Session II: "Epidemiology/Comorbidity"
Chair: Kathleen R. Merikangas, Ph.D.
Epidemiology of Bipolar Spectrum Disorder in
Community-based Studies
Jules Angst, M.D.
Bibliography
Slide
Presentation
Abstract
Bipolar spectrum disorder is much
more prevalent than generally assumed. It embraces a wide range of hypomanic and
manic syndromes, in most cases associated longitudinally with depression.
Research findings depend heavily on the definition of the bipolar spectrum,
which is still developing and far from being settled. The current threshold of
caseness is arbitrary and not validated, and the definition of milder cases has
changed considerably between DSM-III, DSM-III-R and DSM-IV. Hypomania/mania can
be defined by number of symptoms, length, frequency and the consequences of the
manifestations. The syndrome is currently defined by the presence of 3 (or more)
criterial symptoms. The current minimum 4 day-duration criterion for a hypomanic
episode is not based on empirical grounds. Shorter spells of 1-3 days (brief
hypomania) was therefore investigated in our longitudinal epidemiological study.
Lifetime prevalence rates for
bipolar I disorder in the community range from zero to 1.6% and for bipolar II
disorder from 0.3 to 2.0%. Studies which included other subgroups of the
spectrum reported rates between 3.0 and 5.5%. With the exception of our Zurich
cohort study, which found a rate of 5.5%, there is no prevalence data on DSM-IV
hypomania, and there is none at all on DSM-IV cyclothymic disorder. A gender
difference in prevalence is not proven.
Comorbidity of bipolar disorder
was mainly found with panic disorder, social phobia and substance
abuse/dependence, somatization disorder, personality disorders, suicidality and
delinquency. Clinical studies raise the question of associations with GAD, OCD,
Tourette syndrome, impulse control and eating disorders, ADHD and conduct
disorder.
Comorbidity of Migraine and Affective Disorders
Kathleen R. Merikangas, Ph.D.
Bibliography
Slide
Presentation
Abstract
There is now substantial evidence
for a strong association between depression and migraine in both community and
clinical samples. This presentation reviews this evidence and examines possible
mechanisms for this association in a family study of co-aggregation of migraine
and psychiatric disorders. Migraine was strongly associated with both the
affective and anxiety disorders, with the greatest associations emerging for the
bipolar subtype of depression and for panic/agoraphobia subtype of anxiety
disorders. Affective disorders in probands, particularly those with the bipolar
II subtype, were associated with an increased risk of migraine in relatives.
However, there was no symmetric increased risk of depression among the relatives
of probands with migraine alone. The lack of symmetry of the transmissible
association between migraine and depression and patterns of onset suggest that
migraine and depression are syndromic rather than equivalent expressions of the
same underlying etiologic factors. These findings suggest that further research
should examine differences between comorbid bipolar disorder and migraine in
treatment response, biologic markers, and longitudinal course to determine
whether the familial patterns truly indicate distinct pathways to migraine.
Bipolar Disorder During Adolescence and Young
Adulthood in a Community Sample
Peter M. Lewinsohn, Ph.D.
Bibliography
Daniel N. Klein, Ph.D.
John R. Seeley, M.S.
Slide
Presentation
Abstract
The phenomenology and etiology of juvenile
bipolar disorder poses many important clinical and theoretical issues. With
notable exceptions (e.g., Costello, Angold, Burns et al., 1996), most of our
knowledge about juvenile bipolar disorder is based on clinical samples. Recent
work by Dr. Biederman and his associates (e.g., Biederman, 1998) and by Dr.
Geller and her associates (e.g., Geller et al., 1998) have used operational
definitions of juvenile bipolar disorder which are somewhat different from the
DSM criteria. Both groups suggest that the prevalence of juvenile bipolar
disorder is substantial.
We will present data based on a large (n = 1,507)
community sample who were diagnostically assessed twice during adolescence (with
a one-year interval), and on a stratified random sample of the probands at age
24 (n = 865) and their parents and siblings (n = 2,750). We distinguish between
those who meet full criteria for a diagnosis of bipolar disorder and those who
meet criteria for a distinct period of abnormally and persistently elevated,
expansive or irritable mood plus one or more manic symptoms but not all of the
DSM criteria ("subthreshold bipolar").
Our presentation we will include (a)
epidemiologic information about the prevalence, incidence, and the associated
psychosocial impairments in bipolar disorder and subthreshold bipolar during
adolescence and young adulthood; (b) comorbidity between bipolar disorder and
other Axis I and selected Axis II disorders in the probands and in the
first-degree relatives; (c) familial association between bipolar disorder in the
probands and first-degree relatives; and (d) continuity of bipolar disorder from
adolescence into young adulthood.
Personality Disorder
or Bipolar Illness: New Thoughts
Robert M.A. Hirschfeld, M.D.
Bibliography
Slide
Presentation
Abstract
Bipolar disorder and personality disorders age of onset are very
similar, that is in adolescents and early adulthood. Several personality
disorders, including borderline disorder, involve mood mobility, irritability,
impulsively, risk-taking behavior, and self-destructive behavior. This overlap
in symptomatology has been responsible for misdiagnosis or under-diagnosis of
bipolar disorder in the clinic, and has led to a substantial under-treatment.
When one moves from bipolar I disorder, requiring
a history of mania, to bipolar spectrum disorder, which involves much more
subtle mood changes, the distinction between personality disorder and bipolar
spectrum becomes more difficult.
This presentation will overview this issue,
present new data relevant to this, and make recommendations for research and
practice.
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