Stats

Question 1

If you have a first degree relative with bipolar disorder, how much higher is your risk?

Answer 1

Having a first-degree relative with bipolar disorder increases the risk of diagnosis approximately 10-fold.

Question 2

What is the 12 month prevalence of bipolar I disorder in US adults?

Answer 2

The 12-month prevalence of DSM-5 bipolar I disorder in a nationally representative U.S. adult sample was 1.5%

Question 3

Prevalence ratio of men to women in bipolar I disorder?

Answer 3

The lifetime prevalence ratio in men to women is approximately 1.1:1.

Question 4

Peak age of onset of bipolar 1?

Answer 4

The peak age at onset of bipolar I disorder across studies is between 20 and 30 years, but onset occurs throughout the life cycle.

Question 5

Risk of bipolar I in general population vs first degree relative?

Answer 5

Risk of bipolar disorder in the general population is around 1%, while risk in a first-degree relative is 5%–10%.

Question 6

Chance of having another mood episode after you’ve had one manic?

Answer 6

More than 90% of individuals who have a single manic episode go on to have recurrent mood episodes.

Question 7

Monozygotic twins have what concordance rates for bipolar 1 disorder?

Answer 7

monozygotic concordance rates are significantly less than 100% (40%–70%),

Question 8

Heritability of bipolar 1?

Answer 8

about 90%

(Heritability is a measure of how well differences in people’s genes account for differences in their traits. So, a heritability of 0.7 does not mean that a trait is 70% caused by genetic factors; it means that 70% of the variability in the trait in a population is due to genetic differences among people.)

Question 9

Life time risk of suicide in bipolar?

Answer 9

The lifetime risk of suicide in individuals with bipolar disorder is estimated to be 20- to 30-fold greater than in the general population.

An estimated 5%–6% of individuals with bipolar disorders die by suicide.

The risk and incidence of attempted suicide in bipolar II and bipolar I disorder appear to be similar.

Question 10

Prevalence of bipolar II in US and internationally?

Answer 10

The 12-month prevalence of bipolar II disorder in the United States is 0.8%. The 12-month prevalence internationally is 0.3%.

Question 11

Peak age of onset of Bipolar II?

Answer 11

Mid 20s, so slightly later than for bipolar I but earlier than for major depressive disorder.

The illness most often begins with a depressive episode and is not recognized as bipolar II disorder until a hypomanic episode occurs; this happens in about 12% of individuals with the initial diagnosis of major depressive disorder

Question 12

How many people diagnosed with a bipolar II episode will have another episode within the first year of their first episode?

Answer 12

Bipolar II disorder is a highly recurrent disorder, with over 50% of individuals experiencing a new episode within a year after their first episode.

Question 13

% of BP II individuals who are rapid cyclers?

Answer 13

Approximately 5%–15% of individuals with bipolar II disorder have multiple (four or more) mood episodes (hypomanic or major depressive) within the previous 12 months.

More common in women.

Question 14

How many people initially diagnosed with BPII will go on to have a manic episode (and switch to BP I diagnosis)?

Answer 14

About 5%–15% of individuals with bipolar II disorder will ultimately develop a manic episode.

Question 15

Is BP II more common in men or women?

Answer 15

There is little to no evidence of bipolar gender differences in the general population, whereas some, but not all, clinical samples suggest that bipolar II disorder is more common in women than in men, which may reflect gender differences in treatment seeking or other factors.

Question 16

Most common comorbid psychiatric condition in BP II?

Answer 16

Anxiety disorders.
75% have an anxiety disorder, most commonly social anxiety (38%), specific phobia (36%), and generalized anxiety (30%).

Approximately 60% of individuals with bipolar II disorder have three or more co-occurring mental disorders.

Lifetime prevalence of comorbid anxiety disorder does not differ between bipolar I and bipolar II disorders but is associated with a worse course of illness.

Approximately 14% of individuals with bipolar II disorder have at least one lifetime eating
disorder, with binge-eating disorder being more common than bulimia nervosa and anorexia nervosa.

Question 17

Prevalence of cyclothymia?

Answer 17

The lifetime prevalence of cyclothymic disorder in the United States and Europe is approximately 0.4%–2.5%. Prevalence in mood disorders clinics may range from 3% to 5%.

Question 18

Cyclothymia more common in males or females?

Answer 18

In the general population, cyclothymic disorder is apparently equally common in males and females. In clinical settings, females with cyclothymic disorder may be more likely to present for treatment than males.

Question 19

Rates of MDE during pregnancy and post partum?

Answer 19

Between conception and birth, about 9% of women will experience a major depressive episode. The best estimate for prevalence of a major depressive episode between birth and 12 months postpartum is just below 7%.

Question 20

Chance of postpartum mood episode with psychotic features? And what increases the risk?

Answer 20

Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur in from 1 in 500 to 1 in 1,000 deliveries

Risk:
1) may be more common in primiparous women
2) prior postpartum psychotic mood episodes ** for sure –> Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30% and 50%.
3) prior history of a depressive or bipolar disorder (especially bipolar I disorder)
4) family history of bipolar disorders.

Question 21

How common is mania with mixed features?

Answer 21

Depressive symptoms co-occur alongside mania in 10%-30% of
cases.

Note: studies suggesting mixed features are indicative of
a more severe and disabling course, as well as a higher rate of suicide.

Question 22

% of manic episodes that have “with psychosis” specifier? and what does this mean prognostically? what about treatment implications for this?

Answer 22

At least half of manic episodes are characterized by the presence of
psychosis.

and theories suggest that it is a nonspecific feature which
improves alongside underlying manic symptoms

While the prognosis for patients experiencing mood-congruent psychotic features may
not differ from those with an absence of psychotic symptoms, limited evidence does suggest that those with mood-incongruent features
have a more severe illness with poorer long-term prognosis

you might think use an antipsychotic BUT
There is no evidence of superiority of any first-line monotherapy treatment in comparison to other monotherapy options in treating patients with psychotic features. Similarly, there is no evidence that any first-line combination therapy of lithium or divalproex plus an atypical antipsychotic is more effective than other first-line combination
therapy. However, clinical experience suggests that the
combination of lithium or divalproex plus an atypical antipsychotic is more appropriate for manic patients with mood-incongruent psychotic features (ie, other than grandiose delusions).