Bipolarity spectrum

Bipolar disorders have been categorized into bipolar I disorder, bipolar II disorder, and bipolar disorder, not otherwise specified (NOS). Bipolar I disorder is characterized by one or more manic or mixed mood episodes. Bipolar II disorder is characterized by one or more major depressive episodes and at least one hypomanic episode. Hypomania is an abnormally and persistently elevated, expansive, or irritable mood, but not of sufficient severity to cause significant impairment in social or occupational function and does not require hospitalization. Most epidemiologic studies have looked at bipolar disorder of all types (bipolar I and bipolar II), or the bipolar spectrum, which includes all clinical conditions thought to be closely related to bipolar disorder. The lifetime prevalence of bipolar I disorder is estimated to be between 0.3% and 2.4%. The lifetime prevalence of bipolar II disorder ranges from 0.2% to 5%. When including the bipolar spectrum, the lifetime prevalence is between 3% and 6.5%.1... 

Evins AE. Efficacy of newer anticonvulsant medications in bipolar spectrum mood disorders. J Clin Psychiatry 2003 64(Supplement 8) 9-14. 

Adolescent bipolar disorder (BD) was described in the early twentieth century writings of Kraeplin, who noted a significant emergence of BD at puberty (Kraeplin, 1921). It is only within the past decade, however, that adolescent-onset BD has begun to receive significant research attention. Studies estimate the prevalence of bipolar spectrum disorders (e.g., bipolar I, bipolar II, bipolar not otherwise specified) as being 1% in adolescents (Lewinsohn et ah, 1995). In addition, it is estimated that 20%-40% of adults with BD experi-... 

There are several controlled trials of young outpatients with bipolar and bipolar spectrum conditions. Geller et al. (1998) studied 25 adolescents in a 6-week, doubleblind, placebo-controlled study. Twelve received lithium, of whom 4 had BP-I (presumably acute mania), 4 had BP-II (presumably hypomania), and 4 had major depression with bipolar predictors. All had concurrent substance abuse. There were no significant differences in outcome between active and placebo groups, except in... 

Chart reviews and open trials of outpatients with bipolar disorder and bipolar spectrum disorder have been published for 28 risperidone- and 23 olanzapine-treated treated children and adolescents (Frazier et ah, 1999 2001). Significant decreases in mania, depression, and aggression ratings occurred over the course of treatment however, other medications were also used simultaneously. Additional anecdotal information exists for olanzapine (Soutullo et ah, 1999 Chang and Ketter, 2000), quetiapine (Schaller and Behar, 1999), and clozapine (Fuchs, 1994). 

In outpatient samples with an assortment of bipolar and bipolar spectrum disorders, the frequency and magnitude of response are lower for all mood stabiliz-... 

Bipolar spectrum disorders are a serious group of conditions. Their onset in childhood or adolescence has the potential to exert a reactive impact on development, as well as on life in general. Accurate assessment of the bipolar symptoms and concomitant conditions is imperative to provide comprehensive treatment. Unfortunately, support for effective treatment in young people is limited, and to some extent, clinicians must proceed with treatment without the benefit of empirical support. 

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 ... 

Hollander E, Pallanti S, Allen A, Sood E, Baldini Rossi N. Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders Am J Psychiatry 2005 162 137-45. 

Deltito, J. A. 1993. The effect of valproate on bipolar spectrum temperamental disorders. Journal of Clinical Psychiatry 54 301-04. 

Hirschfeld RM. Bipolar spectrum disorder improving its recognition and diagnosis. J Clin Psychiatry 2001 62(Suppl 14) 5-9. 

I The treatment of bipolar disorder is relatively under-researched in relation to schizophrenia and depression, in particular the treatment of bipolar II disorder and bipolar spectrum disorders. 

In 60 patients in an 8-week, double-blind, randomized, placebo-controlled study of divalproex extended release in patients with bipolar spectrum disorders, there was nausea in 12 patients taking divalproex sodium and 7 taking placebo, sedation in 10 and 8, weight gain in six and one, abdominal pain in four and one, and abnormal dreams in four and none [313. Adverse reactions that caused withdrawal among those taking divalproex were thrombocytopenia, severe nausea, menstrual irregularity, and rash (one per patient). 

McElroy SL, Martens BE, Creech RS, Welge JA, Jefferson L, Guerdjikova AI, Keck PE Jr. Randomized, double-blind, placebo-controlled study of divalproex extended release loading monotherapy in ambulatory bipolar spectrum disorder patients with moderate-to-severe hypoma-nia or mild mania. J Clin Psychiatry 2010 71(5) 557-65. 

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