Bipolar disorders

Abstract

Bipolar disorders are chronic and recurrent disorders that affect >1% of the global population. Bipolar disorders are leading causes of disability in young people as they can lead to cognitive and functional impairment and increased mortality, particularly from suicide and cardiovascular disease. Psychiatric and nonpsychiatric medical comorbidities are common in patients and might also contribute to increased mortality. Bipolar disorders are some of the most heritable psychiatric disorders, although a model with gene–environment interactions is believed to best explain the aetiology. Early and accurate diagnosis is difficult in clinical practice as the onset of bipolar disorder is commonly characterized by nonspecific symptoms, mood lability or a depressive episode, which can be similar in presentation to unipolar depression. Moreover, patients and their families do not always understand the significance of their symptoms, especially with hypomanic or manic symptoms. As specific biomarkers for bipolar disorders are not yet available, careful clinical assessment remains the cornerstone of diagnosis. The detection of hypomanic symptoms and longtudinal clinical assessment are crucial to differentiate a bipolar disorder from other conditions. Optimal early treatment of patients with evidence-based medication (typically mood stabilizers and antipsychotics) and psychosocial strategies is necessary.

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Figure 1: Main subtypes of bipolar disorder.
Figure 2: Multifactorial model of bipolar disorders.
Figure 3: Polarity index.
Figure 4: Sources of cognitive dysfunction.

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Acknowledgements

E.V. is grateful for the support received from the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness of Spain (PI 12/00912), integrated into the Plan Nacional de I+D+I and co-funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER); Centro para la Investigación Biomédica en Red de Salud Mental (CIBERSAM), Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2014_SGR 398), the Seventh European Framework Programme (ENBREC); and the Stanley Medical Research Institute. M.B. is supported by an Australian National Health and Medical Research Council Senior Principal Research Fellowship (GNT1059660) and has received grants from the US NIH, the Australian Cooperative Research Centre, the Simons Autism Foundation, the Cancer Council of Victoria, the Stanley Medical Research Foundation, the Medical Benefits Foundation, Beyond Blue, Rotary Health and the Geelong Medical Research Foundation. T.G.S. receives funding from Deutsche Forschungsgemeinschaft (DFG; SCHU 1603/5-1 and SCHU 1603/7-1), the German Federal Ministry of Education and Research (BMBF; 01ZX1314K, 01EE1404H and 01EE1404H), and the Dr Lisa Oehler Foundation (Germany). A.F.C. is supported by a research fellowship award from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; Brazil). T.S. has received grant funding from the Stanley Medical Research Institute and Palo Alto Health Sciences Services. J.R.C. has received federal funding from the US Department of Defense, the US Health Resources Services Administration and the US National Institute of Mental Health. K.G. has received grant support from the Brain and Behaviour Research Foundation and the Cleveland Foundation. K.W.M. is supported by the Lundbeck Foundation Fellowship (R21520154121). I.G. is supported by the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness of Spain (Juan Rodés Contract (JR15/00012) and a grant (PI16/00187)), integrated into the Plan Nacional de I+D+I and co-funded by ISCIII-Subdirección General de Evaluación and FEDER.

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Introduction (E.V.); Epidemiology (M.B.); Mechanisms/pathophysiology (T.G.S., A.F.C. and I.G.); Diagnosis, screening and prevention (T.S.); Management (J.R.C., K.G. and I.G.); Quality of life (K.W.M.); Outlook (E.V.); and Overview of Primer (E.V.).

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Correspondence to Eduard Vieta.

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Competing interests

E.V. has received grants and honoraria from AstraZeneca, Ferrer, Forest Research Institute, Gedeon Richter, GlaxoSmithKline, H. Lundbeck, Janssen, Otsuka, Pfizer, Sanofi-Aventis, Sunovion and Takeda. M.B. has received research grants from Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, the Meat and Livestock Board, Mayne Pharma, Novartis, Organon, Servier and Woolworths. M.B. has also acted as a speaker for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, H. Lundbeck, Janssen-Cilag, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth and has served as a consultant to AstraZeneca, Bioadvantex Pharma, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, H. Lundbeck, Janssen-Cilag, Merck and Servier. T.S. has received grant funding from Elan Pharma International, Merck and Sunovion and has received personal fees from AstraZeneca, CMEology, Global Medication Education, H. Lundbeck, Medscape Education, Merck and Sunovion, and has received royalties from Jones & Bartlett Learning and UpToDate. J.R.C. has received grant support from Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Cephalon (now Teva Pharmaceutical Industries), Dainippon Sumitomo Pharma, Eli Lilly, GlaxoSmithKline, H. Lundbeck, Intra-Cellular Therapies, Janssen, Pfizer, Sunovion and Takeda. J.R.C. has also served as a consultant, advisory board member and speaker for Abbott Laboratories, Allergan, AstraZeneca, Bristol-Myers Squibb, Cephalon (now Teva Pharmaceutical Industries), Dainippon Sumitomo Pharma, GlaxoSmithKline, H. Lundbeck, Janssen, Merck & Co., Otsuka, Pfizer, Repligen, Servier, Solvay, Sunovion and Takeda. K.G. has been on a speakers’ bureau and an advisory board of Sunovion and has received grant support from AstraZeneca. K.W.M. has received consultancy fees in the past 3 years from Allergan and H. Lundbeck. I.G. has consulted for Ferrer and has been a speaker for Ferrer and Janssen-Cilag. T.G.S. and A.F.C. declare no competing interests.

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Vieta, E., Berk, M., Schulze, T. et al. Bipolar disorders. Nat Rev Dis Primers 4, 18008 (2018). https://doi.org/10.1038/nrdp.2018.8

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