heng Chu, Chun-Hsien Wang, Chen-Lin Lee, I. Hui Yeh, Tzung Lieh Yang, Yen Kuang and Lu, Ru-Band 2013. Association study of DRD2 and MAOA genes with subtyped alcoholism comorbid with bipolar disorder in Han Chinese. Progress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 40, Issue. , p. 144.
    Rihmer, Zoltan Dome, Peter and Gonda, Xenia 2013. Antidepressant Response and Subthreshold Bipolarity in “Unipolar” Major Depressive Disorder. Journal of Clinical Psychopharmacology, Vol. 33, Issue. 4, p. 449.
    Gan, Zhaoyu Han, Zili Li, Kanglai Diao, Feici Wu, Xiaoli Guan, Nianhong and Zhang, Jinbei 2012. Validation of the Chinese version of the "Mood Disorder Questionnaire" for screening bipolar disorder among patients with a current depressive episode. BMC Psychiatry, Vol. 12, Issue. 1,
    Jabben, Nienke Penninx, Brenda W.J.H. Beekman, Aartjan T.F. Smit, Johannes H. and Nolen, Willem A. 2011. Co-occurring manic symptomatology as a dimension which may help explaining heterogeneity of depression. Journal of Affective Disorders, Vol. 131, Issue. 1-3, p. 224.
    Johnson, S. L. Morriss, R. Scott, J. Paykel, E. Kinderman, P. Kolamunnage-Dona, R. and Bentall, R. P. 2011. Depressive and manic symptoms are not opposite poles in bipolar disorder. Acta Psychiatrica Scandinavica, Vol. 123, Issue. 3, p. 206.
    Bauer, Michael Glenn, Tasha Rasgon, Natalie Marsh, Wendy Sagduyu, Kemal Munoz, Rodrigo Schmid, Rita Haack, Sara and Whybrow, Peter C. 2011. Association between median family income and self-reported mood symptoms in bipolar disorder. Comprehensive Psychiatry, Vol. 52, Issue. 1, p. 17.
    Schwannauer, Matthias Noble, Abbi and Fraser, Gillian 2011. Behavioural Risk of Bipolar Disorder in an Analogue Population: The Role of Cognitive, Developmental and Interpersonal Factors. Clinical Psychology & Psychotherapy, Vol. 18, Issue. 5, p. 411.
    2010. Cognitive Therapy for Bipolar Disorder. p. 293.
    Biancosino, Bruno Picardi, Angelo Marmai, Luciana Biondi, Massimo and Grassi, Luigi 2010. Factor structure of the Brief Psychiatric Rating Scale in unipolar depression. Journal of Affective Disorders, Vol. 124, Issue. 3, p. 329.
    Davison, Kenneth 2009. Historical aspects of mood disorders. Psychiatry, Vol. 8, Issue. 2, p. 47.
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‘Bipolarity’ in bipolar disorder: Distribution of manic and depressive symptoms in a treated population

  • Mark S. Bauer (a1), Gregory E. Simon (a2), Evette Ludman (a3) and Jurgen Unützer (a3)
Summary

Cross-sectional analysis of 441 individuals with bipolar disorder treated at a US health maintenance organisation investigated the distribution of manic and depressive symptoms in that illness. Clinically significant depressive symptoms occurred in 94.1% of those with (hypo)mania, while70.1% inadepressive episode had clinically significant manic symptoms. DSM-unrecognised depression-plus-hypomania was over twice as prevalent as DSM-recognised mixed episodes. Depressive symptoms were unimodally distributed in (hypo)mania. Depressive and manic symptoms were positively, not inversely correlated, and their co-occurrence was associated with worse quality of life. Implications for the DSM and ICD nosological systems are discussed.

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Copyright
COPYRIGHT: © 2005 The Royal College of Psychiatrists 
Corresponding author
Dr Mark S. Bauer, VAMC-116R, 830 Chalkstone Avenue, Providence, RI 02908-4799, USA. Tel: +1 401 273 7100, ext. 38631; fax: +1401 457 3311; e-mail: mark_bauer@brown.edu
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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes
References
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Akiskal, H. S., Bourgeois, M. L., Angst, J., et al (2000) Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. Journal of Affective Disorders, 59 (suppl. 1), S5–S30.
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM–IV–TR). Washington, DC: APA.
Bauer, M. S. (2003) Bipolar (manic–depressive) disorder. In Psychiatry (2nd edn) (eds Tasman, A., Kay, J. & Lieberman, J.), pp. 1237–1270. Philadelphia, PA: Saunders.
Bauer, M. S., Gyulai, L., Yeh, H-S., et al (1994) Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics, and inter-episode stability. Journal of Affective Disorders, 32, 201–211.
Bauer, M. S., Kirk, G., Gavin, C., et al (2001) Correlates of functional and economic outcome in bipolar disorder: a prospective study. Journal of Affective Disorders, 65, 231–241.
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Judd, L. L., Akiskal, H. S., Schettler, P. J., et al (2002) The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry, 59, 530–537.
Kendell, R. (1982) The choice of diagnostic criteria for biological research. Archives of General Psychiatry, 39, 1334–1339.
Simon, G. E., Ludman, E. J., Unutzer, J., et al (2005) Randomized trial of a population-based care program for people with bipolar disorder. Psychological Medicine, 35, 13–24.
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  • Cited by 46
  • Cited by
    Crossref Citations
    Crossref logo
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.
    Cerimele, Joseph M Fortney, John C Pyne, Jeffrey M and Curran, Geoffrey M 2018. Bipolar disorder in primary care: a qualitative study of clinician and patient experiences with diagnosis and treatment. Family Practice,
    McElroy, Susan L. and Keck, Paul E. 2017. Dysphoric mania, mixed states, and mania with mixed features specifier: are we mixing things up?. CNS Spectrums, Vol. 22, Issue. 02, p. 170.
    Fountoulakis, Konstantinos N. Young, Allan Yatham, Lakshmi Grunze, Heinz Vieta, Eduard Blier, Pierre Moeller, Hans Jurgen and Kasper, Siegfried 2016. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines. International Journal of Neuropsychopharmacology, p. pyw091.
    El-Mallakh, Rif S. and Bauer, Mark S. 2015. Psychiatry. p. 857.
    Pavlickova, Hana Turnbull, Oliver H. Myin-Germeys, Inez and Bentall, Richard P. 2015. The inter-relationship between mood, self-esteem and response styles in adolescent offspring of bipolar parents: An experience sampling study. Psychiatry Research, Vol. 225, Issue. 3, p. 563.
    Perugi, Giulio Quaranta, Giuseppe and Dell’Osso, Liliana 2014. The Significance of Mixed States in Depression and Mania. Current Psychiatry Reports, Vol. 16, Issue. 10,
    Tohen, Mauricio McIntyre, Roger S. Kanba, Shigenobu Fujikoshi, Shinji and Katagiri, Hideaki 2014. Efficacy of olanzapine in the treatment of bipolar mania with mixed features defined by DSM-5. Journal of Affective Disorders, Vol. 168, Issue. , p. 136.
    Bullock, Ben and Murray, Greg 2014. Reduced Amplitude of the 24 Hour Activity Rhythm. Clinical Psychological Science, Vol. 2, Issue. 1, p. 86.
    Tohen, Mauricio Kanba, Shigenobu McIntyre, Roger S. Fujikoshi, Shinji and Katagiri, Hideaki 2014. Efficacy of olanzapine monotherapy in the treatment of bipolar depression with mixed features. Journal of Affective Disorders, Vol. 164, Issue. , p. 57.
    Pavlickova, Hana Varese, Filippo Smith, Angela Myin-Germeys, Inez Turnbull, Oliver H. Emsley, Richard Bentall, Richard P. and Zhang, Xiang Yang 2013. The Dynamics of Mood and Coping in Bipolar Disorder: Longitudinal Investigations of the Inter-Relationship between Affect, Self-Esteem and Response Styles. PLoS ONE, Vol. 8, Issue. 4, p. e62514.
    Hu, Ming-Chuan Lee, Sheng-Yu Wang, Tzu-Yun Chen, Shiou-Lan Chang, Yun-Hsuan Chen, Shih-Heng Chu, Chun-Hsien Wang, Chen-Lin Lee, I. Hui Yeh, Tzung Lieh Yang, Yen Kuang and Lu, Ru-Band 2013. Association study of DRD2 and MAOA genes with subtyped alcoholism comorbid with bipolar disorder in Han Chinese. Progress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 40, Issue. , p. 144.
    Rihmer, Zoltan Dome, Peter and Gonda, Xenia 2013. Antidepressant Response and Subthreshold Bipolarity in “Unipolar” Major Depressive Disorder. Journal of Clinical Psychopharmacology, Vol. 33, Issue. 4, p. 449.
    Gan, Zhaoyu Han, Zili Li, Kanglai Diao, Feici Wu, Xiaoli Guan, Nianhong and Zhang, Jinbei 2012. Validation of the Chinese version of the "Mood Disorder Questionnaire" for screening bipolar disorder among patients with a current depressive episode. BMC Psychiatry, Vol. 12, Issue. 1,
    Jabben, Nienke Penninx, Brenda W.J.H. Beekman, Aartjan T.F. Smit, Johannes H. and Nolen, Willem A. 2011. Co-occurring manic symptomatology as a dimension which may help explaining heterogeneity of depression. Journal of Affective Disorders, Vol. 131, Issue. 1-3, p. 224.
    Johnson, S. L. Morriss, R. Scott, J. Paykel, E. Kinderman, P. Kolamunnage-Dona, R. and Bentall, R. P. 2011. Depressive and manic symptoms are not opposite poles in bipolar disorder. Acta Psychiatrica Scandinavica, Vol. 123, Issue. 3, p. 206.
    Bauer, Michael Glenn, Tasha Rasgon, Natalie Marsh, Wendy Sagduyu, Kemal Munoz, Rodrigo Schmid, Rita Haack, Sara and Whybrow, Peter C. 2011. Association between median family income and self-reported mood symptoms in bipolar disorder. Comprehensive Psychiatry, Vol. 52, Issue. 1, p. 17.
    Schwannauer, Matthias Noble, Abbi and Fraser, Gillian 2011. Behavioural Risk of Bipolar Disorder in an Analogue Population: The Role of Cognitive, Developmental and Interpersonal Factors. Clinical Psychology & Psychotherapy, Vol. 18, Issue. 5, p. 411.
    2010. Cognitive Therapy for Bipolar Disorder. p. 293.
    Biancosino, Bruno Picardi, Angelo Marmai, Luciana Biondi, Massimo and Grassi, Luigi 2010. Factor structure of the Brief Psychiatric Rating Scale in unipolar depression. Journal of Affective Disorders, Vol. 124, Issue. 3, p. 329.
    Davison, Kenneth 2009. Historical aspects of mood disorders. Psychiatry, Vol. 8, Issue. 2, p. 47.
    Download full list
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‘Bipolarity’ in bipolar disorder: Distribution of manic and depressive symptoms in a treated population

  • Mark S. Bauer (a1), Gregory E. Simon (a2), Evette Ludman (a3) and Jurgen Unützer (a3)
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