Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

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90 E. Vieta et al.have focused on the distinctions and similarities between bipolar I and bipolar IIdisorders, and to draw some conclusions about the validity of such a dichotomy.Is there a true dichotomy between bipolar I and bipolar II disorder?Epidemiologic studiesThere are similarities across countries in patterns of bipolar disorder (Weissmanet al., 1996). In regard to gender, bipolar I disorder occurs with equal frequency inboth men and women but bipolar II disorder may be more common in women(American Psychiatric Association, 1994).The prevalence rate of bipolar disorder depends on how it is defined; manyprevalence studies have required the presence of mania for a bipolar diagnosis tobe recorded. The lifetime prevalence rates of bipolar disorder have been settled in1.2% by Regier et al.(1988) and 1.6% by Kessler et al.(1994). Weissman and Myers(1978) found that bipolar I and bipolar II disorders each had a lifetime prevalenceof 0.6%, which combine to 1.2% for all bipolar patients. Schatzberg (1998)suggested that bipolar disorders appear in approximately 1.3% of the population,with a prevalence rate of 0.8% for bipolar I and 0.5% for bipolar II. From adimensional point of view (bipolar spectrum), this lifetime prevalence wouldincrease to at least 5% (Lewinsohn et al., 1995; Angst, 1998; Szádocky et al.,1998). The prevalence rate of the group of brief hypomania, characterized byshort episodes of 1–3 days’ duration, was 2.2% (Angst, 1995).Benazzi (1997) studied the prevalence of bipolar II disorder in a sample of majordepressive outpatients in a private setting. Hypomania was diagnosed according toDSM-IV criteria, but antidepressant-induced hypomania was not excluded. Theauthor found that 45% of patients attending a private clinic had bipolar IIdisorder. This rate is even higher than the 10–40% previously reported in clinicalsamples (Akiskal and Mallya, 1987; Bourgeois, 1996; Cassano et al., 1992).Age at onsetThe first onset of bipolar disorder usually occurs by the second or third decade oflife, although prepubertal and pubertal illness onset is no longer uncommon.McMahon et al.(1994) found that patients with affective disorder in both parentallines experienced an earlier onset. It seems that an earlier onset of illness might beassociated with greater case complexity, episode severity, and comorbidity (Sachsand Thase, 2000).The age of initiation of the disease seems to be higher in bipolar II patients(Gershon et al., 1982; Vieta et al., 1997a; Tondo et al., 1998); nevertheless, otherstudies did not find differences in age-at-onset distributions between bipolar I andbipolar II patients (Benazzi, 1999; Coryell et al., 1985; Egeland et al., 1987;
91 Bipolar I and bipolar II: a dichotomy?Table 4.1 Differential quantitative features between bipolar I and bipolar II disorder: mean standard deviationVariable Bipolar I Bipolar II t PAge 35.6 11.9 39.7 12.3 –1.25 NSPrevious episodes 6.3 4.2 12.6 7.5 –3.67 0.001Manic episodes 3.7 3.4 0 0 NAHypomanic episodes 3.2 3.7 7.0 5.4 –2.96 0.006Depressive episodes 2.6 2.2 5.6 4.1 –3.28 0.003Hospitalizations 3.0 3.3 1.0 1.2 3.43 0.001Age at onset 21.9 8.0 31.2 9.7 –4.01
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Bipolar DisordersMixed States, Rapi
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ContentsList of contributorsPreface
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ContributorsValadeta Ajdacic PhDPsy
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ixList of contributorsAlexia E. Kou
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PrefaceBipolar disorders have a lon
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2 A. Marneros and F. K. Goodwinold
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4 A. Marneros and F. K. GoodwinFig.
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6 A. Marneros and F. K. GoodwinThe
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26 A. Marneros and F. K. Goodwinbou
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30 A. Marneros and F. K. GoodwinTab
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32 A. Marneros and F. K. GoodwinBip
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38 A. Marneros and F. K. GoodwinAki
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Page 60 and 61: 46 G. Perugi and H. S. AkiskalTable
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Page 73 and 74: 59 Longitudinal perspective of mixe
Page 75 and 76: 3Rapid-cycling bipolar disorder1 2O
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Page 99 and 100: 85 Rapid-cycling bipolar disorderJo
Page 101 and 102: 87 Rapid-cycling bipolar disorderde
Page 103: 89 Bipolar I and bipolar II: a dich
Page 107 and 108: 93 Bipolar I and bipolar II: a dich
Page 115 and 116: 101 Bipolar I and bipolar II: a dic
Page 123 and 124: 5Recurrent brief depression as an i
Page 125 and 126: 111 Recurrent brief depressionRecur
Page 127 and 128: 113 Recurrent brief depressionbeen
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Page 131 and 132: 117 Recurrent brief depressionThere
Page 133 and 134: Chronic 4.8 18.2 9.1 10 NCRapid-cyc
Page 135 and 136: 121 Recurrent brief depressionTable
Page 137 and 138: 123 Recurrent brief depressionPreva
Page 139 and 140: 125 Recurrent brief depressionWe fo
Page 141 and 142: 127 Recurrent brief depressionREFER
Page 143 and 144: 129 Recurrent brief depressionMarne
Page 145 and 146: 6Atypical depression and its relati
Page 147 and 148: 133 Atypical depression and bipolar
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141 Atypical depression and bipolar
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7Agitated depression: spontaneous a
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159 Agitated depression: spontaneou
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8Schizoaffective mixed statesAndrea
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189 Schizoaffective mixed statescon
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191 Schizoaffective mixed stateswas
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193 Schizoaffective mixed statesUni
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195 Schizoaffective mixed statesTab
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197 Schizoaffective mixed statesday
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199 Schizoaffective mixed statesTot
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201 Schizoaffective mixed statesBip
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203 Schizoaffective mixed statesThe
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205 Schizoaffective mixed statesMar
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9Acute and transient psychotic diso
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209 Acute and transient psychotic d
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Table 9.10 (cont.)ATPD(n ¼ 39)Bipo
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Table 9.11 (cont.)Bipolar affective
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Table 9.14b Significant differences
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10Bipolar disorder in children and
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239 Bipolar disorder in children an
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Pellegrini et al. (1986) 16 23 (7-1
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253 Atypical features of bipolarity
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12Comorbidity in mixed states and r
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265 Comorbidity in mixed states and
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13Challenges in the genetics of bip
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279 Challenges in the genetics of b
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Table 13.1 Proportion of first-degr
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Table 13.3 Summary of recent bipola
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13q32 = 3.321q22 = 3.6Liu, C.et al.
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14Biological aspects of rapid cycli
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313 Rapid cycling and mixed statesa
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315 Rapid cycling and mixed statesa
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317 Rapid cycling and mixed statesi
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319 Rapid cycling and mixed statesC
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321 Rapid cycling and mixed statesJ
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323 Rapid cycling and mixed statesW
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325 The treatment of bipolar mixed
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16The use of atypical antipsychotic
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355 Use of atypical antipsychotic a
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17Investigational strategies: treat
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371 Investigational strategiesBIPOL
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373 Investigational strategiesinsta
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375 Investigational strategiesWhat
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377 Investigational strategiesTable
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379 Investigational strategiescateg
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381 Investigational strategiesTable
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383 Investigational strategies2. Th
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385 Investigational strategiesSachs
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387 Indexclinical course and outcom
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389 Indexdepressive mixed states 51
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391 IndexLange, J. 163learning disa
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393 Indexpsychopharmacological revo
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395 Indexmania, acute 334mixed stat
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Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

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