The current issue of InFo NEUROLOGIE & PSYCHIATRIE provides you with a broad and informative overview of the topic of “Bipolar Disorder”: the epidemiology, mortality and familial clustering, diagnostic challenges and stratified therapy are addressed.
Bipolar disorder is characterized by an abnormal fluctuation in mood and manifests in manic, hypomanic, and depressive episodes. First manifestations are usually already found in adolescence or early adulthood.
Prof. Dr méd. Martin Preisig, Dr méd. In their article, Sylfa Fassassi and Dr Caroline Vandeleur, Prilly, use current studies to illustrate that the course of bipolar disorder is unfortunately usually unfavorable: Especially when other somatic and psychiatric comorbidities such as anxiety or personality disorders are added, the mortality rate increases. In addition to suicide, the risk of incomplete remission and relapse is also very high – with each new episode, the chance of complete remission becomes less likely. This is a vicious circle that needs to be broken. The authors also discuss epidemiological aspects and familial clustering: The risk of bipolar I disorder is three times higher for members of a family in which such cases have already occurred than for members of healthy families.
Bipolar people predominantly address the depressive symptomatology during their visit to the doctor, not only because they usually spend more time in the depressive states, but also because they evaluate the (hypo)manic periods as more positive and classify their social consequences as less relevant. In this case, there is a risk of a misdiagnosis of unipolar depression and thus of too one-sided therapy. In his article, Philipp Eich, MD, Liestal, warns against inaccurate anamnesis and once again discusses the most important principles of a complete diagnosis and therapy adapted to the patient. In particular, he addresses the perspective of the primary care physician, who has a significant role to play given the long-term nature of history taking, therapy, and monitoring.
To counteract the difficult, inconsistently regulated, and often lengthy trial-and-error therapy adjustment phases, bipolar patients and treatment phases should be stratified, helped in the future by biomarkers and today by history and clinic (history is considered the strongest currently available predictor of treatment success for a reason). In my article, I provide an overview of this important and promising field of research.
I wish you an informative read and greet you warmly
Prof. Dr. med. Gregor Hasler
InFo Neurology & Psychiatry 2014; 12(5): 1.
