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Objectives There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk ( BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. Methods This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM- IV manic symptoms for more than four days, in line with the DSM- IV definition of hypomania/mania. Results A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non- BAR group [χ2(1) = 5.38, p = 0.020]. Four out of these five converters had a DSM- IV diagnosis of bipolar I or bipolar II disorder. Conclusions These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods. [ABSTRACT FROM AUTHOR]

Objective Bipolar disorder is a multifaceted illness and there is often a substantial delay between the first onset of symptoms and diagnosis. Early detection has the potential to curtail illness progression and disorder-associated burden but it requires a clear understanding of the initial bipolar prodrome. This article summarizes the phenomenology of bipolar disorder with an emphasis on the initial prodrome, the evolution of the illness, and the implications for prevention and early intervention. Methods A literature review was undertaken using Medline, Web of Science, and a hand search of relevant literature using keywords (e.g., phenomenology, initial or early symptoms, risk factors, and predictors/prediction). Findings from the literature were reviewed and synthesized and have been put into a clinical context. Results Bipolar disorder is a recurrent, persistent, and disabling illness that typically develops in adolescence or early adulthood. The literature search yielded 28 articles, in which mood lability, nonspecific, non-mood symptoms, and cyclothymic temperament were the most cited prodromal features. Conclusions A small number of key prospective studies have provided evidence in support of an initial bipolar prodrome; however, methodological differences across studies have prohibited its clear delineation. It is, therefore, not currently possible to anticipate those who will develop bipolar disorder solely on the basis of early phenomenology. Accurate characterization of the bipolar disorder prodrome through high-quality, prospective research studies with adequate control groups will ultimately facilitate prompt and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Background: The multiple factors likely to influence estimates of the prevalence of bipolar spectrum disorders (BSD) make it difficult to determine its actual prevalence. A systematic review was undertaken to explore the availability and quality of epidemiological data for BSD. This will inform the Global Burden of Disease 2010 study. Methods: Electronic databases searched were Medline, PsycInfo and EMBASE using search terms generated in consultation with a research librarian. Reference lists were searched and experts contacted to obtain articles not identified through the database search. Prevalence data pertaining to point, 6month or 12month prevalence of BSD were sought. Results: The mean pooled prevalence was 0.741% (point) and 0.843% (6/12months). The study region, response rate and diagnostic tool had a significant impact on prevalence estimates but there were no significant differences in prevalence across prevalence types, gender, sample coverage, economic status and bipolar subtype. Little or no prevalence data was apparent for many regions of the world. Also, the entire bipolar spectrum was rarely assessed. Limitations: Although stringent quality assurance methodology was used, controlling for all sources of variability around the pooled prevalence was not possible. Conclusions: This systematic review has made significant contributions to the epidemiological profile of BSD. Prevalence estimates will be used to generate estimates of burden for BSD in the global burden of disease 2010 study. [Copyright &y& Elsevier]

Background: Previous studies have detected different variables influencing the attitude towards mentally ill individuals but they have never addressed mania. Furthermore, it is not known whether the same factors affect attitudes towards individuals experiencing major depressive or manic episodes. Aims: Besides factors such as familiarity with mental illness, we were interested whether vulnerability to psychosis and mood disorders as well as social desirability can affect attitudes towards major depressive episodes and manic episodes. Methods: Subjects were presented with a case vignette describing an individual experiencing either a major depressive episode or a manic episode (n = 188, age 16-34 years). Their attitudes towards that person were assessed. Furthermore, factors potentially influencing these attitudes have been assessed such as personal vulnerability factors (i.e. cyclothymia and magical ideation) and social desirability bias. Results: Familiarity with the phenomenon of mental illness turned out to influence the attitude towards affective episodes, whereas the influence of the other potential predictors such as their own experience of affective or schizotypal symptoms failed to appear to be of significance. Conclusions: Whereas 'familiarity' turned out to be a factor positively influencing the attitude towards depression, it turned out to have a rather negative influence on the attitude towards mania. This result could have important implications for anti-stigma campaigns. [ABSTRACT FROM AUTHOR]

Abstract: Although first detailed descriptions of what we today term “bipolar disorders” are generally attributed to E. Kraepelin [Kraepelin, E., 1899 (1976 tr). Manic depressive insanity and paranoia. (reprint of English translation). Arno, New York], a review of French psychiatric literature from Esquirol to the middle of 20th century reveals major clinical contributions to the development of the concept of cyclic mood disorders, their phenomenology and classification as embodied in DSM-IV. The main treatise was published by the Paris psychiatric schools of Salpêtrière, Bicêtre, Charenton, Sainte-Anne and Vanves. Already much before Kraepelin, French authors had described most symptoms and the course of future DSM-IV bipolar, manic, major depressive [Falret, J.-P., 1854. De la folie circulaire ou forme de maladie mentale caracterisée par l''alternative régulière de la manie et de la mélancolie, Bull. Acad. Méd. XIX, 382–400.; Baillarger, J., 1854. Note sur un genre de folie dont les accès sont caractérisés par deux périodes régulières, l''une de dépression, l''autre d''excitation, Bull. Acad. Méd. XIX, 340 et Ann. Méd. Psychol. XII, 369], hypomanic and mixed episodes [Falret, J., 1861. Principes à suivre dans la classification des maladies mentales, Ann. Méd. Psychol. XIX, 145.; Falret, J., 1866, 1867. La folie raisonnante ou folie morale, Ann. Méd. Psychol. XXIV, 382, XXV, 68], as well as – under other names – the characteristics of bipolar II disorder, various specifiers describing mood episode and course of recurrent episodes [Ritti, A., 1883. Traité clinique de la folie à double forme (folie, circulaire, délire à formes alternes). Doin, Paris]. The synthesis of these clinical observations led to Magnan''s “intermittent madness” (1893), a precursor of Kraepelin''s “manic-depressive psychosis”. After 1899, French authors generally adhered to their classification of autonomous depressive disorder (melancholia), as distinct from manic-depressive insanity, thereby foreshadowing (much before the work of such Germanophone authors as Leonhard [Leonhard, K., 1957 (1979 tr). Aufteilung der endogenen Psychosen und ihre differenzierte Atiologie. Berlin: Akademie-Verlag; English transl. by R. Berman, Irvington, New York] and Angst [Angst, J., 1966. Zur Atiologie and Nosologie endogener depressiver Psychosen. Springer: Berlin, Heidelberg, New York]) the DSM-IV dichotomy of depressive (unipolar)/bipolar disorders (UP–BP dichotomy). It is further noteworthy that Falret [Falret, J.-P., 1854. De la folie circulaire ou forme de maladie mentale caracterisée par l''alternative régulière de la manie et de la mélancolie, Bull. Acad. Méd. XIX, 382–400] had hinted at the possibility that short hypomanic episodes at the tail end of depressive episodes in ambulatory patients represented formes frustes of circular insanity, thereby anticipating the latest developments in bipolarity — what today is considered the softer end of the bipolar spectrum. The UP–BP dichotomy and the bipolar spectrum today are the two main competing nosologic conceptual frames for mood disorders in both American and European psychiatry — and world psychiatry at large. [Copyright &y& Elsevier]

Although melancholy has been the focus of a large number of studies, this has not been the case for mania and even less for the passage from melancholy to mania, more particularly the passage from a depressive state to a self-triumphant state, the latter expression being used by Freud to characterize states of self-induced excitement or elation. On the basis of the specific pathological model of the passage from melancholy to mania, the present study has therefore attempted to determine the underlying metapsychological processes for what are commonly termed cyclic disorders or changes of mood, the dynamics of which is connected with the types of interaction between the various elements within the psychic system. The theoretical approach that has been adopted is essentially psychoanalytical, and in parallel to Freud’s analysis of this state, we are already able to delineate the context in which cyclic disorders occur: it consists of an “interior theatre”, and on its stage the self in its relation to the ideal self which continues to play the same role as it had previously assumed in its relation to the exterior object, i.e. before it had incorporated the exterior object and allowed it to take its place. The self thus finds itself in the position of the object confronted with its ideal self, and the omnipotence of the latter henceforth determines the course of their relations.Melancholy and mania are thus related to the same “complex” and their metapsychological difference lies in the fate of the introjected object: if in the case of melancholy the object has taken over the role assumed by the self, what has become of the self in the manic state? In the present study, the hypothesis proposed is that of committing an intrapsychic act, an indefinitely perpetrated crime, i.e. the act of murdering the object constructed on the basis of a working model of mourning which requires that the mourner “strikes a fatal blow” for a second time in order to actively confirm the subject’s own satisfaction at remaining alive. However, the state of manic exhaltation, just like the state of melancholic depression, is linked to the conflict between the self and its ideal self and to the law of an alter ego that is always as cruel toward a mythical lost object which remains a cause of irrepressible nostalgia. [Copyright &y& Elsevier]

It is estimated that only one-third of the people with bipolar disorder are correctly diagnosed, and even fewer are receiving appropriate treatment. This information is of concern, particularly in light of emerging data reflecting the potential negative consequences of failed or delayed diagnosis and lack of focused treatment. The article attempts to illuminate this complex disorder by describing the bipolar spectrum through a review of the criteria for diagnosis, aswell as practical advice on improving the detection of the disorder. Treatment options for bipolar disorder, with a focus on the latest pharmacological evidence base, as well as clinical recommendations regarding the safe and effective use of mood stabilizers and antidepressants are presented. [ABSTRACT FROM PUBLISHER]