Hostname: page-component-76d6cb85b7-6jg5l Total loading time: 0 Render date: 2026-07-13T14:33:04.177Z Has data issue: false hasContentIssue false
  • English
  • Français

Bipolar Disorder: A National Health Concern

Published online by Cambridge University Press:  07 November 2014

Roger S. McIntyre  and
Jakub Z. Konarski
Get access Rights & Permissions [Opens in a new window]

Abstract

Bipolar disorders are prevalent, disabling, and costly diseases that often pursue an inexorable course. Underdetection, misdiagnosis, and diagnostic delay frequently and unnecessarily interfere with appropriate treatment of the disorder. Mortality studies in bipolar disorder underscore the relevance of both unnatural and natural causes of death, inviting the need for improved preventative and primary health care for bipolar patients. The treatment framework for bipolar disorder must recognize and anticipate the multidirnensionality and comorbidity of this illness. Pharmacotherapy is necessary, with multiple concomitant medications required for most patients, In addition, adjunctive psychosocial interventions offer enhanced compliance and may beneficially influence psychopathological and functional outcomes. This article emphasizes the public health concern of bipolr disorder, and provides tactics to enhance detection of cryptic bipolar states, underscore the clinical and pathophysiological relevance of comorbidity in bipolar disorder, and provide a framework for multimodality therapy for this condition.

Information

Type
Research Article
Information
CNS Spectrums , Volume 9 , Issue S12: Unmasking Bipolar Disorder: Overcoming the Barriers to Treatment Success , November 2004 , pp. 6 - 15
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1.Angst, F, Stassen, HH, Clayton, PJ, Angst, J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68:167–181.Google Scholar
2.Osby, U, Brandt, L, Correia, N, Ekbom, A, Sparen, P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58(9):844–850.Google Scholar
3.Sharma, R, Markar, HR. Mortality in affective disorder. J Affect Disord. 1994;31(2):91–96.CrossRefGoogle ScholarPubMed
4.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press Inc.; 1994.Google Scholar
5.Weissman, MM, Bland, RC, Canino, GJ, et al.Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996;276(4):293–299.CrossRefGoogle ScholarPubMed
6.Judd, LL, Akiskal, HS, Schettler, PJ, et al.Prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003;60(3):261–269.CrossRefGoogle ScholarPubMed
7.Ghaemi, SN, Ko, JY, Goodwin, FK. “Cade's disease” and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Can J Psychiatry. 2002;47(2):125–134.Google Scholar
8.Akiskal, HS, Bourgeois, ML, Angst, J, Post, R, Moller, H, Hirschfeld, R. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord. 2000;59(Suppl 1):S5–S30.Google Scholar
9.Perris, C. The course of depressive psychoses. Acta Psychiatr Scand. 1968;44(3):238–248.Google Scholar
10.Dunner, DL, Fleiss, JL, Fieve, RR. The course of development of mania in patients with recurrent depression. Am J Psychiatry. 1976;133(8):905–908.Google Scholar
11.Strober, M, Carlson, G. Bipolar illness in adolescents with major depression: clinical, genetic, and psychopharmacologic predictors in a three- to four-year prospective follow-up investigation. Arch Gen Psychiatry. 1982;39(5):549–555.Google Scholar
12.Angst, J. Switch from depression to mania--a record study over decades between 1920 and 1982. Psychopathology. 1985;18(2-3):140–154.Google Scholar
13.Geller, B, Fox, LW, Clark, KA. Rate and predictors of prepubertal bipolarity during follow-up of 6- to 12-year-old depressed children. J Am Acad Child Adolesc Psychiatry. 1994;33(4):461–468.Google Scholar
14.Rao, U, Ryan, ND, Birmaher, B, et al.Unipolar depression in adolescents: clinical outcome in adulthood. J Am Acad Child Adolesc Psychiatry. 1995;34(5):566–578.Google Scholar
15.Kovacs, M. Presentation and course of major depressive disorder during childhood and later years of the life span. J Am Acad Child Adolesc Psychiatry. 1996;35(6):705–715.Google Scholar
16.Goldberg, JF, Harrow, M, Whiteside, JE. Risk for bipolar illness in patients initially hospitalized for unipolar depression. Am J Psychiatry. 2001;158(8): 1265–1270.Google Scholar
17.Angst, J, Merikangas, K. The depressive spectrum: diagnostic classification and course. J Affect Disord. 1997;45(1-2):31–39.Google Scholar
18.Regier, DA, Boyd, JH, Burke, JD, et al.One-month prevalence of mental disorders in the United States. Based on five epidemiologic catchment area sites. Arch Gen Psychiatry. 1988;45(11):977–986.Google Scholar
19.Kessler, RC, McGonagle, KA, Zhao, S, et al.Lifetime and 12-month prevalence of DSM-III-R psychiatic disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.Google Scholar
20.Lewinsohn, PM, Klein, DN, Seeley, JR. Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry. 1995;34(4):454–463.Google Scholar
21.Szadoczky, E, Papp, Z, Vitrai, J, Rihmer, Z, Furedi, J. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. J Affect Disord. 1998;50(2-3):153–162.Google Scholar
22.Angst, j. The emerging epidemiolgoy of hypomania and bipolar II disorder. J Affect Disord. 1998;50:143–151.Google Scholar
23.Judd, LL, Akiskal, HS. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord. 2003;73(1-2):123–131.Google Scholar
24.Hirschfeld, RMA, Williams, JB, Spitzer, RL, et al.Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000; 157(11): 1873–1875.Google Scholar
25.Judd, LL, Schettler, PJ, Akiskal, HS, et al.Long-term symptomatic status of bipolar I vs. bipolar II disorders. Int J Neuropsychopharmocol. 2003;6(2):127–137.Google Scholar
26.Chen, YW, Dilsaver, SC. Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other axis I disorders. Biol Psychiatry. 1996;39(10):896–899.Google Scholar
27.Kessler, RC, Borges, G, Walters, EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56(7):617–626.Google Scholar
28.Tondo, L, Isacsson, G, Baldessarini, R. Suicidal behaviour in bipolar disorder: risk and prevention. CNS Drugs. 2003;17(7):491–511.Google Scholar
29.Leverich, GS, Altshuler, LL, Frye, MA, et al.Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry. 2003;64(5):506–515.Google Scholar
30.Begley, CE, Annegers, JF, Swann, AC, et al.The lifetime cost of bipolar disorder in the US: an estimate for new cases in 1998. Pharmacoeconomics. 2001;19(5 Ptl):483–495.Google Scholar
31.McIntyte, RS, Konarski, JZ, Yatham, LN. Comorbidity in bipolar disorder: a framework for rational treatment selection. Hum Psychophormacol. 2O04;19(6):369–386.Google Scholar
32.McElroy, SL, Altshuler, LL, Suppes, T, et al.Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry. 2001;158(3):420–426.Google Scholar
33.Nutt, DJ, Ballenger, JC, Sheehan, D, Wittchen, HU. Generalized anxiety disorder: comorbidity, comparative biology and treatment. Int J Neuropsychopharmocol. 2002;5(4):315–325.Google Scholar
34.Kessler, R. Comorbidity of unipolar and bipolar depression with othet psychiatric disorders in a general population survey. In: Tohen, M, ed. Comorbidity in Affective Disorders. New York, NY: Marcel Dekker Inc.; 1999:1–25.Google Scholar
35.Chen, YW, Dilsaver, SC. Comorbidity of panic disorder in bipolar illness: evidence from the Epidemiologic Catchment Area survey. Am J Psychiatry. 1995;152(2):280–282.Google Scholar
36.Goodwin, RD, Hoven, CW. Bipolar-panic comorbidity in the general population: prevalence and associated morbidity. J Affect Disord. 2002;70(1):27–33.Google Scholar
37.Birmaher, B, Kennah, A, Brent, D, Ehmann, M, Bridge, J, Axelson, D. Is bipolar disorder specifically associated with panic disorder in youths? J Clin Psychiatry. 2002;63:414–419.Google Scholar
38.Dilsaver, SC, Chen, YW, Swann, AC, et al.Suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania. Psychiatry Res. 1997;73(1-2):47–56.Google Scholar
39.Pini, S, Cassano, GB, Simonini, E, Savino, M, Russo, A, Montgomery, SA. Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. J Affect Disord. 1997;42(2-3):145–153.Google Scholar
40.Frank, E, Cyranowski, JM, Rucci, P, et al.Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Arch Gen Psychiatry. 2002;59(10):905–911.Google Scholar
41.Savino, M, Perugi, G, Simonini, E, et al.Affective comorbidity in panic disorder: Is there a bipolar connection? J Affect Disord. 1993;28(3):155-63.Google Scholar
42.Bowen, R, South, M, Hawkes, J. Mood swings in patients with panic disorder. Can J Psychiatry. 1994;39(2):91–94.Google Scholar
43.Grunhaus, L, Pande, AC, Brown, MB, Greden, JF. Clinical characteristics of patients wth concurrent majot depressive disorder and panic disorder. Am J Psychiatry. 1994;151(4):541–546.Google Scholar
44.Biederman, J, Faraone, SV, Marrs, A, et al.Panic disorder and agoraphobia in consecutively referred children and adolescents. J Am Acad Child Adolesc Psychiatry. 1997;36(2):214–223.Google Scholar
45.MacKinnon, DF, Xu, J, McMahon, FJ, et al.Bipolar disorder and panic disorder in families: an analysis of chromosome 18 data. Am J Psychiatry. 1998;155(6):829-31.Google Scholar
46.MacKinnon, DF, Zandi, PP, Gershon, E, et al.Rapid Switching of Mood in Families With Multiple Cases of Bipolar Disorder. Arch Gen Psychiatry. 2003;60(9):921–928.Google Scholar
47.Rotondo, A, Mazzanti, C, Dell'Osso, L, et al.Catechol O-methyltransferase, serotonin transporter, and tryptophan hydroxylase gene polymorphisms in bipolar disorder patients with and without comotbid panic disorder. Am J Psychiatry. 2002;159(1):23–29.CrossRefGoogle ScholarPubMed
48.Wozniak, J, Biederman, J, Monuteaux, MC, Richards, J, Faraone, SV. Parsing the comorbidity between bipolar disorder and anxiety disorders: a familial risk analysis. J Child Adolesc Psychopharmacol. 2002;12(2): 101–111.Google Scholar
49.MacKinnon, DF, Zandi, PP, Cooper, J, et al.Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. Am J Psychiatry. 2002;159(1):30–35.Google Scholar
50.Tohen, M, Greenfield, SF, Weiss, RD, et al.The effect of comorbid substance use disorders on the course of bipolar disorder: a review. Harv Rev Psychiatry. 1998;6(3):133–141.Google Scholar
51.Sonne, SC, Brady, KT. Substance abuse and bipolar comorbidity. Psychiatr Clin North Am. 1999;22(3):609–627.Google Scholar
52.Cassidy, F, Aheam, EP, Carroll, BJ. Substance abuse in bipolar disorder. Bipolar Disord. 2001;3(4):181–188.Google Scholar
53.Keck, PE Jr, McElroy, SL, Sttakowski, SM, et al.12-Month outcome of patients with bipolat disorder following hospitalization for a manic or mixed episode. Am J Psychiatry. 1998;155(5):646–652.Google Scholar
54.Kruger, S, Shugar, G, Cooke, RG. Comorbidity of binge eating disorder and the partial binge eating syndtome with bipolar disorder. Int J Eat Disord. 1996;19(1):45–52.Google Scholar
55.Lilliker, SL. Prevalence of diabetes in a manic-depressive population. Compr Psychiatry. 1980;21(4):270–275.Google Scholar
56.Cassidy, F, Ahearn, E, Carroll, BJ. Elevated frequency of diabetes mellitus in hospitalized manic-depressive patients. Am J Psychiatry. 1999;156(9):1417–1420.Google Scholar
57.Regenold, WT, Thapar, RK, Marano, C, et al.Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use. J Affect Disord. 2002;70(1):19–26.Google Scholar
58.Ruzickova, M, Slaney, C, Garnham, J, Aida, M. Clinical features of bipolar disorder with and without comorbid diabetes mellitus. Can J Psychiatry. 2003;48(7):458–461.Google Scholar
59.Weeke, A, Juel, K, Vaeth, M. Cardiovascular death and manic-depressive psychosis. J Affect Disord. 1987;13(3):287–292.Google Scholar
60.Harris, EC, Barraclough, B. Excess mortality of mental disorder. Br J Psychiatry. 1998;173:11–53.Google Scholar
61.Fagioltni, A, Frank, E, Houck, PR, et al.Prevalence of obesity and weight change during treatment in patients with bipolar I disorder. J Clin Psychiatry. 2002;63(6):528–533.Google Scholar
62.McElroy, SL, Frye, MA, Suppes, T, et al.Correlates of ovetweight and obesity in 644 patients with bipolar disorder. J Clin Psychiatry. 2002;63(3):207–213.Google Scholar
63.Fagiolini, A, Kupfer, DJ, Houck, PR, Novick, DM, Frank, E. Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry. 2003; 160(1):112–117.CrossRefGoogle ScholarPubMed
64.Sachs, G, Printz, D, Kahn, D, Catpenter, D, Docherty, J. The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder. Postgrad Med. 2000;1:1–104.Google Scholar
65.Zarate, CA, Tohen, M. Bipolar disorder and comorbid axis I disorders: diagnosis and management. In: Yatham, LN, Kusumakar, V, Kutchet, SP. Treatment of Bipolar Disorder: A Clinicians Guide to Biological Treatments. New York, NY: Brunner Routledge; 2002;115–138.Google Scholar
66.Figueroa, M, Gehlsen, J, Hammond, D, et al.Combination chemotherapy in refractory immune thrombocytopenic purpura. N Eng J Med. 1993;328(17):1226–1229.CrossRefGoogle ScholarPubMed
67.Myers, LW, Phillips, JT. Polypharmacy in multiple sclerosis. Epilepsy Res. 1996;11(Suppl):181–195.Google Scholar
68.Carpenter, CC, Fischl, MA, Hammer, SM, et al.Antiretroviral therapy for HIV infection in 1997. Updated recommendations of the International AIDS Society-USA Panel. JAMA. 1997;277(24):1962–1969.Google Scholar
69.Konig, W, Rissom, R, Kalfoglu, G, Stein, A, Reimer, F. Long-term thetapy of affective disorders: monotherapy or polypharmacy? Pharmacopsychiatry. 1988;21(6):272–273.Google Scholar
70.Rosholm, JU, Hallas, J, Gram, LF. Concurrent use of more than one major psychotropic drug (polypsychopharmacy) in out-patients-a prescription database study. Br J Clin Pharmacol. 1994;37(6):533–538.Google Scholar
71.Nichol, MB, Stimmel, GL, Lange, SC. Factors predicting the use of multiple psychotropic medications. J Clin Psychiatry. 1995;56(2):60–66.Google Scholar
72.Frye, MA, Ketter, TA, Leverich, GS, et al.The increasing use of polypharma-cotherapy for refractory mood disorders: 22 years of study. J Clin Psychiatry. 2000;61(1):9–15.Google Scholar
73.Kupfer, DJ, Frank, E, Grochocinski, VJ, et al.Demographic and clinical characteristics of individuals in a bipolar disorder case registry. J Clin Psychiatry. 2002;63(2):120–125.Google Scholar
74.Centorrino, F, Goren, JL, Hennen, J, et al.Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. Am J Psychiatry. 2004;161(4):700–706.Google Scholar
75.Morselli, PL, Elgie, R. GAMIAN-europe/BEAM survey I-global analysis of a patient questionnaire circulated to 3450 members of 12 european advocacy groups operating in the field of mood disorders. Bipolar Disord. 2003;5(4):265–278.CrossRefGoogle ScholarPubMed
76.McIntyre, RS, Mancini, DA, Lin, P, Jordan, J. Treating bipolar disorder, evidence-based guidelines for family medicine. Can Fam Physician. 2004;50:388–394.Google Scholar
77.American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (Revision). Am J Psychiatry. 2002;159(4 Suppl):1–50.Google Scholar