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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Cullen, B. et al. Prevalence and correlates of cognitive impairment in euthymic adults with bipolar disorder: A systematic review. J. Affect. Disord. 205, 165–181 (2016).
Goodwin, F. & Jamison, K. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. (Oxford Univ. Press, 2007).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5. (American Psychiatric Publishing, 2013).
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (DCR-10). (WHO, 1993).
Merikangas, K. R. et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch. Gen. Psychiatry 68, 241–251 (2011).
Blanco, C. et al. Epidemiology of DSM-5 bipolar I disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions — III. J. Psychiatr. Res. 84, 310–317 (2017).
Nivoli, A. M. A. et al. Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity. J. Affect. Disord. 133, 443–449 (2011).
Dagani, J. et al. Meta-analysis of the interval between the onset and management of bipolar disorder. Can. J. Psychiatry 62, 247–258 (2017).
Altamura, A. C. et al. Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur. Arch. Psychiatry Clin. Neurosci. 260, 385–391 (2010).
Vigo, D., Thornicroft, G. & Atun, R. Estimating the true global burden of mental illness. Lancet Psychiatry 3, 171–178 (2016).
Oldis, M. et al. Trajectory and predictors of quality of life in first episode psychotic mania. J. Affect. Disord. 195, 148–155 (2016).
Perlick, D. A., Rosenheck, R. R., Clarkin, J. F., Raue, P. & Sirey, J. Impact of family burden and patient symptom status on clinical outcome in bipolar affective disorder. J. Nerv. Ment. Dis. 189, 31–37 (2001).
Gardner, H. H. et al. The economic impact of bipolar disorder in an employed population from an employer perspective. J. Clin. Psychiatry 67, 1209–1218 (2006).
Macneil, C. A. et al. Psychological needs of adolescents in the early phase of bipolar disorder: implications for early intervention. Early Interv. Psychiatry 5, 100–107 (2011).
Merikangas, K. R. et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch. Gen. Psychiatry 64, 543–552 (2007).
Williams, L. J. et al. Bipolar disorder and adiposity: a study using whole body dual energy X-ray absorptiometry scans. Acta Neuropsychiatr. 23, 219–223 (2011).
Bortolato, B., Berk, M., Maes, M., McIntyre, R. S. & Carvalho, A. F. Fibromyalgia and bipolar disorder: emerging epidemiological associations and shared pathophysiology. Curr. Mol. Med. 16, 119–136 (2016).
Correll, C. U. et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 16, 163–180 (2017).
Vancampfort, D. et al. Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis. World Psychiatry 15, 166–174 (2016).
Roshanaei-Moghaddam, B. & Katon, W. Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatr. Serv. 60, 147–156 (2009).
McElroy, S. L. et al. Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder. Acta Psychiatr. Scand. 133, 144–153 (2016).
Dols, A. et al. The prevalence of late-life mania: a review. Bipolar Disord. 16, 113–118 (2014).
Gonda, X. et al. Suicidal behaviour in bipolar disorder: epidemiology, characteristics and major risk factors. J. Affect. Disord. 143, 16–26 (2012).
Schaffer, A. et al. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord. 17, 1–16 (2015).
Gibbons, R. D., Hur, K., Brown, C. H. & Mann, J. J. Relationship between antiepileptic drugs and suicide attempts in patients with bipolar disorder. Arch. Gen. Psychiatry 66, 1354–1360 (2009).
Mühleisen, T. W. et al. Genome-wide association study reveals two new risk loci for bipolar disorder. Nat. Commun. 5, 3339 (2014).
Lichtenstein, P. et al. Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234–239 (2009).
Forstner, A. J. et al. Genome-wide analysis implicates microRNAs and their target genes in the development of bipolar disorder. Transl Psychiatry 5, e678 (2015).
O’Dushlaine, C. et al. Psychiatric genome-wide association study analyses implicate neuronal, immune and histone pathways. Nat. Neurosci. 18, 199–209 (2015).
Berk, M., Bodemer, W., van Oudenhove, T. & Butkow, N. Dopamine increases platelet intracellular calcium in bipolar affective disorder and controls. Int. Clin. Psychopharmacol. 9, 291–293 (1994).
Malhotra, D. et al. High frequencies of de novo CNVs in bipolar disorder and schizophrenia. Neuron 72, 951–963 (2011).
Priebe, L. et al. Genome-wide survey implicates the influence of copy number variants (CNVs) in the development of early-onset bipolar disorder. Mol. Psychiatry 17, 421–432 (2012).
Green, E. K. et al. Copy number variation in bipolar disorder. Mol. Psychiatry 21, 89–93 (2016).
Budde, M. et al. Genetics of bipolar disorder [German]. Nervenarzt 88, 755–759 (2017).
Goes, F. S. Genetics of bipolar disorder: recent update and future directions. Psychiatr. Clin. North Am. 39, 139–155 (2016).
Budde, M., Degner, D., Brockmöller, J. & Schulze, T. G. Pharmacogenomic aspects of bipolar disorder: an update. Eur. Neuropsychopharmacol. 27, 599–609 (2017).
Hou, L. et al. Genetic variants associated with response to lithium treatment in bipolar disorder: a genome-wide association study. Lancet 387, 1085–1093 (2016). In this study, the International Consortium on Lithium Genetics identified 2 genetic regions that may be useful as biomarkers of lithium response in a sample of 2,563 patients collected by 22 participating sites.
International Consortium on Lithium Genetics (ConLi+Gen) et al. Association of polygenic score for schizophrenia and HLA antigen and inflammation genes with response to lithium in bipolar affective disorder: a genome-wide association study. JAMA Psychiatry 75, 65–74 (2018).
Chudal, R. et al. Perinatal factors and the risk of bipolar disorder in Finland. J. Affect. Disord. 155, 75–80 (2014).
Parboosing, R., Bao, Y., Shen, L., Schaefer, C. A. & Brown, A. S. Gestational influenza and bipolar disorder in adult offspring. JAMA Psychiatry 70, 677–685 (2013).
Talati, A. et al. Maternal smoking during pregnancy and bipolar disorder in offspring. Am. J. Psychiatry 170, 1178–1185 (2013).
Frans, E. M. et al. Advancing paternal age and bipolar disorder. Arch. Gen. Psychiatry 65, 1034–1040 (2008).
Bortolato, B. et al. Systematic assessment of environmental risk factors for bipolar disorder: an umbrella review of systematic reviews and meta-analyses. Bipolar Disord. 19, 84–96 (2017).
Jiménez, E. et al. Impact of childhood trauma on cognitive profile in bipolar disorder. Bipolar Disord. 19, 363–374 (2017).
Tohen, M., Greenfield, S. F., Weiss, R. D., Zarate, C. A. & Vagge, L. M. The effect of comorbid substance use disorders on the course of bipolar disorder: a review. Harv. Rev. Psychiatry 6, 133–141 (1998).
Pacchiarotti, I. et al. The International Society for Bipolar Disorders (ISBD) Task Force report on antidepressant use in bipolar disorders. Am. J. Psychiatry 170, 1249–1262 (2013). As the use of antidepressants in bipolar disorders is up for debate owing to limited data, the International Society for Bipolar Disorders states in this task force its view on the issue.
Bauer, M. S., Whybrow, P. C. & Winokur, A. Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism. Arch. Gen. Psychiatry 47, 427–432 (1990).
D’Mello, D. A., McNeil, J. A. & Msibi, B. Seasons and bipolar disorder. Ann. Clin. Psychiatry 7, 11–18 (1995).
Bauer, M. et al. Solar insolation in springtime influences age of onset of bipolar I disorder. Acta Psychiatr. Scand. 136, 571–582 (2017).
Vieta, E. et al. Enhanced corticotropin response to corticotropin-releasing hormone as a predictor of mania in euthymic bipolar patients. Psychol. Med. 29, 971–978 (1999).
Grande, I., Fries, G. R., Kunz, M. & Kapczinski, F. The role of BDNF as a mediator of neuroplasticity in bipolar disorder. Psychiatry Investig. 7, 243–250 (2010).
Grande, I. et al. Val66Met polymorphism and serum brain-derived neurotrophic factor in bipolar disorder: an open-label trial. Acta Psychiatr. Scand. 129, 393–400 (2014).
Konopaske, G. T., Lange, N., Coyle, J. T. & Benes, F. M. Prefrontal cortical dendritic spine pathology in schizophrenia and bipolar disorder. JAMA Psychiatry 71, 1323–1331 (2014). This article provides some of the first evidence of dendritic spine loss in post-mortem human brain tissue in patients diagnosed with bipolar disorders.
Berk, M. et al. Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci. Biobehav. Rev. 35, 804–817 (2011).
Mertens, J. et al. Differential responses to lithium in hyperexcitable neurons from patients with bipolar disorder. Nature 527, 95–99 (2015).
Salagre, E., Vieta, E. & Grande, I. The visceral brain: bipolar disorder and microbiota. Rev. Psiquiatr. Salud Ment. 10, 67–69 (2017).
Slyepchenko, A. et al. Gut microbiota, bacterial translocation, and interactions with diet: pathophysiological links between major depressive disorder and non-communicable medical comorbidities. Psychother. Psychosom. 86, 31–46 (2016).
Kraepelin, E. Manic-Depressive Insanity and Paranoia (E. & S. Livingstone, 1921).
Berk, M. Neuroprogression: pathways to progressive brain changes in bipolar disorder. Int. J. Neuropsychopharmacol. 12, 441–445 (2009).
Passos, I. C., Mwangi, B., Vieta, E., Berk, M. & Kapczinski, F. Areas of controversy in neuroprogression in bipolar disorder. Acta Psychiatr. Scand. 134, 91–103 (2016).
Post, R. M. Kindling and sensitization as models for affective episode recurrence, cyclicity, and tolerance phenomena. Neurosci. Biobehav. Rev. 31, 858–873 (2007).
Grande, I., Magalhães, P. V., Kunz, M., Vieta, E. & Kapczinski, F. Mediators of allostasis and systemic toxicity in bipolar disorder. Physiol. Behav. 106, 46–50 (2012).
Hibar, D. P. et al. Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group. Mol. Psychiatryhttps://doi.org/10.1038/mp.2017.73 (2017). In this study, the ENIGMA international consortium in neuroimaging reveals brain regions that may be affected in patients with bipolar disorders and clinical factors that are related to reduced cortical surface in this condition.
Cao, B. et al. Hippocampal volume and verbal memory performance in late-stage bipolar disorder. J. Psychiatr. Res. 73, 102–107 (2016).
Grande, I. et al. Staging bipolar disorder: clinical, biochemical, and functional correlates. Acta Psychiatr. Scand. 129, 437–444 (2014).
Berk, M. et al. Staging in bipolar disorder: from theoretical framework to clinical utility. World Psychiatry 16, 236–244 (2017). The authors of this article discuss the cutting-edge knowledge on the classification of staging in bipolar disorders and its clinical conveniences.
Angst, J. & Marneros, A. Bipolarity from ancient to modern times: conception, birth and rebirth. J. Affect. Disord. 67, 3–19.] (2001).
Regier, D. A. et al. DSM-5 field trials in the United States and Canada, part II: test-retest reliability of selected categorical diagnoses. Am. J. Psychiatry 170, 59–70 (2013).
Freedman, R. et al. The initial field trials of DSM-5: new blooms and old thorns. Am. J. Psychiatry 170, 1–5 (2013).
Judd, L. L. et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch. Gen. Psychiatry 59, 530–537 (2002).
Coryell, W. et al. Long-term stability of polarity distinctions in the affective disorders. Am. J. Psychiatry 152, 385–390 (1995).
Vieta, E. & Suppes, T. Bipolar II disorder: arguments for and against a distinct diagnostic entity. Bipolar Disord. 10, 163–178 (2008).
Judd, L. L. et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch. Gen. Psychiatry 60, 261–269 (2003).
Hantouche, E. G. et al. Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP). J. Affect. Disord. 50, 163–173 (1998).
American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision. (American Psychiatric Press, 2000).
Solé, E., Garriga, M., Valentí, M. & Vieta, E. Mixed features in bipolar disorder. CNS Spectr 22, 134–140 (2017).
Koukopoulos, A. & Sani, G. DSM-5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatr. Scand. 129, 4–16 (2014).
Angst, J. et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch. Gen. Psychiatry 68, 791–798 (2011). In this article, Angst and colleagues propose new criteria to define hypomanic and manic episodes. The bipolar-specifier criteria in comparison with the DSM-IV-Text Revision criteria identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria.
Morris, G. et al. A model of the mitochondrial basis of bipolar disorder. Neurosci. Biobehav. Rev. 74, 1–20 (2017).
Denicoff, K. D. et al. Validation of the prospective NIMH-Life-Chart Method (NIMH-LCM-p) for longitudinal assessment of bipolar illness. Psychol. Med. 30, 1391–1397 (2000).
Young, R. C., Biggs, J. T., Ziegler, V. E. & Meyer, D. A. A rating scale for mania: reliability, validity and sensitivity. Br. J. Psychiatry 133, 429–435 (1978).
Angst, J. et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J. Affect. Disord. 88, 217–233 (2005).
Carvalho, A. F. et al. Screening for bipolar spectrum disorders: A comprehensive meta-analysis of accuracy studies. J. Affect. Disord. 172, 337–346 (2015).
Dodd, S. et al. Reliability of the Mood Disorder Questionnaire: comparison with the Structured Clinical Interview for the DSM-IV-TR in a population sample. Aust. N. Z. J. Psychiatry 43, 526–530 (2009).
McIntyre, R. S. et al. The prevalence and illness characteristics of DSM-5-defined “mixed feature specifier” in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project. J. Affect. Disord. 172, 259–264 (2015).
Rush, A. J. et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol. Psychiatry 54, 573–583 (2003).
Hamilton, M. A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 23, 56–62 (1960).
Vieta, E. & Morilla, I. Early group psychoeducation for bipolar disorder. Lancet Psychiatry 3, 1000–1001 (2016).
Yatham, L. et al. Canadian Network for Mood and Anxiety Treatments (CANMAT)/ International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. (in the press).
Fountoulakis, K. N. et al. The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for Bipolar disorder in adults, part 3: the clinical guidelines. Int. J. Neuropsychopharmacol. 20, 180–195 (2016).
Goodwin, G. et al. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J. Psychopharmacol. 30, 495–553 (2016).
Grande, I. et al. Patterns of pharmacological maintenance treatment in a community mental health services bipolar disorder cohort study (SIN-DEPRES). Int. J. Neuropsychopharmacol. 16, 513–523 (2013).
Gao, K. et al. Efficacy and safety of quetiapine-XR as monotherapy or adjunctive therapy to a mood stabilizer in acute bipolar depression with generalized anxiety disorder and other comorbidities. J. Clin. Psychiatry 75, 1062–1068 (2014).
Wu, R. et al. Communication of potential benefits and harm to patients and payers in psychiatry: a review and commentary. Clin. Ther. 33, B62–B76 (2011).
Cipriani, A. et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 378, 1306–1315 (2011). This article presents one of the first network meta-analyses on the treatment of bipolar disorders, in this case focused on the treatment of acute mania. Overall, antipsychotic drugs were significantly more effective than mood stabilizers.
Yildiz, A., Nikodem, M., Vieta, E., Correll, C. U. & Baldessarini, R. J. A network meta-analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania. Psychol. Med. 45, 1–19 (2014).
Fang, F., Wang, Z., Wu, R., Calabrese, J. R. & Gao, K. Is there a ‘weight neutral’ second-generation antipsychotic for bipolar disorder? Expert Rev. Neurother 17, 407–418 (2017).
Welten, C. C. M. et al. Early nonresponse in the antipsychotic treatment of acute mania: a criterion for reconsidering treatment? Results from an individual patient data meta-analysis. J. Clin. Psychiatry 77, e1117–e1123 (2016).
Grande, I. & Vieta, E. Pharmacotherapy of acute mania: monotherapy or combination therapy with mood stabilizers and antipsychotics? CNS Drugs 29, 221–227 (2015).
Geller, B. et al. A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. Arch. Gen. Psychiatry 69, 515–528 (2012).
Medda, P., Toni, C. & Perugi, G. The mood-stabilizing effects of electroconvulsive therapy. J. ECT 30, 275–282 (2014).
Praharaj, S. K., Ram, D. & Arora, M. Efficacy of high frequency (rapid) suprathreshold repetitive transcranial magnetic stimulation of right prefrontal cortex in bipolar mania: a randomized sham controlled study. J. Affect. Disord. 117, 146–150 (2009).
Pathak, V., Sinha, V. K. & Praharaj, S. K. Efficacy of adjunctive high frequency repetitive transcranial magnetic stimulation of right prefrontal cortex in adolescent mania: a randomized sham-controlled study. Clin. Psychopharmacol. Neurosci. 13, 245–249 (2015).
Henriksen, T. E. et al. Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial. Bipolar Disord. 18, 221–232 (2016).
Ye, B.-Y. et al. Effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated meta-analysis with randomized controlled trials. Psychiatry Clin. Neurosci. 70, 351–361 (2016).
Wang, Z. et al. Comparisons of the tolerability and sensitivity of quetiapine-XR in the acute treatment of schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and generalized anxiety disorder. Int. J. Neuropsychopharmacol. 14, 131–142 (2011).
Gao, K., Fang, F., Wang, Z. & Calabrese, J. R. Subjective versus objective weight gain during acute treatment with second-generation antipsychotics in schizophrenia and bipolar disorder. J. Clin. Psychopharmacol. 36, 637–642 (2016).
Grande, I., Berk, M., Birmaher, B. & Vieta, E. Bipolar disorder. Lancet 387, 1561–1572 (2016).
Geddes, J. R. et al. Comparative evaluation of quetiapine plus lamotrigine combination versus quetiapine monotherapy (and folic acid versus placebo) in bipolar depression (CEQUEL): a 2 × 2 factorial randomised trial. Lancet Psychiatry 3, 31–39 (2016).
DelBello, M. P. et al. Efficacy and safety of lurasidone in children and adolescents with bipolar I depression: a double-blind, placebo-controlled study. J. Am. Acad. Child Adolesc. Psychiatry 56, 1015–1025 (2017).
Rosenblat, J. D. et al. Anti-inflammatory agents in the treatment of bipolar depression: a systematic review and meta-analysis. Bipolar Disord. 18, 89–101 (2016).
Sidor, M. M. & MacQueen, G. M. Antidepressants for the acute treatment of bipolar depression. J. Clin. Psychiatry 72, 156–167 (2011).
McGirr, A., Vöhringer, P. A., Ghaemi, S. N., Lam, R. W. & Yatham, L. N. Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials. Lancet Psychiatry 3, 1138–1146 (2016). This article presents a meta-analysis of the effects of adjunctive second-generation antidepressants on mood stabilizers or atypical antipsychotic treatments. The authors find a small benefit in the reduction of depressive symptoms in the short term but an increased risk of treatment-emergent mania or hypomania in the long term.
Vieta, E. & Garriga, M. Adjunctive antidepressants in bipolar depression. Lancet Psychiatry 3, 1095–1096 (2016).
Yatham, L. N. et al. Agomelatine or placebo as adjunctive therapy to a mood stabiliser in bipolar I depression: randomised double-blind placebo-controlled trial. Br. J. Psychiatry 208, 78–86 (2016).
Dierckx, B., Heijnen, W. T., van den Broek, W. W. & Birkenhäger, T. K. Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis. Bipolar Disord. 14, 146–150 (2012).
Schoeyen, H. K. et al. Treatment-resistant bipolar depression: a randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment. Am. J. Psychiatry 172, 41–51 (2015). Despite the evidence of the effectiveness of ECT in unipolar depression, clinical experience was virtually the only evidence in bipolar disorders until this study came out.
Salcedo, S. et al. Empirically supported psychosocial interventions for bipolar disorder: current state of the research. J. Affect. Disord. 201, 203–214 (2016).
Miziou, S. et al. Psychosocial treatment and interventions for bipolar disorder: a systematic review. Ann. Gen. Psychiatry 14, 19 (2015).
Fristad, M. A. & MacPherson, H. A. Evidence-based psychosocial treatments for child and adolescent bipolar spectrum disorders. J. Clin. Child Adolesc. Psychol. 43, 339–355 (2014).
Saunders, E. F. H., Fernandez-Mendoza, J., Kamali, M., Assari, S. & McInnis, M. G. The effect of poor sleep quality on mood outcome differs between men and women: a longitudinal study of bipolar disorder. J. Affect. Disord. 180, 90–96 (2015).
Geddes, J. R. & Miklowitz, D. J. Treatment of bipolar disorder. Lancet 381, 1672–1682 (2013).
Vieta, E. et al. Clinical management and burden of bipolar disorder: results from a multinational longitudinal study (WAVE-bd). Int. J. Neuropsychopharmacol. 16, 1719–1732 (2013). This multinational, multicentre, observational cohort study describes common clinical management and clinical outcomes related to bipolar disorders in real-life settings in contrast to published randomized clinical trials with strict inclusion and exclusion criteria.
Miura, T. et al. Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: a systematic review and network meta-analysis. Lancet Psychiatry 1, 351–359 (2014).
Geddes, J. R. et al. Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet 375, 385–395 (2010).
Nierenberg, A. A. et al. Lithium Treatment Moderate-Dose Use Study (LiTMUS) for Bipolar Disorder: a randomized comparative effectiveness trial of optimized personalized treatment with and without lithium. Am. J. Psychiatry 170, 102–110 (2013).
Shine, B., McKnight, R. F., Leaver, L. & Geddes, J. R. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. Lancet 386, 461–468 (2015).
Vieta, E. et al. Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials. Int. J. Neuropsychopharmacol. 14, 1029–1049 (2011).
Nierenberg, A. A. et al. Bipolar CHOICE (Clinical Health Outcomes Initiative in Comparative Effectiveness): a pragmatic 6-month trial of lithium versus quetiapine for bipolar disorder. J. Clin. Psychiatry 77, 90–99 (2016).
Calabrese, J. R. et al. Mood state at study entry as predictor of the polarity of relapse in bipolar disorder. Biol. Psychiatry 56, 957–963 (2004).
Colom, F., Vieta, E., Daban, C., Pacchiarotti, I. & Sánchez-Moreno, J. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J. Affect. Disord. 93, 13–17 (2006).
Grande, I. et al. Clinical factors leading to lamotrigine prescription in bipolar outpatients: subanalysis of the SIN-DEPRES study. J. Affect. Disord. 143, 102–108 (2012).
Baldessarini, R. J. et al. Predominant recurrence polarity among 928 adult international bipolar I disorder patients. Acta Psychiatr. Scand. 125, 293–302 (2012).
Colom, F. et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch. Gen. Psychiatry 60, 402–407 (2003).
Colom, F. et al. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br. J. Psychiatry 194, 260–265 (2009).
Scott, J. et al. Cognitive-behavioural therapy for bipolar disorder. Br. J. Psychiatry J. Ment. Sci. 188, 488–489 (2006).
Frank, E., Kupfer, D. J., Wagner, E. F., McEachran, A. B. & Cornes, C. Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression. Contributing factors. Arch. Gen. Psychiatry 48, 1053–1059 (1991).
Miklowitz, D. J. et al. Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial. Arch. Gen. Psychiatry 65, 1053–1061 (2008).
Torrent, C. et al. Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am. J. Psychiatry 170, 852–859 (2013). This article presents a randomized controlled study performed in ten centres and demonstrates the efficacy of functional remediation, an ecological intervention, in improving the functional outcome of euthymic patients with bipolar disorders with global psychosocial functional impairment.
Solé, B. et al. Functional remediation for patients with bipolar II disorder: improvement of functioning and subsyndromal symptoms. Eur. Neuropsychopharmacol. 25, 257–264 (2015).
Bonnin, C. M. et al. Functional remediation in bipolar disorder: 1-year follow-up of neurocognitive and functional outcome. Br. J. Psychiatry 208, 87–93 (2016).
Hidalgo-Mazzei, D. et al. Internet-based psychological interventions for bipolar disorder: review of the present and insights into the future. J. Affect. Disord. 188, 1–13 (2015).
Popovic, D. et al. Polarity index of psychological interventions in maintenance treatment of bipolar disorder. Psychother. Psychosom. 82, 292–298 (2013).
Michalak, E. E., Murray, G., Young, A. H. & Lam, R. W. Burden of bipolar depression: impact of disorder and medications on quality of life. CNS Drugs 22, 389–406 (2008).
Vieta, E., Sánchez-Moreno, J., Lahuerta, J., Zaragoza, S. & EDHIPO Group (Hypomania Detection Study Group). Subsyndromal depressive symptoms in patients with bipolar and unipolar disorder during clinical remission. J. Affect. Disord. 107, 169–174 (2008).
Nabavi, B., Mitchell, A. J. & Nutt, D. A. Lifetime prevalence of comorbidity between bipolar affective disorder and anxiety disorders: a meta-analysis of 52 interview-based studies of psychiatric population. EBioMedicine 2, 1405–1419 (2015).
[No authors listed.] The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc. Sci. Med. 41, 1403–1409 (1995).
Vieta, E. & Torrent, C. Functional remediation: the pathway from remission to recovery in bipolar disorder. World Psychiatry 15, 288–289 (2016).
Marwaha, S., Durrani, A. & Singh, S. Employment outcomes in people with bipolar disorder: a systematic review. Acta Psychiatr. Scand. 128, 179–193 (2013).
Träger, C. et al. Influences of patient informed cognitive complaints on activities of daily living in patients with bipolar disorder. An exploratory cross-sectional study. Psychiatry Res. 249, 268–274 (2017).
Grande, I. et al. Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data). Acta Psychiatr. Scand. 127, 403–411 (2013).
Suppes, T. et al. The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. J. Affect. Disord. 67, 45–59 (2001).
Inder, M. L. et al. “I actually don't know who I am”: the impact of bipolar disorder on the development of self. Psychiatry 71, 123–133 (2008).
Martinez-Aran, A. et al. Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord. 9, 103–113 (2007).
Jensen, J. H., Knorr, U., Vinberg, M., Kessing, L. V. & Miskowiak, K. W. Discrete neurocognitive subgroups in fully or partially remitted bipolar disorder: Associations with functional abilities. J. Affect. Disord. 205, 378–386 (2016).
Solé, B. et al. Cognitive variability in bipolar II disorder: who is cognitively impaired and who is preserved. Bipolar Disord. 18, 288–299 (2016).
Tse, S., Chan, S., Ng, K. L. & Yatham, L. N. Meta-analysis of predictors of favorable employment outcomes among individuals with bipolar disorder. Bipolar Disord. 16, 217–229 (2014).
Daglas, R. et al. A single-blind, randomised controlled trial on the effects of lithium and quetiapine monotherapy on the trajectory of cognitive functioning in first episode mania: a 12-month follow-up study. Eur. Psychiatry 31, 20–28 (2016).
Rapado-Castro, M. et al. Cognitive effects of adjunctive N-acetyl cysteine in psychosis. Psychol. Med. 47, 866–876 (2017).
Miskowiak, K. W., Carvalho, A. F., Vieta, E. & Kessing, L. V. Cognitive enhancement treatments for bipolar disorder: a systematic review and methodological recommendations. Eur. Neuropsychopharmacol. 26, 1541–1561 (2016).
Yatham, L. N. et al. Lurasidone versus treatment as usual for cognitive impairment in euthymic patients with bipolar I disorder: a randomised, open-label, pilot study. Lancet Psychiatry 4, 208–217 (2017).
Moreno, C. et al. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch. Gen. Psychiatry 64, 1032–1039 (2007).
Vieta, E. et al. Early intervention in bipolar disorder. Am. J. Psychiatryhttps://doi.org/10.1176/appi.ajp.2017.17090972 (2018). This paper is a review of the controversial topic of the management of early stages in bipolar disorders.
Bastiampillai, T., Gupta, A., Allison, S. & Chan, S. K. W. NICE guidance: why not clozapine for treatment-refractory bipolar disorder? Lancet Psychiatry 3, 502–503 (2016).
Bonnin, C. M. et al. Effects of functional remediation on neurocognitively impaired bipolar patients: enhancement of verbal memory. Psychol. Med. 46, 291–301 (2016).
Vieta, E. Personalised medicine applied to mental health: precision psychiatry. Rev. Psiquiatr. Salud Ment. 8, 117–118 (2015).
Fernandes, B. S. et al. The new field of ‘precision psychiatry’. BMC Med. 15, 80 (2017).
Vieta, E. The bipolar maze: a roadmap through translational psychopathology. Acta Psychiatr. Scand. 129, 323–327 (2014).
Vieta, E. DSM-5.1. Acta Psychiatr. Scand. 134, 187–188 (2016).
Ghasemi, M., Phillips, C., Fahimi, A., McNerney, M. W. & Salehi, A. Mechanisms of action and clinical efficacy of NMDA receptor modulators in mood disorders. Neurosci. Biobehav. Rev. 80, 555–572 (2017).
Sampaio-Junior, B. et al. Efficacy and safety of transcranial direct current stimulation as an add-on treatment for bipolar depression: a randomized clinical trial. JAMA Psychiatryhttps://doi.org/10.1001/jamapsychiatry.2017.4040 (2017).
Swann, A. C. et al. Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. Am. J. Psychiatry 170, 31–42 (2013).
Popovic, D. et al. Polarity index of pharmacological agents used for maintenance treatment of bipolar disorder. Eur. Neuropsychopharmacol. 22, 339–346 (2012). This study presents the concept of the polarity index, which measures how antidepressant versus antimanic a drug is in bipolar disorder prophylaxis.
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.
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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