A computer-aided search of MEDLINE database for 1966 to November, 2000, was done with the subject headings “bipolar disorder” and various subjects pertinent for this review. A review of identified report bibliographies and an intensive search by hand with standard textbooks on bipolar disorder was also done. Because of the large number of articles identified and the limitations for quoting references in this article, authors made selections according to the valid criteria of what is judged
SeminarBipolar disorder
Section snippets
Diagnostic features
There are two main types of mood disorder, each with different sex and genetic characteristics: major depressive (unipolar) and manic-depressive (bipolar). Bipolar disorder can be further subdivided into bipolar I disorder, a recurrent mood disorder, featuring either one or more manic or mixed episodes, or both manic and mixed episodes and at least one major depressive episode, or bipolar II disorder, characterised by one or more episodes of major depression and at least one hypomanic episode (
Course of illness
The peak age of onset falls between age 15 and 24 years, although there is often a 5–10-year interval before treatment is obtained.1 If the onset of symptoms occurs after age 60 years, the condition is probably secondary to other medical causes—eg, neurological (trauma, neoplasm, multiple sclerosis, epilepsy), endocrine (hyperthyroidism, Cushing's disease), infectious (AIDS), inflammatory (systemic lupus erythematosus) disorders. Bipolar disorder has a high rate of recurrence; more than 90% of
Pathophysiology
In-vivo biochemical studies, neuropathological studies, and studies with new neuroimaging techniques are being done to try to understand the cause of bipolar disease.7, 8, 9
One traditional line of research focuses on potential changes to the function of neurotransmitters such as norepinephrine, dopamine, and serotonin. In the 1970s, many thought that bipolar disorder was caused by an imbalance between cholinergic and catecholaminergic neuronal activity, since centrally active cholinergic
Genetic factors
Results of family-studies and twin-studies suggest a genetic basis for bipolar disorder.22 The lifetime risk of bipolar disorder in first-degree relatives of a bipolar patient is 40–70% for a monozygotic twin and 5–10% for all other first-degree relatives. However, the mode of inheritance seems complex, indicating a non-Mendelian inheritance and a contribution by several genes. Genomic imprinting and mitochondrial inheritance are also thought to contribute to the inheritance pattern. Because of
Management
In view of the devastating course of bipolar disorder, prevention strategies that are effective, evidence-based, and safe need to be developed. In the meantime, the choice of treatments for bipolar disorder is constantly being revised, as new drugs become available and anticonvulsants take on an increasingly important role. New treatment regimens to counteract resistance to primary treatment or prophylaxis have also been developed. Here, we review and comment on evidence available for treatment
Search strategy
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