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Bipolar disorders

Nature Reviews Disease Primers volume 4, Article number: 18008 (2018) Cite this article

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Abstract

Bipolar disorders are chronic and recurrent disorders that affect >1% of the global population. Bipolar disorders are leading causes of disability in young people as they can lead to cognitive and functional impairment and increased mortality, particularly from suicide and cardiovascular disease. Psychiatric and nonpsychiatric medical comorbidities are common in patients and might also contribute to increased mortality. Bipolar disorders are some of the most heritable psychiatric disorders, although a model with gene–environment interactions is believed to best explain the aetiology. Early and accurate diagnosis is difficult in clinical practice as the onset of bipolar disorder is commonly characterized by nonspecific symptoms, mood lability or a depressive episode, which can be similar in presentation to unipolar depression. Moreover, patients and their families do not always understand the significance of their symptoms, especially with hypomanic or manic symptoms. As specific biomarkers for bipolar disorders are not yet available, careful clinical assessment remains the cornerstone of diagnosis. The detection of hypomanic symptoms and longtudinal clinical assessment are crucial to differentiate a bipolar disorder from other conditions. Optimal early treatment of patients with evidence-based medication (typically mood stabilizers and antipsychotics) and psychosocial strategies is necessary.

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Figure 1: Main subtypes of bipolar disorder.
Figure 2: Multifactorial model of bipolar disorders.
Figure 3: Polarity index.
Figure 4: Sources of cognitive dysfunction.

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Acknowledgements

E.V. is grateful for the support received from the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness of Spain (PI 12/00912), integrated into the Plan Nacional de I+D+I and co-funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER); Centro para la Investigación Biomédica en Red de Salud Mental (CIBERSAM), Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2014_SGR 398), the Seventh European Framework Programme (ENBREC); and the Stanley Medical Research Institute. M.B. is supported by an Australian National Health and Medical Research Council Senior Principal Research Fellowship (GNT1059660) and has received grants from the US NIH, the Australian Cooperative Research Centre, the Simons Autism Foundation, the Cancer Council of Victoria, the Stanley Medical Research Foundation, the Medical Benefits Foundation, Beyond Blue, Rotary Health and the Geelong Medical Research Foundation. T.G.S. receives funding from Deutsche Forschungsgemeinschaft (DFG; SCHU 1603/5-1 and SCHU 1603/7-1), the German Federal Ministry of Education and Research (BMBF; 01ZX1314K, 01EE1404H and 01EE1404H), and the Dr Lisa Oehler Foundation (Germany). A.F.C. is supported by a research fellowship award from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; Brazil). T.S. has received grant funding from the Stanley Medical Research Institute and Palo Alto Health Sciences Services. J.R.C. has received federal funding from the US Department of Defense, the US Health Resources Services Administration and the US National Institute of Mental Health. K.G. has received grant support from the Brain and Behaviour Research Foundation and the Cleveland Foundation. K.W.M. is supported by the Lundbeck Foundation Fellowship (R21520154121). I.G. is supported by the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness of Spain (Juan Rodés Contract (JR15/00012) and a grant (PI16/00187)), integrated into the Plan Nacional de I+D+I and co-funded by ISCIII-Subdirección General de Evaluación and FEDER.

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Authors and Affiliations

  1. Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain

    Eduard Vieta & Iria Grande

  2. IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia

    Michael Berk

  3. Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, Victoria, Australia

    Michael Berk

  4. The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia

    Michael Berk

  5. Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich, Munich, Germany

    Thomas G. Schulze

  6. Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany

    Thomas G. Schulze

  7. Human Genetics Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA

    Thomas G. Schulze

  8. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA

    Thomas G. Schulze

  9. Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany

    Thomas G. Schulze

  10. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    André F. Carvalho

  11. Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada

    André F. Carvalho

  12. Department of Psychiatry and Behavioral Sciences, Bipolar and Depression Research Program, School of Medicine, Stanford University, Stanford, CA, USA

    Trisha Suppes

  13. Bipolar and Depression Research Program, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Trisha Suppes

  14. Mood and Anxiety Clinic, The Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Joseph R. Calabrese & Keming Gao

  15. University Hospital Cleveland Medical Center, Cleveland, OH, USA

    Joseph R. Calabrese & Keming Gao

  16. Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    Kamilla W. Miskowiak

  17. Department of Psychology, University of Copenhagen, Copenhagen, Denmark

    Kamilla W. Miskowiak

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  1. Eduard Vieta
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Contributions

Introduction (E.V.); Epidemiology (M.B.); Mechanisms/pathophysiology (T.G.S., A.F.C. and I.G.); Diagnosis, screening and prevention (T.S.); Management (J.R.C., K.G. and I.G.); Quality of life (K.W.M.); Outlook (E.V.); and Overview of Primer (E.V.).

Corresponding author

Correspondence to Eduard Vieta.

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Competing interests

E.V. has received grants and honoraria from AstraZeneca, Ferrer, Forest Research Institute, Gedeon Richter, GlaxoSmithKline, H. Lundbeck, Janssen, Otsuka, Pfizer, Sanofi-Aventis, Sunovion and Takeda. M.B. has received research grants from Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, the Meat and Livestock Board, Mayne Pharma, Novartis, Organon, Servier and Woolworths. M.B. has also acted as a speaker for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, H. Lundbeck, Janssen-Cilag, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth and has served as a consultant to AstraZeneca, Bioadvantex Pharma, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, H. Lundbeck, Janssen-Cilag, Merck and Servier. T.S. has received grant funding from Elan Pharma International, Merck and Sunovion and has received personal fees from AstraZeneca, CMEology, Global Medication Education, H. Lundbeck, Medscape Education, Merck and Sunovion, and has received royalties from Jones & Bartlett Learning and UpToDate. J.R.C. has received grant support from Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Cephalon (now Teva Pharmaceutical Industries), Dainippon Sumitomo Pharma, Eli Lilly, GlaxoSmithKline, H. Lundbeck, Intra-Cellular Therapies, Janssen, Pfizer, Sunovion and Takeda. J.R.C. has also served as a consultant, advisory board member and speaker for Abbott Laboratories, Allergan, AstraZeneca, Bristol-Myers Squibb, Cephalon (now Teva Pharmaceutical Industries), Dainippon Sumitomo Pharma, GlaxoSmithKline, H. Lundbeck, Janssen, Merck & Co., Otsuka, Pfizer, Repligen, Servier, Solvay, Sunovion and Takeda. K.G. has been on a speakers’ bureau and an advisory board of Sunovion and has received grant support from AstraZeneca. K.W.M. has received consultancy fees in the past 3 years from Allergan and H. Lundbeck. I.G. has consulted for Ferrer and has been a speaker for Ferrer and Janssen-Cilag. T.G.S. and A.F.C. declare no competing interests.

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Vieta, E., Berk, M., Schulze, T. et al. Bipolar disorders. Nat Rev Dis Primers 4, 18008 (2018). https://doi.org/10.1038/nrdp.2018.8

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