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Bipolar Disorder

  • Leonardo Tondo
  • Matthew J. Albert
  • Alexia E. Koukopoulos
  • Christopher Baethge
  • Ross J. Baldessarini
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

The 19th-century concept of manic-depressive illness was separated into the distinct syndromes of bipolar disorder (BPD) and recurrent major depression in the mid-20th century. BPD is an episodic illness characterized by acute depressive, manic, or mixed states of variable frequency, duration and severity, and often with psychotic features, with intervals of full or partial recovery. Modern diagnostic systems recognize three forms: bipolar I (mania and usually also depression), bipolar II (recurrent depression and hypomania), and cyclothymia (moderate, continuous mood swings). BPD is associated with variable dysfunction and excess mortality, with a 20-fold increased risk of suicide. Lifetime prevalence of type I BPD is approx 1.2%, but including type II, cyclothymia, juvenile variants, and proposed “bipolar spectrum” disorders yields total rates at least 5%. Heritability of risk for BPD is supported by family, twin, and some adoption studies, but specific genetic factors are not firmly identified. Biological investigations in BPD have documented disturbed biorhythms; knowledge of actions of mood-altering medicines has encouraged speculation about biochemical factors, and brain-imaging technologies are being applied intensively to seek structural or functional differences unique to patients with BPD. However, a BPD-specific pathophysiology has not been defined. Clinical care of patients with BPD is complex and challenging. Risks are associated with under- or overtreating with mood-altering agents. Treatment of bipolar depression remains particularly unsatisfactory. Overuse of antidepressants can induce mixed states, mania, or rapid-cycling, and the adverse sedative, neurological, and metabolic effects of some antipsychotic agents and anticonvulsants can be intolerable. Modern therapeutic management is based on long-term efforts to stabilize mood, optimize functioning and quality of life, and reduce risks of premature mortality with combinations of mood-stabilizing medicines and supportive psychosocial care.

Key Words

Anticonvulsants antidepressants antipsychotics bipolar disorder depression disability lithium mania manic-depressive illness mortality psychoeducation psychosis suicide 

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Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Leonardo Tondo
    • 1
    • 2
  • Matthew J. Albert
    • 3
  • Alexia E. Koukopoulos
    • 3
  • Christopher Baethge
    • 4
    • 5
  • Ross J. Baldessarini
    • 4
  1. 1.Department of PsychologyUniversity of CagliariCagliari, Sardinia
  2. 2.Centro Lucio BiniStanley Medical Research CenterCagliari, Sardinia
  3. 3.Department of PsychiatryUniversity of Rome at San Andrea Hospital and Centro Lucio BiniRomeItaly
  4. 4.Department of Psychiatry, McLean HospitalHarvard Medical SchoolBoston
  5. 5.Department of PsychiatryFree University of BerlinBerlinGermany

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