Clinical correlates of seasonality in bipolar disorder: A specifier that needs specification?

Abstract

Objective Seasonal pattern (SP) is a bipolar disorder (BD) specifier that indicates a tendency towards affective relapses during specific moments of the year. SP affects 15%–25% of BD patients. In the past, SP was applied only to depressive relapses while, in DSM‐5, SP may be applied to both depressive and (hypo)manic episodes. We examined the association between different clinical correlates of BD and SP according to its current definition in a cohort of patients with BD type I (BDI) and II (BDII). Methods Patients were recruited from a specialized unit and assessed according to the season of relapse and type of episode per season. SP and non‐SP patients were compared looking into sociodemographic and clinical correlates. Significant variables at univariate comparisons were included in multivariate logistic regression with SP as the dependent variable. Results 708 patients were enrolled (503 BDI, 205 BDII), and 117 (16.5%) fulfilled DSM‐5 criteria for SP. The mean age was 45.3 years (SD = 14.18), and 389 were female (54.9%). The logistic regression model included a significant contribution of BDII (OR = 2.23, CI 1.4–3.55), family history of mood disorder (OR = 1.97, CI 1.29–3.01), undetermined predominant polarity (OR = 0.44, CI 0.28–0.70), and aggressive behavior (OR = 0.42, CI 0.23–0.75). Conclusion Our results outline a novel positive association of SP with undetermined predominant polarity, BDII, family history of mood disorder, and with fewer aggressiveness‐related symptoms. Seasonality is associated with a biphasic pattern with similar dominance of (hypo)mania and depression and is more frequent in BDII as compared to BDI. Seasonal episodes may be easier to predict, but difficult to prevent.

Which mixed depression model? A comparison between DSM‐5‐defined mixed features and Koukopoulos' criteria

“…The patients' characteristics included in the regression model were selected a priori among the available variables describing the clinical course of the illness or recognized as related to bipolarity 1,30–33 . These variables were: gender, age, age at disorder onset, family history for mood disorder, current suicidal risk (dichotomizing the related Mini international Neuropsychiatric Interview 19 ), lifetime suicide attempts, previous hospitalizations, severity of the illness (splitting the Clinical Global Impression severity CGI‐S score), co‐occurrent Cluster B Personality Disorder or Substance Use Disorder or Anxiety Disorder, impulsivity levels, 27 and seasonality pattern 28 …”

Association between polarity of first episode and solar insolation in bipolar I disorder

“…A seasonal analysis was not completed due to the inclusion of both tropical and non-tropical locations in the dataset. In other research, a seasonal pattern was found in about one-fourth of patients with BD, occurring more frequently in BD II [112,113]. Although the diagnosis was based on the DSM-IV or DSM-5 criteria, the process of data gathering was not standardized across collection sites.…”

Diagnostic considerations in identifying bipolar disorder in primary care

“…For example, depressive symptoms may occur more frequently in the winter, while manic and hypomanic symptoms may occur more frequently in the spring, summer, and early fall 6. A recent study found that seasonal variations occur more frequently in individuals with bipolar II, rather than bipolar I, disorder 7. Asking individuals if their mood symptoms markedly increase at certain times of the year can assist in identification of BD.…”