Factores asociados a la polaridad predominante en el trastorno bipolar: una revisión sistemática

García-Jiménez, Jesús; Álvarez-Fernández, Marisol; Aguado-Bailón, Lidia; Gutiérrez‐Rojas, Luis

doi:10.1016/j.rpsm.2017.06.008

Cited by 11 publications

(10 citation statements)

References 48 publications

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“…The current classifications of bipolar disorder (BD) have proved their usefulness in practice, although they provide limited information on certain socio-demographic, clinical and therapeutic variables [1]. For this reason, in the latest version of the DSM it is recommended to use some of the accepted additional coders (for example anxious distress or melancholic relapse characteristics), whose objective is to complement the diagnosis in a direct and simple way, providing data of interest in the approach to these patients [2].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Utility of the Predominant Polarity in Bipolar Disorder Patients

Rojas¹

2018

Bipolar Disord

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Introduction: Current classification of bipolar disorder (BD) in type I or type II may be of little use in routine clinical practice to provide information on relevance epidemiological and clinical variables. New complementary coders like the predominant polarity (PP), which is defined as a clear tendency in the patient to present relapses in the manic polarity predominance (MPP) or in the depressive polarity predominance (DPP) along the disease may be important to develop clinical and pharmacological strategies to prevent any kind of relapse. Objectives: To define the concept of PP and the epidemiological and clinical variables associated with the PP in order to know the clinical implications of that specific diagnosis factor. Methods: We realized a systematic review in the principal medical databases (until June 2016) including key words as "bipolar disorder", "polarity" and "predominant polarity". Results: After apply the inclusion criteria we analysed 16 articles. The MPP was associated with manic onset of illness, history of substance abuse before the beginning of the disease and with a better response to atypical antipsychotics and mood stabilizers. Meanwhile the DPP is related with a depressive onset of the disease, a higher number of relapses, longer acute episodes, and a higher risk of suicide. Also, the delay until the correct diagnosis, the presence of mixed states and the comorbidity with anxiety disorders are more frequents in DPP that shows an increased use of quetiapine and lamotrigine. Conclusion: PP may be useful in the clinical management of BD. Further studies on biological and clinical factors are needed, with a common definition and a unified methodology.

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Section: Introductionmentioning

confidence: 99%

“…In order to gather the most up-to-date information on PP, our research group carried out a systematic review of the most important databases. From the 907 articles that the initial search discovered only 16 that fulfilled the inclusion criteria were selected (this process appears in detail in the original article) [1].…”

Section: Introductionmentioning

confidence: 99%

Clinical Utility of the Predominant Polarity in Bipolar Disorder Patients

Rojas¹

2018

Bipolar Disord

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“…In the literature, many original articles conclude that AO, OP, and PP are associated with important prognostic factors (see below). However, two systematic reviews recently published indicate the existence of some contradictory associations, which could have influenced that they were not finally included in the DS list of the DSM-5 (8,9). Regarding the AO, the meta-analysis of Joslyn et al (9) indicates that patients under 20 years of age at BD onset show more frequently a greater diagnostic delay (10)(11)(12), longer delay in treatment initiation (9)(10)(11)(12)(13)(14), they have more severe depressive symptoms (10)(11)(12)15), high comorbidity with anxiety disorders (15)(16)(17) and higher risk of substance abuse (18,19), all of which are associated with worse clinical course.…”

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confidence: 99%

“…The PP, defined as the tendency to present more frequently manic or depressive decompensations, and the OP or type of polarity of the index episode have been studied in another systematic review (8). The results of this study suggest that patients who are usually decompensated to the manic pole, i.e., manic PP (MPP), usually initiates with a manic episode (22)(23)(24), respond better to atypical antipsychotics and mood stabilizers (25) and they are frequently consumers of toxic substances prior to the onset of BD (24,26,27).…”

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Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder

et al. 2020

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Objective: The aim of this study is to determine the prevalence of three possible diagnostic specifiers, namely predominant polarity (PP) throughout illness, polarity of the first episode and early age at onset, in a sample of bipolar disorder (BD) patients and their association with important socio-demographic, clinical and course-of-illness variables. Methods: A retrospective and naturalistic study on 108 BD outpatients, who were classified according to the PP, polarity of the first episode and early age at onset (≤ 20 years) [vs. late (>20 years)] and were characterized by their demographics, clinical data, functionality and social support, among others features. After bivariate analyses, those variables showing certain association ( P value < 0.25) with the three dependent variables were entered in logistic regression backward selection procedures to identify the variables independently associated with the PP, polarity of the first episode and early age at onset. Results: The sample consisted of 75 women ad 33 men, 74% with type I BD and 26% with type II. Around 70% had depressive PP, onset with a depressive episode and onset after age 20. Depressive PP was independently associated with depressive onset, higher score on the CGI severity scale and work disability. Onset with depressive episode was associated with type II BD, longer diagnostic delay and higher score on family disability. Early age at onset (≤ 20 years) was associate with younger age, longer diagnostic delay, presence of ever psychotic symptoms, current use of antipsychotic drugs and higher social support score. Conclusions: The results of this study show that BD patients with depressive PP, onset with depression and early age at onset may represent greater severity, because they are frequently associated with variables that worsen the prognosis. Our findings match up with the conclusions of two systematic reviews and we also include a disability factor (at family and work) that has not been previously reported. This work contributes to the use of polarity and age at onset in BD patients, as it can become a useful instrument in the prognostic and therapeutic applications.

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