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The importance of making the diagnosis of bipolar disorder symptoms and distinguishing it from unipolar depression is self-evident, but also highlighted by the findings of several recent outcome studies. First, bipolar spectrum disorder (bipolar I, II, and NOS disorders as well as cyclothymia) is common and a global public health problem.[Notes 1,2] Using the MDQ to screen for bipolar disorder symptoms in a US national community sample, Hirschfeld and colleagues [Note 2] found that the lifetime prevalence was 3.4%. Individuals with bipolar disorder symptoms in this survey reported significantly more difficulties with work-related performance, social and leisure time activities, and family and interpersonal interactions than nonspectrum respondents.[Note 3] Women with bipolar spectrum disorder reported significantly more bipolar disorder symptoms such disruption in family and social life, and men reported significantly more frequent time in jail, arrested, or convicted for criminal behavior.
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MacQueen and colleagues [Note 4] reported that the number of bipolar depressive, but not manic, episodes was the strongest determinant of functioning and well-being in patients with bipolar disorder symptoms. Similarly, Altshuler and colleagues Note [5] found that chronic subsyndromal depressive symptoms were the strongest predictor of functional impairment in bipolar disorder. The problem of persistent subsyndromal depressive symptoms in patients with bipolar disorder was also identified in 2 other studies.[Notes 6,7] Judd and colleagues,[Note 6] in a longitudinal follow-up study of 86 patients with bipolar II disorder, assessed weekly for an average of 13 years, found that most patients spent most of the time not manic, depressed, or well, but rather experiencing subsyndromal depressive symptoms. Benazzi [Note 7] reported that 45% of patients with level II bipolar disorder symptoms had residual depressive symptoms for more than 2 years from their index depressive episode.
These persistent residual bipolar disorder symptoms were significantly correlated with illness duration and number of mood episode recurrences.
Since mood episodes are likely to recur in bipolar disorder symptoms, identifying signs of depressive episode recurrence can assist in rapid intervention. Two studies recently examined prodromal depressive symptoms in bipolar disorder.[Notes 8,9] Jackson and colleagues [Note 8] found the 4 most common prodromal bipolar disorder symptoms reported in the literature to be mood change (48%), psychomotor symptoms (41%), increased anxiety (36%), and appetite change (36%). Keitner and colleagues [Note 9] interviewed 74 patients with bipolar I disorder and their families to identify prodromal symptoms of bipolar depression. They found some interesting similarities and differences in perception and recognition of such bipolar disorder symptoms.
In summary, the diagnosis of bipolar depression is an important consideration in patients presenting with depressive symptoms. The importance of accurate diagnosis rests not only with providing appropriate treatment, but also in avoiding potentially destabilizing treatment. Screening tools and careful diagnostic personal and family history can increase the sensitivity for detecting bipolar depression. Treating to full remission of bipolar disorder symptoms is especially critical to avoid the long-term debilitating effects of chronic, residual subsyndromal depression.
Learn more about Bipolar Disorder Symptoms here.
Notes to this article on Bipolar Disorder Symptoms:
1. Murray CJL, Lopez AD. The Global Burden of Disease: Summary. Cambridge, Mass: Harvard University Press; 1996.
2. Hirschfeld RMA, Calabrese JR, Weisman MM, et al. Screening for bipolar disorder in the community. J Clin Psychiatry. 2003;64:53-59.
3. Calabrese JR, Hirschfeld RMA, Reed M, et al. Impact of bipolar disorder on a U.S. community sample. J Clin Psychiatry. 2003;64:425-432. Abstract
4. MacQueen GM, Young RT, Robb JC, et al. Effect of number of episodes on wellbeing and functioning of patients with bipolar disorder. Acta Psychiatr Scand. 2000;101:374-381. Abstract
5. Altshuler LL, Gitlin MJ, Mintz J, et al. Subsyndromal depression is associated with functional impairment in patients with bipolar disorder. J Clin Psychiatry. 2002;63:807-811. Abstract
6. Judd LL, Akiskal HS, Schettler PJ, et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003;60:261-269. Abstract
7. Benazzi F. Residual depressive symptoms in bipolar depression [letter]. Am J Psychiatry. 2002;159:882.
8. Jackson A, Cavanaugh J, Scott J. A systematic review of manic and depressive prodromes. J Affect Disord. 2003;74:209-217. Abstract
9. Keitner GI, Solomon DA, Ryan CE, et al. Prodromal and residual symptoms in bipolar I disorder. Compr Psychiatry. 1996;37:362-367. Abstract
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