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Gender Differences in Clinical Characteristics and Comorbidities in Bipolar Disorder: a Study from South India

Abstract

The clinical features and course of bipolar disorder differ between women and men; however, studies are limited in Indian population. The objective of this study was to identify gender differences in patients with bipolar disorder. This was a cross-sectional, hospital-based observational study conducted over a period of 25 months. The sample consisted of 110 males and 90 females with a diagnosis of bipolar disorder according to ICD-10 Diagnostic Criteria for Research. Socio-demographic and clinical details were collected using semi-structured proforma. All patients were evaluated on Mini International Neuropsychiatric Interview Plus, Presumptive Stressful Life Events Scale and Clinical Global Impression. Sample consisted of 55% men and 45% women. The total number of episodes was similar between genders, however, the number of manic episodes (p = 0.004) was significantly more in males and the number of depressive (p = 0.003) and mixed episodes (p = 0.018) were significantly more in females. Majority of males had first episode of mania, whereas, first episode in females were mostly depressive (p < 0.001). Comorbid physical disorders were seen in 61.1% females and 40% males. Bipolar disorder subtype, episode types and number varied across gender. Co-morbid hypothyroidism, migraine, and obesity are seen more often in women and substance use was higher in men.

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References

  1. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lépine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen H, Yeh EK. Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996;276:293–9.

    CAS  PubMed  Article  Google Scholar 

  2. Liebenluft E. Issues in the treatment of women with bipolar illness. J Clin Psychiatry. 1997;58(Suppl 15):5–11.

    Google Scholar 

  3. Calabrese J, Woyshville M, Kimmel S, Rapport D. Predictors of valproate response in bipolar rapid cycling. J Clin Psychopharmacol. 1993;13:280–3.

    CAS  PubMed  Article  Google Scholar 

  4. Bauer M, Calabrese J, Dunner D, Post R, Whybrow PC, Gyulai L, Tay LK, Younkin SR, Bynum D, Lavori P. Multisite data reanalysis of the validity of rapid cycling as a course modifier for bipolar disorder in DSM-IV. Am J Psychiatry. 1994;151:506–15.

    CAS  PubMed  Article  Google Scholar 

  5. Coryell W, Endicott J, Keller M. Rapidly cycling affective disorder. Demographics, diagnosis, family history, and course. Arch Gen Psychiatry. 1992;49:126–31.

    CAS  PubMed  Article  Google Scholar 

  6. Leibenluft E. Women with bipolar illness: clinical and research issues. Am J Psychiatry. 1996;153:163–73.

    CAS  PubMed  Article  Google Scholar 

  7. Angst J. The course of affective disorders. II. Typology of bipolar manic-depressive illness. Arch Psychiatr Nervenkr. 1978;226:65–74.

    CAS  PubMed  Article  Google Scholar 

  8. Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB. Sex and depression in the National Comorbidity Survey I: lifetime prevalence, chronicity and recurrence. J Affect Disord. 1993;29:85–96.

    CAS  PubMed  Article  Google Scholar 

  9. Subramanian K, Sarkar S, Kattimani S. Bipolar disorder in Asia: illness course and contributing factors. Asian J Psychiatr. 2017;29:16–29.

    PubMed  Article  Google Scholar 

  10. Chatterjee S, Kulhara P. Symptom resolution and short term course in mania. Indian J Psychiatry. 1989;31:213–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Kawa I, Carter JD, Joyce PR, Doughty CJ, Frampton CM, Wells JE, et al. Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation. Bipolar Disord. 2005;7:119–25.

    PubMed  Article  Google Scholar 

  12. Arnold LM. Gender differences in bipolar disorder. Psychiatr Clin North Am. 2003;26:595–620.

    PubMed  Article  Google Scholar 

  13. Sylvia LG, Montana RE, Deckersbach T, Thase ME, Tohen M, Harrington NR, et al. Poor quality of life and functioning in bipolar disorder. Int J Bipolar Disord. 2017;5:10.

    PubMed  PubMed Central  Article  Google Scholar 

  14. Bhattacharya A, Khess CR, Munda SK, Bakhla AK, Praharaj SK, Kumar M. Sex difference in symptomatology of manic episode. Compr Psychiatry. 2011;52:288–92.

    PubMed  Article  Google Scholar 

  15. Kessing LV. Gender differences in the phenomenology of bipolar disorder. Bipolar Disord. 2004;6:421–5.

    PubMed  Article  Google Scholar 

  16. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.

    PubMed  Google Scholar 

  17. Denicoff KD, Leverich GS, Nolen WA, Rush AJ, McElroy SL, Keck PE, et al. Validation of the prospective NIMH-life-chart method (NIMH-LCM-p) for longitudinal assessment of bipolar illness. Psychol Med. 2000;30:1391–7.

    CAS  PubMed  Article  Google Scholar 

  18. Singh G, Kaur D, Kaur H. Presumptive stressful life events scale (PSLES) - a new stressful life events scale for use in India. Indian J Psychiatry. 1984;26:107–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Guy W. Clinical Global Impressions. ECDEU Assessment Manual for Psychopharmacology—Revised. Rockville: U.S. Department of Health, Education, and Welfare; Public Health Service, Alcohol; Drug Abuse, and Mental Health Administration; National Institute of Mental Health; Psychopharmacology Research Branch; Division of Extramural Research Programs; 1976. p. 218–22.

    Google Scholar 

  20. Inc SPSS. Released 2007. SPSS for windows, version 16.0. Chicago. SPSS Inc.

  21. Viguera AC, Tondo L, Baldessarini RJ. Sex differences in response to lithium treatment. Am J Psychiatry. 2000;157:1509–11.

    CAS  PubMed  Article  Google Scholar 

  22. Hendrick V, Altshuler LL, Gitlin MJ, Delrahim S, Hammen C. Gender and bipolar illness. J Clin Psychiatry. 2000;61:393–6.

    CAS  PubMed  Article  Google Scholar 

  23. Khess CR, Das J, Akhtar S. Four year follow-up of first episode manic patients. Indian J Psychiatry. 1997;39:160–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Chopra HD, Bhaskaran K, Verma IP. Socio-economic status and manic depressive psychosis. Indian J Psychiatry. 1970;12:40–7.

    Google Scholar 

  25. Mortensen PB, Pedersen CB, Melbye M, Mors O, Ewald H. Individual and familial risk factors for bipolar affective disorders in Denmark. Arch Gen Psychiatry. 2003;60:1209–15.

    PubMed  Article  Google Scholar 

  26. Sreedhar D, Kulkarni KR, Purty A, Muralidharan K, Janardhan Reddy YC, Jain S. Gender differences in the 5 years course of bipolar disorder after a first manic episode: a retrospective review. Indian J Psychol Med. 2017;39:712–3.

    PubMed  PubMed Central  Article  Google Scholar 

  27. Parial S. Bipolar disorder in women. Indian J Psychiatry. 2015;57:S252–63.

    PubMed  PubMed Central  Article  Google Scholar 

  28. Taschev T. The course and prognosis of depression on the basis of 652 patients deceased. In: Angst J, editor. Classification and prediction of outcome of depression. Stuttgart: Shattaner Verlag; 1973. p. 157–72.

    Google Scholar 

  29. Rybakowski J, Chlopocka-Wosniak M, Kapelski Z, Strzyzewski W. The relative prophylactic efficacy of lithium against manic and depressive recurrences in bipolar patients. Int Pharmacopsychiatry. 1980;15:86–90.

    CAS  PubMed  Article  Google Scholar 

  30. Roy-Byrne P, Post R, Uhde T, Porcu T, Davis D. The longitudinal course of recurrent affective illness: life chart data from research patients at NIMH. Acta Psychiatr Scand. 1985;317(Suppl):1–34.

    CAS  Article  Google Scholar 

  31. Suominen K, Mantere O, Valtonen H, Arvilommi P, Leppamaki S, Isometsa E. Gender differences in bipolar disorder type I and II. Acta Psychiatr Scand. 2009;120:464–73.

    CAS  PubMed  Article  Google Scholar 

  32. Benazzi F. Gender differences in bipolar II and unipolar depressed outpatients: a 557-case study. Ann Clin Psychiatry. 1999;11:55–9.

    CAS  PubMed  Article  Google Scholar 

  33. Szádóczky E, Papp Z, Vitrai J, Ríhmer Z, Füredi J. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. J Affect Disord. 1998;50:153–62.

    PubMed  Article  Google Scholar 

  34. Grant BF, Goldstein RB, Chou SP, Huang B, Stinson FS, Dawson DA, Saha TD, Smith SM, Pulay AJ, Pickering RP, Ruan WJ, Compton WM. Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the wave 2 National Epidemiologic Survey on alcohol and related conditions. Mol Psychiatry. 2009;14:1051–66.

    CAS  PubMed  Article  Google Scholar 

  35. McElroy SL, Arnold LM, Altshuler LL. Bipolarity in women: therapeutic. In: Akiskal HS, Tohen M, editors. Bipolar psychopharmacotherapy: caring for the patient. 1st ed. West Sussex: Wiley; 2006. p. 235–78.

    Chapter  Google Scholar 

  36. Viguera A, Baldessarini R, Tondo L. Response to lithium maintenance treatment in bipolar disorders: comparison of women and men. Bipolar Disord. 2001;3:245–52.

    CAS  PubMed  Article  Google Scholar 

  37. Tondo L, Baldessarini RJ, Hennen J, Floris G, Silvetti F, Tohen M. Lithium treatment and risk of suicidal behavior in bipolar disorder patients. J Clin Psychiatry. 1998;59:405–14.

    CAS  PubMed  Article  Google Scholar 

  38. Mahmood T, Romans S, Silverstone T. Prevalence of migraine in bipolar disorder. J Affect Disord. 1999;52:239–41.

    CAS  PubMed  Article  Google Scholar 

  39. Munoli RN, Praharaj SK, Sharma PS. Co-morbidity in bipolar disorder: a retrospective study. Indian J Psychol Med. 2014;36:270–5.

    PubMed  PubMed Central  Article  Google Scholar 

  40. Helzer J, Burnam A, McEvoy L. Alcohol abuse and dependence. In: Robins LN, Regier DA, editors. Psychiatric disorders in America. New York: Free; 1991. p. 81–129.

    Google Scholar 

  41. Saunders EF, Nazir R, Kamali M, Ryan KA, Evans S, Langenecker S, et al. Gender differences, clinical correlates, and longitudinal outcome of bipolar disorder with comorbid migraine. J Clin Psychiatry. 2014;75:512–9.

    PubMed  PubMed Central  Article  Google Scholar 

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The study was conceived by all the authors. The first author collected the data and second author wrote the first draft. The third author performed the statistical analysis. All the authors contributed to and approved the final manuscript.

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Correspondence to Samir Kumar Praharaj.

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Research Involving Human Participants and/or Animals

The study has been approved by Institutional Ethics Committee and is in according to the Declaration of Helsinki.

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Pillai, M., Munoli, R.N., Praharaj, S.K. et al. Gender Differences in Clinical Characteristics and Comorbidities in Bipolar Disorder: a Study from South India. Psychiatr Q 92, 693–702 (2021). https://doi.org/10.1007/s11126-020-09838-y

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Keywords

  • Bipolar disorder
  • Gender differences
  • Comorbidity