The Age of Onset of Bipolar Disorders

  • Jessica Dagani
  • Ross J. Baldessarini
  • Giulia Signorini
  • Olav Nielssen
  • Giovanni de GirolamoEmail author
  • Matthew Large


Objective: To carry out a systematic review and meta-analysis of age of onset (AoO) of bipolar disorder (BD).

Method: We followed PRISMA guidelines to gather and analyse findings from systematic searches of the PubMed, Web of Science, and Psychology and Behavioral Sciences Collection electronic literature databases. Pooled estimates of the AoO of BD were calculated by random-effects meta-analytic modelling and tested for influences of selected factor by subgroup and meta-regression analyses.

Results: Of the 8,735 initially identified reports, 264 with a total of 65,565 BD patients met inclusion criteria. Pooled AoO was 25.3 years (CI, 24.4–26.2) with high inter-study heterogeneity (95% prediction interval, 11.1–39.5 years). Between countries, AoO estimates ranged from 19.9 years in Hungary to 45.0 years in Croatia. We found a trend towards a younger AoO among people with a positive family history of mood disorder. Factors not found to be associated with reported AoO included current age, sex, publication year, method of estimating AoO, and polarity of first lifetime mood episode. In addition, AoO did not differ between BD-I and BD-II, even with both diagnoses evaluated under matched conditions.

Conclusions: Most patients diagnosed with BD had an onset age between 15 and 35 years, with a pooled mean of 25 years. AoO differed widely among countries. Family history of mood disorder was not associated with younger AoO, although there was a trend towards significance. In contrast to findings of previous individual studies, BD-I diagnosis was not associated with younger AoO. Explaining marked differences in AoO of BD between individual studies and regions requires further research.



Supported in part by a grant from the Bruce J. Anderson Foundation and by the McLean Private Donors Psychiatry Research Fund (to RJB). We are grateful to Drs. Clarissa Ferrari, Moira Marizzoni, Fabiana Faustini, Giulia Oliosi, and Sabina Moro for valuable contributions to the preparation of the manuscript.

Disclosures: No author or immediate family member has financial relationships with commercial organizations that might appear to represent conflicts of interest with the material presented here.


  1. Aghanwa HS. Recurrent unipolar mania in a psychiatric hospital setting in the Fiji Islands. Psychopathology. 2001;34:312–7.PubMedCrossRefGoogle Scholar
  2. Akdeniz F, Vahip S, Pirildar S, et al. Risk factors associated with childbearing-related episodes in women with bipolar disorder. Psychopathology. 2003;36:234–8.PubMedCrossRefGoogle Scholar
  3. Akiskal HS, Walker P, Puzantian VR, et al. Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. J Affect Disord. 1983;5:115–28.PubMedPubMedCentralCrossRefGoogle Scholar
  4. Aldana LL, Miguel PS, Lopez MR, et al. Bipolar patients in community mental health centers and specialized units. Could they be pooled? Rev Psiquiatr Salud Ment. 2009;2:128–32.PubMedCrossRefGoogle Scholar
  5. Altamura AC, Dell’Osso B, Berlin HA, et al. Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci. 2010;260:385–91.PubMedCrossRefGoogle Scholar
  6. Altindag A, Yanik M, Nebioglu M. Comorbid personality disorders in subjects with bipolar I disorder. Int J Psychiatry Clin Pract. 2006;10:33–7.PubMedCrossRefGoogle Scholar
  7. Altshuler LL, Curran JG, Hauser P, et al. T2 hyperintensities in bipolar disorder: magnetic resonance imaging comparison and literature meta-analysis. Am J Psychiatry. 1995;152:1139–44.PubMedCrossRefGoogle Scholar
  8. Ancın I, Santos JL, Teijeira C, et al. Sustained attention as a potential endophenotype for bipolar disorder. Acta Psychiatr Scand. 2010;122:235–45.PubMedCrossRefGoogle Scholar
  9. Andersson S, Barder HE, Hellvin T, et al. Neuropsychological and electrophysiological indices of neurocognitive dysfunction in bipolar II disorder. Bipolar Disord. 2008;10:888–99.PubMedCrossRefGoogle Scholar
  10. Andreazza AC, Kapczinski F, Kauer-Sant’Anna M, et al. 3-Nitrotyrosine and glutathione antioxidant system in patients in the early and late stages of bipolar disorder. J Psychiatry Neurosci. 2009;34:263–71.PubMedPubMedCentralGoogle Scholar
  11. Arai M, Obata N, Kockelkorn TT, et al. Lack of association between polymorphisms in the 5' upstream region of the DISC1 gene and mood disorders. Psychiatr Genet. 2007;17:357.PubMedCrossRefGoogle Scholar
  12. Arnold LM. Gender differences in bipolar disorder. Psychiatr Clin North Am. 2003;26:595–620.PubMedCrossRefGoogle Scholar
  13. Atkinson M, Zibin S, Chuang H. Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology. Am J Psychiatry. 1997;154:99–105.PubMedCrossRefGoogle Scholar
  14. Atmaca M, Yildirim H, Ozdemir H, et al. Hippocampal 1H MRS in first-episode bipolar I patients. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:1235–9.PubMedCrossRefGoogle Scholar
  15. Azorin JM, Kaladjian A, Adida M, et al. Factors associated with rapid cycling in bipolar I manic patients: findings from a French national study. CNS Spectr. 2008;13:780–7.PubMedCrossRefGoogle Scholar
  16. Baethge C, Smolka MN, Gruschka P, et al. Does prophylaxis-delay in bipolar disorder influence outcome? Results from a long-term study of 147 patients. Acta Psychiatr Scand. 2003a;107:260–7.PubMedCrossRefGoogle Scholar
  17. Baethge C, Tondo L, Bratti IM, et al. Prophylaxis latency and outcome in bipolar disorders. Can J Psychiatry. 2003b;48:449–57.PubMedCrossRefGoogle Scholar
  18. Baethge C, Tondo L, Baldessarini RJ. Methodological considerations in a review of effects of earlier treatment of bipolar disorder. Int J Bipolar Disord. 2017;5:12–4.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Baldessarini RJ. Chemotherapy in Psychiatry. 3rd ed. New York: Springer Press; 2013.CrossRefGoogle Scholar
  20. Baldessarini RJ, Tondo L, Hennen J, et al. Latency and episodes before treatment: response to lithium maintenance in bipolar I and II disorders. Bipolar Disord. 1999;1:91–7.PubMedCrossRefGoogle Scholar
  21. Baldessarini RJ, Bolzani L, Cruz N, et al. Onset-age of bipolar disorders at six international sites. J Affect Disord. 2010;121:143–6.PubMedCrossRefGoogle Scholar
  22. Baldessarini RJ, Salvatore P, Khalsa HK, et al. Episode cycles with increasing recurrences in first-episode bipolar-I disorder patients. J Affect Disord. 2012a;136:149–54.PubMedCrossRefGoogle Scholar
  23. Baldessarini RJ, Tondo L, Vazquez GH, et al. Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients. World Psychiatry. 2012b;11:40–6.PubMedPubMedCentralCrossRefGoogle Scholar
  24. Baldessarini RJ, Tondo L, Visioli C. First-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatr Scand. 2014;129:383–92.PubMedCrossRefGoogle Scholar
  25. Baron M, Risch N, Mendlewicz J. Age at onset in bipolar-related major affective illness: clinical and genetic implications. J Psychiatr Res. 1982;17:5–18.PubMedCrossRefGoogle Scholar
  26. Basso MR, Lowery N, Neel J, et al. Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder. Neuropsychology. 2002;16:84–91.PubMedCrossRefGoogle Scholar
  27. Bauer MS, Whybrow PC, Gyulai L, et al. Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics and inter-episode stability. J Affect Disord. 1994;32:201–11.PubMedCrossRefGoogle Scholar
  28. Bauer M, Glenn T, Rasgon N, et al. Association between age of onset and mood in bipolar disorder: comparison of subgroups identified by cluster analysis and clinical observation. J Psychiatr Res. 2010;44:1170–5.PubMedCrossRefGoogle Scholar
  29. Bauer M, Glenn T, Alda M, et al. Relationship between sunlight and the age of onset of bipolar disorder: an international multisite study. J Affect Disord. 2014;167:104–11.PubMedCrossRefGoogle Scholar
  30. Beckmann H, Goodwin FK. Urinary MHPG in subgroups of depressed patients and normal controls. Neuropsychobiology. 1980;6:91–100.PubMedCrossRefGoogle Scholar
  31. Bellantuono C, Barraco A, Rossi A, et al. The management of bipolar mania: a national survey of baseline data from the EMBLEM study in Italy. BMC Psychiatry. 2007;7:33.PubMedPubMedCentralCrossRefGoogle Scholar
  32. Bellivier F, Golmard JL, Rietschel M, et al. Age at onset in bipolar I affective disorder: further evidence for three subgroups. Am J Psychiatry. 2003;160:999–1001.PubMedCrossRefGoogle Scholar
  33. Bellivier F, Etain B, Malafosse A, et al. Age at onset in bipolar I affective disorder in the USA and Europe. World J Biol Psychiatry. 2014;15:369–76.PubMedCrossRefGoogle Scholar
  34. Benazzi F. Gender differences in bipolar II and unipolar depressed outpatients: a 557-case study. Ann Clin Psychiatry. 1999;11:55–9.PubMedCrossRefGoogle Scholar
  35. Benazzi F. A tetrachoric factor analysis validation of mixed depression. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:186–92.PubMedCrossRefGoogle Scholar
  36. Benedetti A, Scarpellini P, Casamassima F, et al. Bipolar disorder in late life: clinical characteristics in a sample of older adults admitted for manic episode. Clin Pract Epidemiol Ment Health. 2008;4:22. Scholar
  37. Benedetti F, Dallaspezia S, Lorenzi C, et al. Gene-gene interaction of glycogen synthase kinase 3-beta and serotonin transporter on human antidepressant response to sleep deprivation. J Affect Disord. 2012;136:514–9.PubMedCrossRefGoogle Scholar
  38. Benedetti F, Riccaboni R, Poletti S, et al. The serotonin transporter genotype modulates the relationship between early stress and adult suicidality in bipolar disorder. Bipolar Disord. 2014;16:857–66.PubMedCrossRefGoogle Scholar
  39. Berk M, Hallam K, Lucas N, et al. Early intervention in bipolar disorders: opportunities and pitfalls. Med J Aust. 2007;187:S11–4.PubMedGoogle Scholar
  40. Beyer JL, Kuchibhatla M, Cassidy F, et al. Stressful life events in older bipolar patients. Int J Geriatr Psychiatry. 2008;23:1271–5.PubMedPubMedCentralCrossRefGoogle Scholar
  41. Biffin F, Tahtalian S, Filia K, et al. The impact of age at onset of bipolar I disorder on functioning and clinical presentation. Acta Neuropsychiatr. 2009;21:191–6.PubMedCrossRefGoogle Scholar
  42. Birmaher B, Axelson D, Goldstein B, et al. Psychiatric disorders in preschool offspring of parents with bipolar disorder: the Pittsburgh Bipolar Offspring Study (BIOS). Am J Psychiatry. 2010;167:321–30.PubMedPubMedCentralCrossRefGoogle Scholar
  43. Blumberg HP, Kaufman J, Martin A, et al. Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder. Arch Gen Psychiatry. 2003;60:1201–8.PubMedCrossRefGoogle Scholar
  44. Bora E, Vahip S, Akdeniz F, et al. The effect of previous psychotic mood episodes on cognitive impairment in euthymic bipolar patients. Bipolar Disord. 2007;9:468–77.PubMedCrossRefGoogle Scholar
  45. Bozikas VP, Tonia T, Fokas K, et al. Impaired emotion processing in remitted patients with bipolar disorder. J Affect Disord. 2006;91:53–6.PubMedCrossRefGoogle Scholar
  46. Brambilla P, Harenski K, Nicoletti M, et al. Differential effects of age on brain gray matter in bipolar patients and healthy individuals. Neuropsychobiology. 2001;43:242–7.PubMedCrossRefGoogle Scholar
  47. Bratti IM, Baldessarini RJ, Baethge C, et al. Pretreatment episode count and response to lithium treatment in manic-depressive illness. Harv Rev Psychiatry. 2003;11:245–56.PubMedCrossRefGoogle Scholar
  48. Braunig P, Sarkar R, Effenberger S, et al. Gender differences in psychotic bipolar mania. Gend Med. 2009;6:356–61.PubMedCrossRefGoogle Scholar
  49. Brugue E, Colom F, Sanchez-Moreno J, et al. Depression subtypes in bipolar I and II disorders. Psychopathology. 2008;41:111–4.PubMedCrossRefGoogle Scholar
  50. Carballo JJ, Harkavy-Friedman J, Burke AK, et al. Family history of suicidal behavior and early traumatic experiences: additive effect on suicidality and course of bipolar illness? J Affect Disord. 2008;109:57–63.PubMedPubMedCentralCrossRefGoogle Scholar
  51. Cardoso BM, Kauer Sant’Anna M, Dias VV, et al. The impact of co-morbid alcohol use disorder in bipolar patients. Alcohol. 2008;42:451–7.PubMedCrossRefGoogle Scholar
  52. Carlson GA, Pataki C. Understanding early age of onset: a review of the last 5 years. Curr Psychiatry Rep. 2016;18:114.PubMedCrossRefGoogle Scholar
  53. Carlson GA, Kotov R, Chang SW, et al. Early determinants of four-year clinical outcomes in bipolar disorder with psychosis. Bipolar Disord. 2012;14:19–30.PubMedPubMedCentralCrossRefGoogle Scholar
  54. Casas-Barquero N, Garcia-Lopez O, Fernandez-Arguelles P, et al. Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study. Neuropsychiatr Dis Treat. 2007;3:269–75.PubMedPubMedCentralCrossRefGoogle Scholar
  55. Cervantes P, Gelber S, Kin FN, et al. Circadian secretion of cortisol in bipolar disorder. J Psychiatry Neurosci. 2001;26:411–6.PubMedPubMedCentralGoogle Scholar
  56. Cha B, Kim JH, Ha TH, et al. Polarity of the first episode and time to diagnosis of bipolar I disorder. Psychiatry Investig. 2009;6:96–101.PubMedPubMedCentralCrossRefGoogle Scholar
  57. Chen YW, Dilsaver SC. Comorbidity of panic disorder in bipolar illness: evidence from the Epidemiologic Catchment Area Survey. Am J Psychiatry. 1995;152:280–2.PubMedCrossRefGoogle Scholar
  58. Cichon S, Nothen MM, Catalano M, et al. Identification of two novel polymorphisms and a rare deletion variant in the human dopamine D4 receptor gene. Psychiatr Genet. 1995;5:97–103.PubMedCrossRefGoogle Scholar
  59. Col SE, Caykoylu A, Karakas Ugurlu G, et al. Factors affecting treatment compliance in patients with bipolar I disorder during prophylaxis: a study from Turkey. Gen Hosp Psychiatry. 2014;36:208–13.PubMedCrossRefGoogle Scholar
  60. Colom F, Vieta E, Daban C, et al. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord. 2006;93:13–7.PubMedCrossRefGoogle Scholar
  61. Colom F, Reinares M, Pacchiarotti I, et al. Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis. Acta Neuropsychiatrica. 2010;22:50–3.PubMedCrossRefGoogle Scholar
  62. Conus P, Abdel-Baki A, Harrigan S, et al. Pre-morbid and outcome correlates of first episode mania with psychosis: is a distinction between schizoaffective and bipolar I disorder valid in the early phase of psychotic disorders? J Affect Disord. 2010;126:88–95.PubMedCrossRefGoogle Scholar
  63. Conus P, Macneil C, McGorry PD. Public health significance of bipolar disorder: implications for early intervention and prevention. Bipolar Disord. 2014;16:548–56.PubMedCrossRefGoogle Scholar
  64. Dagani J, Signorini G, Nielssen O, et al. Meta-analysis of the interval between the onset and management of bipolar disorder. Can J Psychiatry. 2017;62:247–58.CrossRefGoogle Scholar
  65. Dawson EL, Shear PK, Howe SR, et al. Impulsivity predicts time to reach euthymia in adults with bipolar disorder. Bipolar Disord. 2014;16:846–56.PubMedCrossRefGoogle Scholar
  66. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7:iii–x, 1–173.PubMedCrossRefGoogle Scholar
  67. Del Grande C, Muti M, Musetti L, et al. Long-term treatment of bipolar disorder: how should we use lithium salts? Riv Psichiatr. 2012;47:515–26.PubMedGoogle Scholar
  68. Dell’Osso B, Grancini B, Vismara M, et al. Age at onset in patients with bipolar I and II disorder: a comparison of large sample studies. J Affect Disord. 2016;201:57–63.PubMedCrossRefGoogle Scholar
  69. Demirel H, Yesilbas D, Ozver I, et al. Psychopathy and facial emotion recognition ability in patients with bipolar affective disorder with or without delinquent behaviors. Compr Psychiatry. 2014;55:542–6.PubMedCrossRefGoogle Scholar
  70. Derntl B, Seidel EM, Kryspin-Exner I, et al. Facial emotion recognition in patients with bipolar I and bipolar II disorder. Br J Clin Psychol. 2009;48:363–75.PubMedCrossRefGoogle Scholar
  71. DeRosse P, Burdick KE, Lencz T, et al. Empirical support for DSM-IV schizoaffective disorder: clinical and cognitive validators from a large patient sample. PLoS One. 2013;8(5):e63734. Scholar
  72. Dervic K, Garcia-Amador M, Sudol K, et al. Bipolar I and II versus unipolar depression: clinical differences and impulsivity/aggression traits. Eur Psychiatry. 2015;30:106–13.PubMedCrossRefGoogle Scholar
  73. Di Florio A, Jones L, Forty L, et al. Mood disorders and parity—a clue to the aetiology of the postpartum trigger. J Affect Disord. 2014;152–154:334–9.PubMedPubMedCentralCrossRefGoogle Scholar
  74. Dias VV, Brissos S, Cardoso C, et al. Serum homocysteine levels and cognitive functioning in euthymic bipolar patients. J Affect Disord. 2009;113:285–90.PubMedCrossRefGoogle Scholar
  75. Diflorio A, Jones I. Is sex important? Gender differences in bipolar disorder. Int Rev Psychiatry. 2010;22:437–52.PubMedCrossRefGoogle Scholar
  76. Ehnvall A, Agren H. Patterns of sensitisation in the course of affective illness. A life-charting study of treatment-refractory depressed patients. J Affect Disord. 2002;70:67–75.PubMedCrossRefGoogle Scholar
  77. El Kissi Y, Krir MW, Ben Nasr S, et al. Life events in bipolar patients: a comparative study with siblings and healthy controls. J Affect Disord. 2013;151:378–83.PubMedCrossRefGoogle Scholar
  78. El-Hadidy MA, Abdeen HM, Abd El-Aziz SM, et al. WITHDRAWN:C677T Methylenetetrahydrofolate reductase gene polymorphism in schizophrenia and bipolar disorder. Psychiatr Genet. 2013;
  79. Engström C, Brandstrom S, Sigvardsson S, et al. Bipolar disorder. II: personality and age of onset. Bipolar Disord. 2003;5:340–8.PubMedCrossRefGoogle Scholar
  80. Ernst CL, Goldberg JF. Clinical features related to age at onset in bipolar disorder. J Affect Disord. 2004;82:21–7.PubMedCrossRefGoogle Scholar
  81. Eryilmaz G, Hizli Sayar G, Ozten E, et al. Effect of valproate on the plasma concentrations of aripiprazole in bipolar patients. Int J Psychiatry Clin Pract. 2014;18:288–92.PubMedCrossRefGoogle Scholar
  82. Etain B, Roy I, Henry C, et al. No evidence for physical anhedonia as a candidate symptom or an endophenotype in bipolar affective disorder. Bipolar Disord. 2007;9:706–12.PubMedCrossRefGoogle Scholar
  83. Etain B, Aas M, Andreassen OA, et al. Childhood trauma is associated with severe clinical characteristics of bipolar disorders. J Clin Psychiatry. 2013;74:991–8.PubMedCrossRefGoogle Scholar
  84. Evans DL. Bipolar disorder: diagnostic challenges and treatment considerations. J Clin Psychiatry. 2000;61(Supp 13):26–31.PubMedGoogle Scholar
  85. Faedda GL, Axelson DB, Baldessarini RJ, et al. International Society of Bipolar Disorders task force report: review of factors predicting bipolar disorder. Bipolar Disord. 2018 (in press).Google Scholar
  86. Fagiolini A, Frank E, Rucci P, et al. Mood and anxiety spectrum as a means to identify clinically relevant subtypes of bipolar I disorder. Bipolar Disord. 2007;9:462–7.PubMedPubMedCentralCrossRefGoogle Scholar
  87. Feinman JA, Dunner DL. The effect of alcohol and substance abuse on the course of bipolar affective disorder. J Affect Disord. 1996;37:43–9.PubMedCrossRefGoogle Scholar
  88. Ferrari AJ, Stockings E, Khoo JP, et al. The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar Disord. 2016;18:440–50.PubMedCrossRefGoogle Scholar
  89. Forbes EE, Miller A, Cohn JF, et al. Affect-modulated startle in adults with childhood-onset depression: relations to bipolar course and number of lifetime depressive episodes. Psychiatry Res. 2005;134:11–25.PubMedCrossRefGoogle Scholar
  90. Fornaro M, Perugi G, Gabrielli F, et al. Lifetime co-morbidity with different subtypes of eating disorders in 148 females with bipolar disorders. J Affect Disord. 2010;121:147–51.PubMedCrossRefGoogle Scholar
  91. Franchini L, Zanardi R, Smeraldi E, et al. Early onset of lithium prophylaxis as a predictor of good long-term outcome. Eur Arch Psychiatry Clin Neurosci. 1999;249:227–30.PubMedCrossRefGoogle Scholar
  92. Francis A, Gasparo P. Interval between symptom onset and hospitalization in mania. J Affect Disord. 1994;31:179–85.PubMedCrossRefGoogle Scholar
  93. Frangou S. Predictors of outcome in a representative population of bipolar disorder. Bipolar Disord. 2002;4(Suppl 1):41–2.PubMedCrossRefGoogle Scholar
  94. Frey BN, Zunta-Soares GB, Caetano SC, et al. Illness duration and total brain gray matter in bipolar disorder: evidence for neurodegeneration? Eur Neuropsychopharmacol. 2008;18:717–22.PubMedCrossRefGoogle Scholar
  95. Gan Z, Diao F, Wei Q, et al. A predictive model for diagnosing bipolar disorder based on the clinical characteristics of major depressive episodes in Chinese population. J Affect Disord. 2011;134:119–25.PubMedCrossRefGoogle Scholar
  96. Gao K, Kemp DE, Ganocy SJ, et al. Treatment-emergent mania/hypomania during antidepressant monotherapy in patients with rapid cycling bipolar disorder. Bipolar Disord. 2008;10:907–15.PubMedCrossRefGoogle Scholar
  97. Garcia-Amador M, Colom F, Valenti M, et al. Suicide risk in rapid cycling bipolar patients. J Affect Disord. 2009;117:74–8.PubMedCrossRefGoogle Scholar
  98. Gasperini M, Scherillo P, Manfredonia MG, et al. A study of relapses in subjects with mood disorder on lithium treatment. Eur Neuropsychopharmacol. 1993;3:103–10.PubMedCrossRefGoogle Scholar
  99. Gassab L, Mechri A, Gaha L, et al. Bipolarity correlated factors in major depression: about 155 Tunisian inpatients. Encephale. 2002;28:283–9.PubMedGoogle Scholar
  100. Ghaemi SN, Hsu DJ, Ko JY, et al. Bipolar spectrum disorder: a pilot study. Psychopathology. 2004;37:222–6.PubMedCrossRefGoogle Scholar
  101. Glenn T, Whybrow PC, Rasgon N, et al. Approximate entropy of self-reported mood prior to episodes in bipolar disorder. Bipolar Disord. 2006;8:424–9.PubMedCrossRefGoogle Scholar
  102. Goghari VM, Sponheim SR. Differential association of the COMT Val158Met polymorphism with clinical phenotypes in schizophrenia and bipolar disorder. Schizophr Res. 2008;103:186–91.PubMedCrossRefGoogle Scholar
  103. Gogos A, Joshua N, Rossell SL. Use of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to investigate group and gender differences in schizophrenia and bipolar disorder. Aust N Z J Psychiatry. 2010;44:220–9.PubMedCrossRefGoogle Scholar
  104. Goldberg JF, Garno JL. Age at onset of bipolar disorder and risk for comorbid borderline personality disorder. Bipolar Disord. 2009;11:205–8.PubMedCrossRefGoogle Scholar
  105. Goldberg JF, Garno JL, Leon AC, et al. Association of recurrent suicidal ideation with nonremission from acute mixed mania. Am J Psychiatry. 1998;155:1753–5.PubMedCrossRefGoogle Scholar
  106. Goldstein BI, Levitt AJ. Further evidence for a developmental subtype of bipolar disorder defined by age at onset: results from the national epidemiologic survey on alcohol and related conditions. Am J Psychiatry. 2006;163:1633–6.PubMedCrossRefGoogle Scholar
  107. Grande I, Magalhaes PV, Chendo I, et al. Staging bipolar disorder: clinical, biochemical, and functional correlates. Acta Psychiatr Scand. 2014;129:437–44.PubMedCrossRefGoogle Scholar
  108. Grigoroiu-Serbanescu M, Nöthen MM, Ohlraun S, et al. Family history influences age of onset in bipolar I disorder in females but not in males. Am J Med Genet B Neuropsychiatr Genet. 2005;133B:6–11.PubMedCrossRefGoogle Scholar
  109. Grigoroiu-Serbanescu M, Rietschel M, Hauser J, et al. Commingling analysis of age-of-onset in bipolar I disorder and the morbid risk for major psychoses in first degree relatives of bipolar I probands. J Affect Disord. 2014;168:197–204.PubMedCrossRefGoogle Scholar
  110. Gruber SA, Rosso IM, Yurgelun-Todd D. Neuropsychological performance predicts clinical recovery in bipolar patients. J Affect Disord. 2008;105:253–60.PubMedCrossRefGoogle Scholar
  111. Gulseren S, Gurcan M, Gulseren L, et al. T2 hyperintensities in bipolar patients and their healthy siblings. Arch Med Res. 2006;37:79–85.PubMedCrossRefGoogle Scholar
  112. Gutiérrez-Rojas L, Gurpegui M, Ayuso-Mateos JL, et al. Quality of life in bipolar disorder patients: a comparison with a general population sample. Bipolar Disord. 2008;10:625–34.PubMedCrossRefGoogle Scholar
  113. Harnic D, Pompili M, Mazza M, et al. Affective temperaments and psychopathological dimensions of personality in bipolar and cyclothymic patients. Behav Med. 2013;39:17–23.PubMedCrossRefGoogle Scholar
  114. Haro JM, van Os J, Vieta E, et al. Evidence for three distinct classes of ‘typical’, ‘psychotic’ and ‘dual’ mania: results from the EMBLEM study. Acta Psychiatr Scand. 2006;113:112–20.PubMedCrossRefGoogle Scholar
  115. Hauser P, Matochik J, Altshuler LL, et al. MRI-based measurements of temporal lobe and ventricular structures in patients with bipolar I and bipolar II disorders. J Affect Disord. 2000;60:25–32.PubMedCrossRefGoogle Scholar
  116. Hays JC, Krishnan KR, George LK, et al. Age of first onset of bipolar disorder: demographic, family history, and psychosocial correlates. Depress Anxiety. 1998;7:76–82.PubMedCrossRefGoogle Scholar
  117. Hendrick V, Altshuler LL, Gitlin MJ, et al. Gender and bipolar illness. J Clin Psychiatry. 2000;61:393–6; quiz 397.PubMedCrossRefGoogle Scholar
  118. Henry C, Van den Bulke D, Bellivier F, et al. Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Res. 2008;159:1–6.PubMedCrossRefGoogle Scholar
  119. Herrman H. Early intervention as a priority for world psychiatry. Early Interv Psychiatry. 2014;8:305–6.PubMedCrossRefGoogle Scholar
  120. Holtzman JN, Miller S, Hooshmand F, et al. Gender by onset age interaction may characterize distinct phenotypic subgroups in bipolar patients. J Psychiatr Res. 2016;76:128–35.PubMedCrossRefGoogle Scholar
  121. Horesh N, Apter A, Zalsman G. Timing, quantity and quality of stressful life events in childhood and preceding the first episode of bipolar disorder. J Affect Disord. 2011;134:434–7.PubMedCrossRefGoogle Scholar
  122. Hosang GM, Korszun A, Jones L, et al. Life-event specificity: bipolar disorder compared with unipolar depression. Br J Psychiatry. 2012a;201:458–65.PubMedCrossRefGoogle Scholar
  123. Hosang GM, Uher R, Maughan B, et al. The role of loss and danger events in symptom exacerbation in bipolar disorder. J Psychiatr Res. 2012b;46:1584–9.PubMedCrossRefGoogle Scholar
  124. Johnson L, Andersson-Lundman G, Aberg-Wistedt A, et al. Age of onset in affective disorder: its correlation with hereditary and psychosocial factors. J Affect Disord. 2000;59:139–48.PubMedCrossRefGoogle Scholar
  125. Joslyn C, Hawes DJ, Hunt C, et al. Is age of onset associated with severity, prognosis, and clinical features in bipolar disorder? A meta-analytic review. Bipolar Disord. 2016;18:389–403.PubMedCrossRefGoogle Scholar
  126. Joyce K, Thompson A, Marwaha S. Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review. Int J Bipolar Disord. 2016;4:19. Epub 2016 Sep 9.CrossRefPubMedPubMedCentralGoogle Scholar
  127. Kanske P, Heissler J, Schonfelder S, et al. Neural correlates of emotional distractibility in bipolar disorder patients, unaffected relatives, and individuals with hypomanic personality. Am J Psychiatry. 2013;170:1487–96.PubMedCrossRefGoogle Scholar
  128. Kato T, Winokur G, Coryell W, et al. Failure to demonstrate parent-of-origin effect in transmission of bipolar II disorder. J Affect Disord. 1998;50:135–41.PubMedCrossRefGoogle Scholar
  129. Kato T, Kunugi H, Nanko S, et al. Association of bipolar disorder with the 5178 polymorphism in mitochondrial DNA. Am J Med Genet. 2000;96:182–6.PubMedCrossRefGoogle Scholar
  130. Kauer-Sant’Anna M, Tramontina J, Andreazza AC, et al. Traumatic life events in bipolar disorder: impact on BDNF levels and psychopathology. Bipolar Disord. 2007;9(Suppl 1):128–35.PubMedCrossRefGoogle Scholar
  131. Kawa I, Carter JD, Joyce PR, et al. Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation. Bipolar Disord. 2005;7:119–25.PubMedCrossRefPubMedCentralGoogle Scholar
  132. Keck PE Jr, McElroy SL, Strakowski SM, et al. Outcome and comorbidity in first- compared with multiple-episode mania. J Nerv Ment Dis. 1995;183:320–4.PubMedCrossRefPubMedCentralGoogle Scholar
  133. Kennedy N, Boydell J, Kalidindi S, et al. Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. Am J Psychiatry. 2005;162:257–62.PubMedCrossRefPubMedCentralGoogle Scholar
  134. Kesebir S, Isitmez S, Gundogar D. Compulsive buying in bipolar disorder: is it a comorbidity or a complication? J Affect Disord. 2012;136:797–802.PubMedCrossRefPubMedCentralGoogle Scholar
  135. Khess CR, Das J, Akhtar S. Four year follow-up of first episode manic patients. Indian J Psychiatry. 1997;39:160–5.PubMedPubMedCentralGoogle Scholar
  136. Kim MJ, Lyoo IK, Dager SR, et al. The occurrence of cavum septi pellucidi enlargement is increased in bipolar disorder patients. Bipolar Disord. 2007;9:274–80.PubMedCrossRefPubMedCentralGoogle Scholar
  137. Kim B, Kim SJ, Son JI, et al. Weight change in the acute treatment of bipolar I disorder: a naturalistic observational study of psychiatric inpatients. J Affect Disord. 2008;105:45–52.PubMedCrossRefPubMedCentralGoogle Scholar
  138. Kim YK, Hwang JA, Lee HJ, et al. There is no association between the serotonin receptor gene and bipolar I disorder in the Korean population. Nord J Psychiatry. 2014;68:488–93.PubMedCrossRefPubMedCentralGoogle Scholar
  139. Koc I, Kesebir S. The subgroup effect of adult attention deficit hyperactivity on disability and quality of life among bipolar patients. Bull Clin Psychopharmacol. 2014;24:49–54.CrossRefGoogle Scholar
  140. Kucukali CI, Aydin M, Ozkok E, et al. Angiotensin-converting enzyme polymorphism in schizophrenia, bipolar disorders, and their first-degree relatives. Psychiatr Genet. 2010;20:14–9.PubMedCrossRefPubMedCentralGoogle Scholar
  141. Kudo T, Ishida S, Kubota H, et al. Manic episode in epilepsy and bipolar I disorder: a comparative analysis of 13 patients. Epilepsia. 2001;42:1036–42.PubMedCrossRefPubMedCentralGoogle Scholar
  142. Kumar CT, Christodoulou T, Vyas NS, et al. Deficits in visual sustained attention differentiate genetic liability and disease expression for schizophrenia from Bipolar Disorder. Schizophr Res. 2010;124:152–60.PubMedCrossRefPubMedCentralGoogle Scholar
  143. Kunugi H, Iijima Y, Tatsumi M, et al. No association between the Val66Met polymorphism of the brain-derived neurotrophic factor gene and bipolar disorder in a Japanese population: a multicenter study. Biol Psychiatry. 2004;56:376–8.PubMedCrossRefGoogle Scholar
  144. Kurumaji A, Narushima K, Ooshima K, et al. Clinical course of the bipolar II disorder in a Japanese sample. J Affect Disord. 2014;168:363–6.PubMedCrossRefPubMedCentralGoogle Scholar
  145. Lagerberg TV, Kvitland LR, Aminoff SR, et al. Indications of a dose-response relationship between cannabis use and age at onset in bipolar disorder. Psychiatry Res. 2014;215:101–4.PubMedCrossRefGoogle Scholar
  146. Lambert M, Niehaus V, Correll C. Pharmacotherapy in children and adolescents at clinical-high risk for psychosis and bipolar disorder. Pharmacopsychiatry. 2016;49:229–44.PubMedCrossRefGoogle Scholar
  147. Large M, Nielssen O, Slade T, et al. Measurement and reporting of the duration of untreated psychosis. Early Interv Psychiatry. 2008;2:201–11.PubMedCrossRefGoogle Scholar
  148. Latalova K, Prasko J, Pastucha P, et al. Bipolar affective disorder and dissociation—comparison with healthy controls. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011;155:181–6.PubMedCrossRefGoogle Scholar
  149. Lee JH, Dunner DL. The effect of anxiety disorder comorbidity on treatment resistant bipolar disorders. Depress Anxiety. 2008;25:91–7.PubMedCrossRefPubMedCentralGoogle Scholar
  150. Lee KY, Song JY, Kim SH, et al. Association between CLOCK 3111T/C and preferred circadian phase in Korean patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34:1196–201.PubMedCrossRefGoogle Scholar
  151. Lev-Ran S, Le Foll B, McKenzie K, et al. Bipolar disorder and co-occurring cannabis use disorders: characteristics, co-morbidities and clinical correlates. Psychiatry Res. 2013;209:459–65.PubMedCrossRefGoogle Scholar
  152. Levin JB, Seifi N, Cassidy KA, et al. Comparing medication attitudes and reasons for medication nonadherence among three disparate groups of individuals with serious mental illness. J Nerv Ment Dis. 2014;202:769–73.PubMedPubMedCentralCrossRefGoogle Scholar
  153. Levy B, Medina AM, Manove E, et al. The characteristics of a discrete mood episode, neuro-cognitive impairment and re-hospitalization in bipolar disorder. J Psychiatr Res. 2011;45:1048–54.PubMedPubMedCentralCrossRefGoogle Scholar
  154. Lex C, Hautzinger M, Meyer TD. Cognitive styles in hypomanic episodes of bipolar I disorder. Bipolar Disord. 2011;13:355–64.PubMedCrossRefGoogle Scholar
  155. Li M, Cui L, Deng W, et al. Voxel-based morphometric analysis on the volume of gray matter in bipolar I disorder. Psychiatry Res. 2011;191:92–7.PubMedCrossRefGoogle Scholar
  156. Li J, Kale Edmiston E, Chen K, et al. A comparative diffusion tensor imaging study of corpus callosum subregion integrity in bipolar disorder and schizophrenia. Psychiatry Res. 2014;221:58–62.PubMedCrossRefGoogle Scholar
  157. Li Z, Deng W, Liu X, et al. Contingent negative variation in patients with deficit schizophrenia or bipolar I disorder with psychotic features: measurement and correlation with clinical characteristics. Nord J Psychiatry. 2015;69:196–203.PubMedCrossRefGoogle Scholar
  158. Licht RW, Gouliaev G, Vestergaard P, et al. Treatment of manic episodes in Scandinavia: the use of neuroleptic drugs in a clinical routine setting. J Affect Disord. 1994;32:179–85.PubMedCrossRefGoogle Scholar
  159. Lopez P, Mosquera F, de Leon J, et al. Suicide attempts in bipolar patients. J Clin Psychiatry. 2001;62:963–6.PubMedCrossRefGoogle Scholar
  160. Lopez-Jaramillo C, Lopera-Vasquez J, Gallo A, et al. Effects of recurrence on the cognitive performance of patients with bipolar I disorder: implications for relapse prevention and treatment adherence. Bipolar Disord. 2010;12:557–67.PubMedCrossRefGoogle Scholar
  161. Loranger AW, Levine PM. Age at onset of bipolar affective illness. Arch Gen Psychiatry. 1978;35:1345–8.PubMedCrossRefGoogle Scholar
  162. Maina G, Albert U, Bellodi L, et al. Health-related quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes. J Clin Psychiatry. 2007;68:207–12.PubMedCrossRefGoogle Scholar
  163. Maina G, Bechon E, Rigardetto S, et al. General medical conditions are associated with delay to treatment in patients with bipolar disorder. Psychosomatics. 2013;54:437–42.PubMedCrossRefGoogle Scholar
  164. Malhi GS, Bargh DM, Coulston CM, et al. Predicting bipolar disorder on the basis of phenomenology: implications for prevention and early intervention. Bipolar Disord. 2014;16:455–70.PubMedCrossRefPubMedCentralGoogle Scholar
  165. Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry. 2005;62:975–83.PubMedCrossRefPubMedCentralGoogle Scholar
  166. Martínez-Arán A, Vieta E, Reinares M, et al. Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry. 2004;161:262–70.PubMedCrossRefPubMedCentralGoogle Scholar
  167. Martínez-Arán A, Vieta E, Colom F, et al. Do cognitive complaints in euthymic bipolar patients reflect objective cognitive impairment? Psychother Psychosom. 2005;74:295–302.PubMedCrossRefPubMedCentralGoogle Scholar
  168. Mathieu F, Etain B, Daban C, et al. Affect intensity measure in bipolar disorders: a multidimensional approach. J Affect Disord. 2014;157:8–13.PubMedCrossRefPubMedCentralGoogle Scholar
  169. Matsuo K, Walss-Bass C, Nery FG, et al. Neuronal correlates of brain-derived neurotrophic factor Val66Met polymorphism and morphometric abnormalities in bipolar disorder. Neuropsychopharmacology. 2009;34:1904–13.PubMedCrossRefPubMedCentralGoogle Scholar
  170. Mazza M, Mandelli L, Zaninotto L, et al. Bipolar disorder: “pure” versus mixed depression over a 1-year follow-up. Int J Psychiatry Clin Pract. 2012;16:113–20.PubMedCrossRefPubMedCentralGoogle Scholar
  171. Mazzarini L, Colom F, Pacchiarotti I, et al. Psychotic versus non-psychotic bipolar II disorder. J Affect Disord. 2010;126:55–60.PubMedCrossRefPubMedCentralGoogle Scholar
  172. McCraw S, Parker G, Graham R, et al. The duration of undiagnosed bipolar disorder: effect on outcomes and treatment response. J Affect Disord. 2014;168:422–9.PubMedCrossRefPubMedCentralGoogle Scholar
  173. McElroy SL, Keck PE Jr, Pope HG Jr, et al. Correlates of antimanic response to valproate. Psychopharmacol Bull. 1991;27:127–33.PubMedPubMedCentralGoogle Scholar
  174. McElroy SL, Frye MA, Hellemann G, et al. Prevalence and correlates of eating disorders in 875 patients with bipolar disorder. J Affect Disord. 2011;128:191–8.PubMedCrossRefPubMedCentralGoogle Scholar
  175. McGorry PD, Killackey E, Yung AR. Early intervention in psychotic disorders: detection and treatment of the first episode and the critical early stages. Med J Aust. 2007;187:S8–10.PubMedGoogle Scholar
  176. McGorry P, Johanessen JO, Lewis S, et al. Early intervention in psychosis: keeping faith with evidence-based health care. Psychol Med. 2010;40:399–404.PubMedCrossRefGoogle Scholar
  177. McIntyre RS, Soczynska JK, Mancini D, et al. Comparing features of bipolar disorder to major depressive disorder in a tertiary mood disorders clinic. Ann Clin Psychiatry. 2007;19:313–7.PubMedCrossRefGoogle Scholar
  178. McIntyre RS, Kennedy SH, Soczynska JK, et al. Attention-deficit/hyperactivity disorder in adults with bipolar disorder or major depressive disorder: results from the international mood disorders collaborative project. Prim Care Companion J Clin Psychiatry. 2010;12.
  179. Medda P, Perugi G, Zanello S, et al. Comparative response to electroconvulsive therapy in medication-resistant bipolar I patients with depression and mixed state. J ECT. 2010;26:82–6.PubMedCrossRefGoogle Scholar
  180. Miklowitz DJ, George EL, Richards JA, et al. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry. 2003;60:904–12.PubMedCrossRefGoogle Scholar
  181. Miller S, Hallmayer J, Wang PW, et al. Brain-derived neurotrophic factor val66met genotype and early life stress effects upon bipolar course. J Psychiatr Res. 2013;47:252–8.PubMedCrossRefGoogle Scholar
  182. Min HJ, Cho HS, Kim SJ, et al. Association of the brain-derived neurotrophic factor gene and clinical features of bipolar disorder in Korea. Clin Psychopharmacol Neurosci. 2012;10:163–7.PubMedPubMedCentralCrossRefGoogle Scholar
  183. Mitchell PB, Johnston AK, Corry J, et al. Characteristics of bipolar disorder in an Australian specialist outpatient clinic: comparison across large datasets. Aust N Z J Psychiatry. 2009;43:109–17.PubMedCrossRefGoogle Scholar
  184. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8:336–41.PubMedCrossRefGoogle Scholar
  185. Montlahuc C, Curis E, Jonas SF, et al. Age-at-onset subsets of bipolar I disorders: a critical insight into admixture analyses. Int J Methods Psychiatr Res. 2016;26(3). Scholar
  186. Morselli PL, Elgie R, GAMIAN-Europe. GAMIAN-Europe/BEAM survey I—global analysis of a patient questionnaire circulated to 3450 members of 12 European advocacy groups operating in the field of mood disorders. Bipolar Disord. 2003;5:265–78.PubMedCrossRefGoogle Scholar
  187. Mosolov S, Ushkalova A, Kostukova E, et al. Bipolar II disorder in patients with a current diagnosis of recurrent depression. Bipolar Disord. 2014;16:389–99.PubMedCrossRefGoogle Scholar
  188. Mrad A, Mechri A, Rouissi K, et al. Clinical characteristics of bipolar I patients according to their family history of affective disorders. Encephale. 2007;33:762–7.PubMedCrossRefGoogle Scholar
  189. Mula M, Pini S, Monteleone P, et al. Different temperament and character dimensions correlate with panic disorder comorbidity in bipolar disorder and unipolar depression. J Anxiety Disord. 2008;22:1421–6.PubMedCrossRefGoogle Scholar
  190. Mula M, Pini S, Calugi S, et al. Distinguishing affective depersonalization from anhedonia in major depression and bipolar disorder. Compr Psychiatry. 2010;51:187–92.PubMedCrossRefGoogle Scholar
  191. Nardi AE, Nascimento I, Freire RC, et al. Demographic and clinical features of schizoaffective (schizobipolar) disorder—a 5-year retrospective study. Support for a bipolar spectrum disorder. J Affect Disord. 2005;89:201–6.PubMedCrossRefGoogle Scholar
  192. Negash A, Alem A, Kebede D, et al. Prevalence and clinical characteristics of bipolar I disorder in Butajira, Ethiopia: a community-based study. J Affect Disord. 2005;87:193–201.PubMedCrossRefGoogle Scholar
  193. Nehra R, Chakrabarti S, Pradhan BK, et al. Comparison of cognitive functions between first- and multi-episode bipolar affective disorders. J Affect Disord. 2006;93:185–92.PubMedCrossRefGoogle Scholar
  194. Nery FG, Miranda-Scippa A, Nery-Fernandes F, et al. Prevalence and clinical correlates of alcohol use disorders among bipolar disorder patients: results from the Brazilian Bipolar Research Network. Compr Psychiatry. 2014;55:1116–21.PubMedCrossRefGoogle Scholar
  195. Neves FS, Malloy-Diniz LF, Barbosa IG, et al. Bipolar disorder first episode and suicidal behavior: are there differences according to type of suicide attempt? Rev Bras Psiquiatr. 2009;31:114–8.PubMedCrossRefGoogle Scholar
  196. Neves FS, Malloy-Diniz LF, Romano-Silva MA, et al. Is the serotonin transporter polymorphism (5-HTTLPR) a potential marker for suicidal behavior in bipolar disorder patients? J Affect Disord. 2010;125:98–102.PubMedCrossRefGoogle Scholar
  197. Nguyen TV, Low NC. Comorbidity of migraine and mood episodes in a nationally representative population-based sample. Headache. 2013;53:498–506.PubMedCrossRefGoogle Scholar
  198. Nivoli AM, Murru A, Pacchiarotti I, et al. Bipolar disorder in the elderly: a cohort study comparing older and younger patients. Acta Psychiatr Scand. 2014;130:364–73.PubMedCrossRefGoogle Scholar
  199. Oepen G, Baldessarini RJ, Salvatore P, et al. On the periodicity of manic-depressive insanity, by Eliot Slater (1938): translated excerpts and commentary. J Affect Disord. 2004;78:1–9.PubMedCrossRefGoogle Scholar
  200. Ohara K, Nagai M, Suzuki Y, et al. Low activity allele of catechol-o-methyltransferase gene and Japanese unipolar depression. Neuroreport. 1998;9:1305–8.PubMedCrossRefGoogle Scholar
  201. Okan Ibiloglu A, Caykoylu A. The comorbidity of anxiety disorders in bipolar I and bipolar II patients among Turkish population. J Anxiety Disord. 2011;25:661–7.PubMedCrossRefGoogle Scholar
  202. Onyeama M, Agomoh A, Jombo E. Bipolar disorder in Enugu, South East Nigeria: demographic and diagnostic characteristics of patients. Psychiatr Danub. 2010;22(Suppl 1):S152–7.PubMedGoogle Scholar
  203. Oquendo MA, Waternaux C, Brodsky B, et al. Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters. J Affect Disord. 2000;59:107–17.PubMedCrossRefGoogle Scholar
  204. Ortiz A, Bradler K, Slaney C, et al. An admixture analysis of the age at index episodes in bipolar disorder. Psychiatry Res. 2011;188:34–9.PubMedCrossRefGoogle Scholar
  205. Ostacher MJ, Perlis RH, Nierenberg AA, et al. Impact of substance use disorders on recovery from episodes of depression in bipolar disorder patients: prospective data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2010;167:289–97.PubMedCrossRefGoogle Scholar
  206. Oswald P, Souery D, Kasper S, et al. Current issues in bipolar disorder: a critical review. Eur Neuropsychopharmacol. 2007;17:687–95.PubMedCrossRefGoogle Scholar
  207. Ozerdem A, Tunca Z, Kaya N. The relatively good prognosis of bipolar disorders in a Turkish bipolar clinic. J Affect Disord. 2001;64:27–34.PubMedCrossRefGoogle Scholar
  208. Ozgürdal S, van Haren E, Hauser M, et al. Early mood swings as symptoms of the bipolar prodrome: preliminary results of a retrospective analysis. Psychopathology. 2009;42:337–42.PubMedCrossRefGoogle Scholar
  209. Ozyildirim I, Cakir S, Yazici O. Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder. Eur Psychiatry. 2010;25:47–51.PubMedCrossRefGoogle Scholar
  210. Pacheco A, Barguil M, Contreras J, et al. Social and clinical comparison between schizophrenia and bipolar disorder type I with psychosis in Costa Rica. Soc Psychiatry Psychiatr Epidemiol. 2010;45:675–80.PubMedCrossRefGoogle Scholar
  211. Pae CU, Serretti A, Mandelli L, et al. Effect of 5-haplotype of dysbindin gene (DTNBP1) polymorphisms for the susceptibility to bipolar I disorder. Am J Med Genet B Neuropsychiatr Genet. 2007;144B:701–3.PubMedCrossRefGoogle Scholar
  212. Paholpak S, Kongsakon R, Pattanakumjorn W, et al. Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry. Neuropsychiatr Dis Treat. 2014;10:803–10.PubMedPubMedCentralCrossRefGoogle Scholar
  213. Papadimitriou GN, Dikeos DG, Karadima G, et al. Association between the GABA(A) receptor alpha5 subunit gene locus (GABRA5) and bipolar affective disorder. Am J Med Genet. 1998;81:73–80.PubMedCrossRefGoogle Scholar
  214. Pardoen D, Bauwens F, Dramaix M, et al. Life events and primary affective disorders. A one year prospective study. Br J Psychiatry. 1996;169:160–6.PubMedCrossRefGoogle Scholar
  215. Parmentier C, Etain B, Yon L, et al. Clinical and dimensional characteristics of euthymic bipolar patients with or without suicidal behavior. Eur Psychiatry. 2012;27:570–6.PubMedCrossRefGoogle Scholar
  216. Patrick V, Dunner DL, Fieve RR. Life events and primary affective illness. Acta Psychiatr Scand. 1978;58:48–55.PubMedCrossRefGoogle Scholar
  217. Patton GC, Hetrick SE, McGorry P. Service responses for youth onset mental disorders. Curr Opin Psychiatry. 2007;20:319–24.PubMedCrossRefGoogle Scholar
  218. Pavlickova H, Turnbull O, Bentall RP. Cognitive vulnerability to bipolar disorder in offspring of parents with bipolar disorder. Br J Clin Psychol. 2014;53:386–401.PubMedCrossRefGoogle Scholar
  219. Perich T, Mitchell PB, Loo C, et al. Cognitive styles and clinical correlates of childhood abuse in bipolar disorder. Bipolar Disord. 2014;16:600–7.PubMedCrossRefGoogle Scholar
  220. Perron H, Hamdani N, Faucard R, et al. Molecular characteristics of Human Endogenous Retrovirus type-W in schizophrenia and bipolar disorder. Transl Psychiatry. 2012;2:e201. Scholar
  221. Perroud N, Cordera P, Zimmermann J, et al. Comorbidity between attention deficit hyperactivity disorder (ADHD) and bipolar disorder in a specialized mood disorders outpatient clinic. J Affect Disord. 2014;168:161–6.PubMedCrossRefGoogle Scholar
  222. Perugi G, Akiskal HS, Micheli C, et al. Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J Affect Disord. 1997;43:169–80.PubMedCrossRefGoogle Scholar
  223. Perugi G, Micheli C, Akiskal HS, et al. Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients. Compr Psychiatry. 2000;41:13–8.PubMedCrossRefGoogle Scholar
  224. Piccardi MP, Ardau R, Chillotti C, et al. Manic-depressive illness: an association study with the inositol polyphosphate 1-phosphatase and serotonin transporter genes. Psychiatr Genet. 2002;12:23–7.PubMedCrossRefGoogle Scholar
  225. Pinto C, Souza RP, Lioult D, et al. Parent of origin effect and allelic expression imbalance of the serotonin transporter in bipolar disorder and suicidal behaviour. Eur Arch Psychiatry Clin Neurosci. 2011;261:533–8.PubMedCrossRefGoogle Scholar
  226. Pope M, Dudley R, Scott J. Determinants of social functioning in bipolar disorder. Bipolar Disord. 2007;9:38–44.PubMedCrossRefGoogle Scholar
  227. Popescu C, Ionescu R, Jipescu I, et al. Psychomotor functioning in unipolar and bipolar affective disorders. Rom J Neurol Psychiatry. 1991;29:17–33.PubMedGoogle Scholar
  228. Porcelli S, Balzarro B, de Ronchi D, et al. Quetiapine extended release: preliminary evidence of a rapid onset of the antidepressant effect in bipolar depression. J Clin Psychopharmacol. 2014;34:303–6.PubMedCrossRefGoogle Scholar
  229. Post RM, Leverich GS, Kupka RW, et al. Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood. J Clin Psychiatry. 2010;71:864–72.PubMedCrossRefGoogle Scholar
  230. Primavera D, Carta R, Lepori T, et al. Duration of untreated psychosis and cognitive deficits in a cohort of chronic psychotic patients. Clin Ter. 2013;164(4):e263–71. Scholar
  231. Radonic E, Rados M, Kalember P, et al. Comparison of hippocampal volumes in schizophrenia, schizoaffective and bipolar disorder. Coll Antropol. 2011;35(Suppl 1):249–52.PubMedGoogle Scholar
  232. Ram D, Ram D. Subsyndromal states in bipolar disorder. Indian J Psychiatry. 2010;52:367–70.PubMedPubMedCentralCrossRefGoogle Scholar
  233. Ramacciotti CE, Paoli RA, Marcacci G, et al. Relationship between bipolar illness and binge-eating disorders. Psychiatry Res. 2005;135:165–70.PubMedCrossRefGoogle Scholar
  234. Ratheesh A, Davey C, Hetrick S, et al. A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder. Acta Psychiatr Scand. 2017;135:273–84.CrossRefGoogle Scholar
  235. Ravizza L, Tiraferri R, Rebaudengo P, et al. Age of onset and familial occurrence of manic-depressive psychosis. Riv Patol Nerv Ment. 1982;103:97–104.PubMedGoogle Scholar
  236. Reinares M, Papachristou E, Harvey P, et al. Towards a clinical staging for bipolar disorder: defining patient subtypes based on functional outcome. J Affect Disord. 2013;144:65–71.PubMedCrossRefGoogle Scholar
  237. Rinieris PM, Stefanis CN, Lykouras EP, et al. Affective disorders and ABO blood types. Acta Psychiatr Scand. 1979;60:272–8.PubMedCrossRefGoogle Scholar
  238. Robb JC, Young LT, Cooke RG, et al. Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores. J Affect Disord. 1998;49:189–93.PubMedCrossRefGoogle Scholar
  239. Robertson A, de Moore G, Boyce P. Bipolar II disorder in rural New South Wales. Australas Psychiatry. 2012;20:203–7.PubMedCrossRefGoogle Scholar
  240. Roiser JP, Cannon DM, Gandhi SK, et al. Hot and cold cognition in unmedicated depressed subjects with bipolar disorder. Bipolar Disord. 2009;11:178–89.PubMedPubMedCentralCrossRefGoogle Scholar
  241. Rosa AR, Andreazza AC, Kunz M, et al. Predominant polarity in bipolar disorder: diagnostic implications. J Affect Disord. 2008;107:45–51.PubMedCrossRefGoogle Scholar
  242. Rydén E, Thase ME, Straht D, et al. A history of childhood attention-deficit hyperactivity disorder (ADHD) impacts clinical outcome in adult bipolar patients regardless of current ADHD. Acta Psychiatr Scand. 2009;120:239–46.PubMedCrossRefGoogle Scholar
  243. Safari R, Tunca Z, Ozerdem A, et al. New alterations at potentially regulated regions of the glial derived neurotrophic factor gene in bipolar disorder. J Affect Disord. 2014;167:244–50.PubMedCrossRefGoogle Scholar
  244. Sassi RB, Nicoletti M, Brambilla P, et al. Increased gray matter volume in lithium-treated bipolar disorder patients. Neurosci Lett. 2002;329:243–5.PubMedCrossRefGoogle Scholar
  245. Sato T, Bottlender R, Kleindienst N, et al. Syndromes and phenomenological subtypes underlying acute mania: a factor analytic study of 576 manic patients. Am J Psychiatry. 2002;159:968–74.PubMedCrossRefGoogle Scholar
  246. Saus E, Soria V, Escaramis G, et al. A haplotype of glycogen synthase kinase 3beta is associated with early onset of unipolar major depression. Genes Brain Behav. 2010;9:799–807.PubMedCrossRefGoogle Scholar
  247. Savitz JB, van der Merwe L, Stein DJ, et al. Neuropsychological task performance in bipolar spectrum illness: genetics, alcohol abuse, medication and childhood trauma. Bipolar Disord. 2008;10:479–94.PubMedCrossRefGoogle Scholar
  248. Scassellati C, Rotondo A, Bonvicini C, et al. Further evidence on the lack of association between glycogen synthase kinase 3beta gene polymorphisms and bipolar disorder. Psychiatr Genet. 2007;17:249–50.PubMedCrossRefGoogle Scholar
  249. Schaffer A, Cairney J, Cheung A, et al. Community survey of bipolar disorder in Canada: lifetime prevalence and illness characteristics. Can J Psychiatry. 2006;51:9–16.PubMedCrossRefGoogle Scholar
  250. Schoeyen HK, Vaaler AE, Auestad BH, et al. Despite clinical differences, bipolar disorder patients from acute wards and outpatient clinics have similar educational and disability levels compared to the general population. J Affect Disord. 2011;132:209–15.PubMedCrossRefGoogle Scholar
  251. Schroeter ML, Abdul-Khaliq H, Diefenbacher A, et al. S100B is increased in mood disorders and may be reduced by antidepressive treatment. Neuroreport. 2002;13:1675–8.PubMedCrossRefGoogle Scholar
  252. Seidman LJ, Lanca M, Kremen WS, et al. Organizational and visual memory deficits in schizophrenia and bipolar psychoses using the Rey-Osterrieth complex figure: effects of duration of illness. J Clin Exp Neuropsychol. 2003;25:949–64.PubMedCrossRefPubMedCentralGoogle Scholar
  253. Serretti A, Mandelli L, Lattuada E, et al. Clinical and demographic features of mood disorder subtypes. Psychiatry Res. 2002;112:195–210.PubMedCrossRefPubMedCentralGoogle Scholar
  254. Serretti A, Malitas PN, Mandelli L, et al. Further evidence for a possible association between serotonin transporter gene and lithium prophylaxis in mood disorders. Pharmacogenomics J. 2004;4:267–73.PubMedCrossRefPubMedCentralGoogle Scholar
  255. Serretti A, Chiesa A, Calati R, et al. Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder. Eur Arch Psychiatry Clin Neurosci. 2013;263:93–103.PubMedCrossRefPubMedCentralGoogle Scholar
  256. Sethi S, Khanna R. Phenomenology of mania in eastern India. Psychopathology. 1993;26:274–8.PubMedCrossRefPubMedCentralGoogle Scholar
  257. Shabani A, Teimurinejad S, Kokar S, et al. Suicide risk factors in iranian patients with bipolar disorder: a 21-month follow-up from BDPF study. Iran J Psychiatry Behav Sci. 2013;7:16–23.PubMedPubMedCentralGoogle Scholar
  258. Shah A, Shen N, El-Mallakh RS. Weight gain occurs after onset of bipolar illness in overweight bipolar patients. Ann Clin Psychiatry. 2006;18:239–41.PubMedCrossRefPubMedCentralGoogle Scholar
  259. Sierra P, Livianos L, Rojo L. Quality of life for patients with bipolar disorder: relationship with clinical and demographic variables. Bipolar Disord. 2005;7:159–65.PubMedCrossRefPubMedCentralGoogle Scholar
  260. Skjelstad DV, Malt UF, Holte A. Symptoms and behaviors prior to the first major affective episode of bipolar II disorder. An exploratory study. J Affect Disord. 2011;132:333–43.PubMedCrossRefPubMedCentralGoogle Scholar
  261. Slama F, Bellivier F, Henry C, et al. Bipolar patients with suicidal behavior: toward the identification of a clinical subgroup. J Clin Psychiatry. 2004;65:1035–9.PubMedCrossRefPubMedCentralGoogle Scholar
  262. Sonne SC, Brady KT, Morton WA. Substance abuse and bipolar affective disorder. J Nerv Ment Dis. 1994;182:349–52.PubMedCrossRefPubMedCentralGoogle Scholar
  263. Souery D, Lipp O, Rivelli SK, et al. Tyrosine hydroxylase polymorphism and phenotypic heterogeneity in bipolar affective disorder: a multicenter association study. Am J Med Genet. 1999;88:527–32.PubMedCrossRefGoogle Scholar
  264. Souery D, Zaninotto L, Calati R, et al. Depression across mood disorders: review and analysis in a clinical sample. Compr Psychiatry. 2012;53:24–38.PubMedCrossRefGoogle Scholar
  265. Spijker AT, Giltay EJ, van Rossum EF, et al. Glucocorticoid and mineralocorticoid receptor polymorphisms and clinical characteristics in bipolar disorder patients. Psychoneuroendocrinology. 2011;36:1460–9.PubMedCrossRefGoogle Scholar
  266. Squassina A, Manchia M, Costa M, et al. Age at onset in bipolar disorder: Investigation of the role of TaqIA polymorphism of DRD2 gene in a Sardinian sample. Eur Psychiatry. 2011;26:141–3.PubMedCrossRefGoogle Scholar
  267. Strakowski SM, Keck PE Jr, McElroy SL, et al. Twelve-month outcome after a first hospitalization for affective psychosis. Arch Gen Psychiatry. 1998;55:49–55.PubMedCrossRefGoogle Scholar
  268. Strakowski SM, DelBello MP, Fleck DE, et al. Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Arch Gen Psychiatry. 2005;62:851–8.PubMedCrossRefGoogle Scholar
  269. Suominen K, Mantere O, Valtonen H, et al. Early age at onset of bipolar disorder is associated with more severe clinical features but delayed treatment seeking. Bipolar Disord. 2007;9:698–705.PubMedCrossRefGoogle Scholar
  270. Swann AC, Lijffijt M, Lane SD, et al. Antisocial personality disorder and borderline symptoms are differentially related to impulsivity and course of illness in bipolar disorder. J Affect Disord. 2013;148:384–90.PubMedCrossRefGoogle Scholar
  271. Sylvia LG, Rabideau DJ, Nierenberg AA, et al. The effect of personalized guideline-concordant treatment on quality of life and functional impairment in bipolar disorder. J Affect Disord. 2014;169:144–8.PubMedPubMedCentralCrossRefGoogle Scholar
  272. Szadoczky E, Papp Z, Vitrai J, et al. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. J Affect Disord. 1998;50:153–62.PubMedCrossRefGoogle Scholar
  273. Szczepankiewicz A, Skibinska M, Suwalska A, et al. The association study of three FYN polymorphisms with prophylactic lithium response in bipolar patients. Hum Psychopharmacol. 2009;24:287–91.PubMedCrossRefGoogle Scholar
  274. Takei Y, Suda M, Aoyama Y, et al. Near-infrared spectroscopic study of frontopolar activation during face-to-face conversation in major depressive disorder and bipolar disorder. J Psychiatr Res. 2014;57:74–83.PubMedCrossRefGoogle Scholar
  275. Tamam L, Tuglu C, Karatas G, et al. Adult attention-deficit hyperactivity disorder in patients with bipolar I disorder in remission: preliminary study. Psychiatry Clin Neurosci. 2006;60:480–5.PubMedCrossRefPubMedCentralGoogle Scholar
  276. Tamam L, Karakus G, Ozpoyraz N. Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: prevalence and clinical correlates. Eur Arch Psychiatry Clin Neurosci. 2008;258:385–93.PubMedCrossRefGoogle Scholar
  277. Taylor Tavares JV, Clark L, Cannon DM, et al. Distinct profiles of neurocognitive function in unmedicated unipolar depression and bipolar II depression. Biol Psychiatry. 2007;62:917–24.PubMedCrossRefGoogle Scholar
  278. Thesing CS, Stek ML, van Grootheest DS, et al. Childhood abuse, family history and stressors in older patients with bipolar disorder in relation to age at onset. J Affect Disord. 2015;184:249–55.PubMedCrossRefGoogle Scholar
  279. Thomé ES, Dargel AA, Migliavacca FM, et al. Stigma experiences in bipolar patients: the impact upon functioning. J Psychiatr Ment Health Nurs. 2012;19:665–71.PubMedCrossRefGoogle Scholar
  280. Tohen M, Calabrese J, Vieta E, et al. Effect of comorbid anxiety on treatment response in bipolar depression. J Affect Disord. 2007;104:137–46.PubMedCrossRefGoogle Scholar
  281. Tondo L, Baldessarini RJ. Suicide in bipolar disorder. In: Yildiz A, Nemeroff C, Ruiz P, editors. The bipolar book: history, neurobiology, and treatment. New York: Oxford University Press; 2015. p. 509–28.CrossRefGoogle Scholar
  282. Tondo L, Lepri B, Cruz N, et al. Age at onset in 3014 Sardinian bipolar and major depressive disorder patients. Acta Psychiatr Scand. 2010;121:446–52.PubMedCrossRefGoogle Scholar
  283. Tondo L, Visioli C, Preti A, et al. Bipolar disorders following initial depression: modeling predictive clinical factors. J Affect Disord. 2014;167:44–9.CrossRefGoogle Scholar
  284. Tondo L, Pompili M, Forte A, et al. Suicide attempts in bipolar disorders: comprehensive review of 101 reports. Acta Psychiatr Scand. 2016;133:174–86.PubMedCrossRefGoogle Scholar
  285. Toniolo RA, Caetano SC, da Silva PV, et al. Clinical significance of lifetime panic disorder in the course of bipolar disorder type I. Compr Psychiatry. 2009;50:9–12.PubMedCrossRefPubMedCentralGoogle Scholar
  286. Torrent C, Martínez-Arán A, Daban C, et al. Cognitive impairment in bipolar II disorder. Br J Psychiatry. 2006;189:254–9.PubMedCrossRefPubMedCentralGoogle Scholar
  287. Torrent C, Bonnin Cdel M, Martínez-Arán A, et al. Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am J Psychiatry. 2013;170:852–9.PubMedCrossRefPubMedCentralGoogle Scholar
  288. Torres IJ, DeFreitas VG, DeFreitas CM, et al. Neurocognitive functioning in patients with bipolar I disorder recently recovered from a first manic episode. J Clin Psychiatry. 2010;71:1234–42.PubMedCrossRefPubMedCentralGoogle Scholar
  289. Tozzi F, Manchia M, Galwey NW, et al. Admixture analysis of age at onset in bipolar disorder. Psychiatry Res. 2011;185:27–32.PubMedCrossRefPubMedCentralGoogle Scholar
  290. Tundo A, Calabrese JR, Marchetti F, et al. Continuous circular cycling in bipolar disorder as a predictor of poor outcome. J Affect Disord. 2013;150:823–8.PubMedCrossRefPubMedCentralGoogle Scholar
  291. Turecki G, Grof P, Grof E, et al. Mapping susceptibility genes for bipolar disorder: a pharmacogenetic approach based on excellent response to lithium. Mol Psychiatry. 2001;6:570–8.PubMedCrossRefPubMedCentralGoogle Scholar
  292. Van Den Bossche MJ, Strazisar M, De Bruyne S, et al. Identification of a CACNA2D4 deletion in late onset bipolar disorder patients and implications for the involvement of voltage-dependent calcium channels in psychiatric disorders. Am J Med Genet B Neuropsychiatr Genet. 2012;159B:465–75.CrossRefGoogle Scholar
  293. Verdolini N, Dean J, Elisei S, et al. Bipolar disorder: the importance of clinical assessment in identifying prognostic factors—an audit. Part 1: an analysis of potential prognostic factors. Psychiatr Danub. 2014;26(Suppl 1):289–300.PubMedPubMedCentralGoogle Scholar
  294. Verdoux H, Mury M, Besancon G, et al. Comparative study of substance dependence comorbidity in bipolar, schizophrenic and schizoaffective disorders. Encephale. 1996;22:95–101.PubMedPubMedCentralGoogle Scholar
  295. Versace A, Almeida JR, Hassel S, et al. Elevated left and reduced right orbitomedial prefrontal fractional anisotropy in adults with bipolar disorder revealed by tract-based spatial statistics. Arch Gen Psychiatry. 2008;65:1041–52.PubMedPubMedCentralCrossRefGoogle Scholar
  296. Vieta E, Suppes T. Bipolar II disorder: arguments for and against a distinct diagnostic entity. Bipolar Disord. 2008;10:163–78.PubMedCrossRefGoogle Scholar
  297. Vieta E, Gasto C, Otero A, et al. Differential features between bipolar I and bipolar II disorder. Compr Psychiatry. 1997;38:98–101.PubMedCrossRefGoogle Scholar
  298. Vieta E, Sanchez-Moreno J, Lahuerta J, et al. Subsyndromal depressive symptoms in patients with bipolar and unipolar disorder during clinical remission. J Affect Disord. 2008;107:169–74.PubMedCrossRefGoogle Scholar
  299. Vinberg M, Mikkelsen RL, Kirkegaard T, et al. Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder: a naturalistic study. J Affect Disord. 2017;208:521–7.PubMedCrossRefGoogle Scholar
  300. Wang Z, Li Z, Chen J, Huang J, et al. Association of BDNF gene polymorphism with bipolar disorders in Han Chinese population. Genes Brain Behav. 2012;11:524–8.PubMedCrossRefGoogle Scholar
  301. Washizuka S, Ikeda A, Kato N, et al. Possible relationship between mitochondrial DNA polymorphisms and lithium response in bipolar disorder. Int J Neuropsychopharmacol. 2003;6:421–4.PubMedCrossRefGoogle Scholar
  302. Wehr TA, Sack DA, Rosenthal NE, et al. Rapid cycling affective disorder: contributing factors and treatment responses in 51 patients. Am J Psychiatry. 1988;145:179–84.PubMedCrossRefGoogle Scholar
  303. Welge JA, Keck PE Jr, Meinhold JM. Predictors of response to treatment of acute bipolar manic episodes with divalproex sodium or placebo in 2 randomized, controlled, parallel-group trials. J Clin Psychopharmacol. 2004;24:607–12.PubMedCrossRefGoogle Scholar
  304. Wilson S, Sponheim SR. Dimensions underlying psychotic and manic symptomatology: extending normal-range personality traits to schizophrenia and bipolar spectra. Compr Psychiatry. 2014;55:1809–19.PubMedCrossRefGoogle Scholar
  305. Wu JC, Kelsoe JR, Schachat C, et al. Rapid and sustained antidepressant response with sleep deprivation and chronotherapy in bipolar disorder. Biol Psychiatry. 2009;66:298–301.PubMedCrossRefGoogle Scholar
  306. Xiang YT, Zhang L, Wang G, et al. Sociodemographic and clinical features of bipolar disorder patients misdiagnosed with major depressive disorder in China. Bipolar Disord. 2013;15:199–205.PubMedCrossRefGoogle Scholar
  307. Yildiz A, Sachs GS. Age onset of psychotic versus non-psychotic bipolar illness in men and in women. J Affect Disord. 2003;74:197–201.PubMedCrossRefGoogle Scholar
  308. Yildiz A, Nemeroff C, Ruiz P, editors. The bipolar book: history, neurobiology, and treatment. New York: Oxford University Press; 2015.Google Scholar
  309. Zander C, Schurhoff F, Laurent C, et al. CAG repeat sequences in bipolar affective disorder: no evidence for association in a French population. Am J Med Genet. 1998;81:338–41.PubMedCrossRefGoogle Scholar
  310. Zeschel E, Correll CU, Haussleiter IS, et al. The bipolar disorder prodrome revisited: is there a symptomatic pattern? J Affect Disord. 2013;151:551–60.PubMedCrossRefGoogle Scholar
  311. Zhang HY, Ishigaki T, Tani K, et al. Serotonin2A receptor gene polymorphism in mood disorders. Biol Psychiatry. 1997;41:768–73.PubMedCrossRefGoogle Scholar
  312. Zhang X, Zhang C, Wu Z, et al. Association of genetic variation in CACNA1C with bipolar disorder in Han Chinese. J Affect Disord. 2013;150:261–5.PubMedCrossRefGoogle Scholar
  313. Zuncheddu C, Carpiniello B. Sexual dysfunctions and bipolar disorder: a study of patients submitted to a long-term lithium treatment. Clin Ter. 2006;157:419–24.PubMedGoogle Scholar
  314. Zutshi A, Reddy YC, Thennarasu K, et al. Comorbidity of anxiety disorders in patients with remitted bipolar disorder. Eur Arch Psychiatry Clin Neurosci. 2006;256:428–36.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Jessica Dagani
    • 1
  • Ross J. Baldessarini
    • 2
    • 3
  • Giulia Signorini
    • 1
  • Olav Nielssen
    • 4
    • 5
    • 6
  • Giovanni de Girolamo
    • 1
    Email author
  • Matthew Large
    • 5
    • 7
  1. 1.Unit of Psychiatric Epidemiology and EvaluationIRCCS St John of God Clinical Research CenterBresciaItaly
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.International Consortium for Bipolar and Psychotic Disorder Research, Mailman Research Center, McLean HospitalBelmontUSA
  4. 4.Macquarie UniversitySydneyAustralia
  5. 5.School of PsychiatryUniversity of New South WalesSydneyAustralia
  6. 6.St Vincents HospitalSydneyAustralia
  7. 7.Prince of Wales Hospital SydneySydneyAustralia

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