Predominant Polarity and Polarity Index of Maintenance Treatments for Bipolar Disorder: A Validation Study in a Large Naturalistic Sample in Italy

Albert, Umberto; Manchia, Mirko; Burato, Sofia; Carpiniello, Bernardo; Salvo, Gabriele Di; Pinna, Federica; Rosso, Gianluca; Maina, Giuseppe

doi:10.3390/medicina57060598

Cited by 4 publications

(6 citation statements)

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“…Following the final screening based on full texts, 28 studies met the eligibility criteria and were included in the meta-analysis. 12 , 15 – 18 , 30 – 52 A flowchart with details of screening, the study selection process and reasons for exclusion is presented in Fig. 1 .…”

Section: Resultsmentioning

confidence: 99%

“… 50 The majority of studies ( k = 16) were conducted in Europe, i.e. six were from Italy, 30 , 38 – 41 , 45 three from Spain, 15 , 46 , 49 two from France 32 , 42 and Germany, 51 , 52 and one each from Belgium, 18 Finland 17 and Greece. 31 Five studies were conducted in Asia: four in India 16 , 36 , 44 , 47 and one in Singapore; 37 and five studies in South America, i.e.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-four studies 12,[15][16][17][18][30][31][32][34][35][36][37][38][39][41][42][43][44][45][47][48][49][50][51] including 7381 individuals with bipolar disorder were included in the meta-analyses on weighted prevalence of mPP and dPP. We found similar rates of mPP (weighted prevalence = 30.0%, 95% CI: 23.1 to 37.4%; Supplementary Fig.…”

Section: Prevalence Of Hypomanic/manic and Depressive Predominant Pol...mentioning

confidence: 99%

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Prevalence and correlates of manic/hypomanic and depressive predominant polarity in bipolar disorder: systematic review and meta-analysis

Bartoli,

Bassetti,

Gazzola

et al. 2024

BJPsych open

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Background Identification of the predominant polarity, i.e. hypomanic/manic (mPP) or depressive predominant polarity (dPP), might help clinicians to improve personalised management of bipolar disorder. Aims We performed a systematic review and meta-analysis to estimate prevalence and correlates of mPP and dPP in bipolar disorder. Method The protocol was registered in the Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/8S2HU). We searched main electronic databases up to December 2023 and performed random-effects meta-analyses of weighted prevalence of mPP and dPP. Odds ratios and weighted mean differences (WMDs) were used for relevant correlates. Results We included 28 studies, providing information on rates and/or correlates of mPP and dPP. We estimated similar rates of mPP (weighted prevalence = 30.0%, 95% CI: 23.1 to 37.4%) and dPP (weighted prevalence = 28.5%, 95% CI: 23.7 to 33.7%) in bipolar disorder. Younger age (WMD = −3.19, 95% CI: −5.30 to −1.08 years), male gender (odds ratio = 1.39, 95% CI: 1.10 to 1.76), bipolar-I disorder (odds ratio = 4.82, 95% CI: 2.27 to 10.24), psychotic features (odds ratio = 1.56, 95% CI: 1.01 to 2.41), earlier onset (WMD = −1.57, 95% CI: −2.88 to −0.26 years) and manic onset (odds ratio = 13.54, 95% CI: 5.83 to 31.46) were associated with mPP (P < 0.05). Depressive onset (odds ratio = 12.09, 95% CI: 6.38 to 22.90), number of mood episodes (WMD = 0.99, 95% CI: 0.28 to 1.70 episodes), history of suicide attempts (odds ratio = 2.09, 95% CI: 1.49 to 2.93) and being in a relationship (odds ratio = 1.98, 95% CI: 1.22 to 3.22) were associated with dPP (P < 0.05). No differences were estimated for other variables. Conclusions Despite some limitations, our findings support the hypothesis that predominant polarity might be a useful specifier of bipolar disorder. Evidence quality was mixed, considering effects magnitude, consistency, precision and publication bias. Different predominant polarities may identify subgroups of patients with specific clinical characteristics.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Prevalence Of Hypomanic/manic and Depressive Predominant Pol...mentioning

confidence: 99%

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Prevalence and correlates of manic/hypomanic and depressive predominant polarity in bipolar disorder: systematic review and meta-analysis

Bartoli,

Bassetti,

Gazzola

et al. 2024

BJPsych open

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“…Clinical correlates of manic predominant polarity includebut are not limited to -male gender, longer duration of mania, residual manic symptoms, longer duration of euthymia, cyclothymic or hyperthymic temperament, irritability, and cognitive impairment. Clinical correlates of depressive predominant polarity include -but are not limited to -female gender, bipolar II disorder, traumatic events, mixed episodes, higher number of prior mood episodes, and residual depressive symptoms 157,158 .…”

Section: Onset and Clinical Coursementioning

confidence: 99%

“…A clinically relevant course feature in bipolar disorder is the predominant polarity of the mood episodes. Predominant polarity has been defined as a >2:1 ratio of either depressive episodes (depressive predominant polarity) or manic episodes (manic predominant polarity) 157,158 . The proportion of bipolar patients in whom the predominant polarity can be ascertained has been variously estimated from 28 to 100%.…”

Section: Onset and Clinical Coursementioning

confidence: 99%

The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

et al. 2022

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Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multiomic" measures, electronic health records), analyzed using ad vanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at pointofcare is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features -especially during depressive episodes -and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentallyoriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, provid ing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at pointofcare.

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Combining predominant polarity and affective spectrum concepts in bipolar disorder: towards a novel theoretical and clinical perspective

Bartoli,

Malhi,

Carrà

2024

Int J Bipolar Disord

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This is an overview of recent advances on predominant polarity conceptualization in bipolar disorder (BD). Current evidence on its operationalized definitions, possible contextualization within the affective spectrum, along with its epidemiological impact, and treatment implications, are summarized. Predominant polarity identifies three subgroups of patients with BD according to their mood recurrencies: (i) those with depressive or (ii) manic predominance as well as (iii) patients without any preponderance (‘nuclear’ type). A predominant polarity can be identified in approximately half of patients, with similar rates for depressive and manic predominance. Different factors may influence the predominant polarity, including affective temperaments. More generally, affective disorders should be considered as existing on a spectrum ranging from depressive to manic features, also accounting for disorders with ‘ultrapredominant’ polarity, i.e., unipolar depression and mania. While mixed findings emerge on its utility in clinical practice, it is likely that the construct of predominant polarity, in place of conventional differentiation between BD-I and BD-II, may be useful to clarify the natural history of the disorder and select the most appropriate interventions. The conceptualization of predominant polarity seems to reconcile previous theoretical views of both BD and affective spectrum into a novel perspective. It may provide useful information to clinicians for the early identification of possible trajectories of BD and thus guide them when selecting interventions for maintenance treatment. However, further research is needed to clarify the specific role of predominant polarity as a key determinant of BD course, outcome, and treatment response.

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Predominant Polarity and Polarity Index of Maintenance Treatments for Bipolar Disorder: A Validation Study in a Large Naturalistic Sample in Italy

Cited by 4 publications

References 45 publications

Prevalence and correlates of manic/hypomanic and depressive predominant polarity in bipolar disorder: systematic review and meta-analysis

Prevalence and correlates of manic/hypomanic and depressive predominant polarity in bipolar disorder: systematic review and meta-analysis

The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

Combining predominant polarity and affective spectrum concepts in bipolar disorder: towards a novel theoretical and clinical perspective

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