Bipolar disorder incidence

Murphy and Wetzel (45) concluded that the current estimate of 11 % to 15% lifetime risk of suicide in alcoholics was not tenable based on a more careful examination of the data, and was probably more in the range of 2% to 3.4%. This percentage is still in contrast with the approximate 1% annual incidence of suicide in the United States. Much of the increase, however, could be related to another Axis I diagnosis (e.g., bipolar disorder). 

Bipolar disorder (manic-depressive illness) represents one of the most dramatic presentations in all of medicine and simultaneously poses one of the more difficult therapeutic challenges. It is characterized by mania or hypomania, alternating irregularly or intermingling with episodes of depression however, a small group (approximately 1%) may only experience recurrent manic episodes (i.e., unipolar mania). The estimated risk of developing a bipolar disorder is 0.5% to 1%, and the incidence of new cases per year is in the range of 0.01 % for men and 0.01 % to 0.03% for women (1). Bipolar spectrum can be conceived of as a continuum of more to less severe clinical presentations ... 

We note that the incidence of depressive symptoms occurred in about 70% of these patients, again underscoring the frequent interplay between the two mood states in bipolar disorder. 

It appears that a number of complications await the recovering bipolar patient after an episode of mania. For example, Lucas et al. ( 44) reported on a retrospective linear discriminant analysis of 100 manic episodes (1981 to 1985) during the recovery phase and found that the incidence of subsequent depression was 30% in the first month. Many episodes were transient, however, and did not necessarily require treatment. This phenomenon could be successfully predicted in 81% of cases in which there is a premorbid history of cyclothymia with either a personal or a family history of depression. The highly significant association between family history and postmanic depression again supports the hypothesis of a genetic basis for bipolar disorder. 

Maintenance and prophylaxis with lithium, and perhaps other mood stabilizers, favorably alters the longitudinal course of a bipolar disorder. Thus, efforts to enhance long-term compliance are a necessary part of any overall strategy. The incidence of adverse or toxic events is relatively low, and close attention to the more clinically relevant consequences can usually prevent serious sequelae ( 198).An issue of critical importance for future research is the potential efficacy of alternative maintenance medication for those who fail to respond adequately to acute or long-term lithium therapy. 

Answers to these questions are just beginning to evolve (Tables 5—5 through 5 — 10). For example, the incidence of depression is about 5% of the population, whereas the incidence of bipolar disorder is about 1%. Thus, up to 15 million individuals are currently suffering from depression and another 2 to 3 million from bipolar disorders in the United States. Unfortunately, only about one-third of individuals with depression are in treatment, not only because of underrecognition by health care providers but also because individuals often conceive of their depression as a type of moral deficiency, which is shameful and should be hidden. Individuals often feel as if they could get better if they just pulled themselves up by the bootstraps ... 

When 22 men and 38 women who had taken lithium for at least a year (mean 6.9 years) for bipolar disorder were evaluated for adverse effects, hypothyroidism requiring thyroid supplementation was found in 16 (14 women and 2 men) 9 had a goiter (637). The area from which some of the patients came was known to have a high background incidence of thyroid dysfunction. 

Nasrallah HA, Brecher M, Paulsson B, Placebo-level incidence of extrapyramidal symptoms (EPS) with quetiapine in controlled studies of patients with bipolar mania. Bipolar Disord 2006 8(5 Pt l) 467-74,... 

Mania (affective disturbances) recently has been divided into two functional groups, bipolar and unipolar affective disorders. Bipolar disorders Include both manic and depressive episodes whereas unipolar disorders show only recurrent depressive episodes. Patients with bipolar disorders usually have an early onset of the Illness (20-35 years age) with high incidence of mania and suicide. Some evidence suggests that this condition is hereditary, transmitted through the X-chromosone. On the other hand, onset of unipolar disorders usually occurs at a later age (30-45) and hereditary association is less well defined. 

Bipolar disorder is frequently not recognized and treated for many years because of its fluemating course and episodic mood states. The onset of bipolar disorder is rare before puberty, but its incidence increases during late adolescence and into early adulthood (usually between the ages of 15 and 30). The average age of onset of a first manic episode is 21 for both men and women. The first episode in females is more likely to be a major depressive episode, whereas males are more likely to first experience a manic episode. ... 

Figure 5.1 As of 1995, only 0.6 percent of people had been diagnosed with bipolar disorder, as can be seen in this chart from the World Health Organization. The largest percentage of cases (0.48 percent) occurred in people aged 20-64. The incidence of bipolar depression was also slightly higher in the Americas, the Eastern Mediterranean, and the Western Pacific.

Psychiatric The incidence of suicide-related events in patients with schizophrenia or bipolar disorder taking aripiprazole has been studied using administrative data from three US sources [65 "]. Suicide attempts and death by suicide were assessed in patients aged at least 18 years. Among 20489 antipsychotic drug users (8985 patient-years), unadjusted suicide event rates per 1000 patient-years were 21 for aripiprazole 24 for olanzapine 32 for quetiapine 20 for risperidone and 49 for ziprasidone. Compared with current users of the other antipsychotic... 

The association between the use of antiepileptic drugs and suicide-related events (attempted suicide and completed suicide) in patients with epilepsy, depression, or bipolar disorder has been studied in 5130 795 patients [66 ]. The incidence of suicide-related events per 100 person-years was 15 among patients without epilepsy, depression, bipolar disorder, or antiepileptic drug treatment, 382 among patients with epilepsy who did not take antiepileptic drugs, and... 

Nervous system A study comparing somnolence with asenapine, olanzapine, risperidone and haloperidol relative to placebo evaluated 10 clinical trials of patients with schizophrenia or bipolar disorder [36 -]. The duration and incidence of somnolence was greatest for asenapine and olanzapine (maximal for olanzapine) and with shorter time to onset than the other antipsychotics and placebo patients with bipolar disorder were the most sensitive. 

Rasanen, P., Tiihonen, J., and Hakko, H. (1998) The incidence and onset-age of hospitalized bipolar affective disorder in Finland. J Affect Disord 48 63-68. 

Early reports found clozapine to benefit some affectively disordered patients (e.g., bipolar, schizoaffective) who had previously been treatment-refractory, but improved rapidly and significantly on this agent ( 108, 109, 278). Further, many patients were able to sustain their early gains in psychosocial functioning over a 3-5-year period. The low incidence of EPS and TD also increased interest in potentially new indications for these agents. 

Brune M. The incidence of akathisia in bipolar affective disorder treated with neuroleptics—a preliminary report. J Affect Disord 1999 53(2) 175-7. 

Risperidone has also been used in combination with topiramate in a Spanish multicenter study in 58 patients (28 men and 30 women mean age 41 years) with bipolar I disorder, with manic but not mixed episodes (20). Risperidone (mean dose 2.7 mg/day) and topiramate (mean dose 236 mg/day) were started with a maximum 48-hour time difference risperidone was used for acute manic symptoms and topiramate for longer-term stabilization and prevention of relapse. The incidence of any adverse event was 64%, mostly somnolence, paresthesia, dizziness, tremor, weight loss (n = 27 mean change -1.1 kg), extrapyramidal disorders, gastrointestinal effects, and cognitive disturbances. One patient developed tardive dyskinesia during the study and there were five dropouts because of adverse effects adverse effects that required withdrawal of risperidone but not topiramate were amenorrhea (n = 3) and sexual dysfunction (n = 1). 

In a prospective study, the incidence of rash was calculated in 237 patients who were taking lamotrigine for bipolar I disorder in Korea, of whom 30 developed a rash at a median time of onset of 16 days [162. In two cases the rash was serious, but none developed Stevens-Johnson sjmdrome or toxic epidermal necrolysis. 

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