Bipolar or unipolar? - the question for clinicians and researchers

Correct diagnosis and criteria of affective disorders is always a subject of interest to researchers and practitioners.

The study aimed at assessing frequency of various traits and symptoms of bipolar affective disorders (BP-I, BP-II, BP-S spectrum) in patients (n=246) treated for recurrent affective disorders (unipolar-UP). The analysis was based on criteria of affective disorders of Ghaemi et al. and Hirschfeld's Mood Disorders Questionnaire.

UP was confirmed in 32.9% of individuals, whereas 19.5% were BP-I, 35% BP-II and 12.6% BP-S. UP patients were significantly more often professionally active than those with BP (37.2% vs. 22.7%). Duration of a disorder was significantly shorter and the number of depressive episodes lower in the UP group. In comparison with UP, BP-I were associated with the previous occurrence of unusual and/or risky behaviour (OR=24.5), excessive, irrational expenditure (OR=21.1), lack of a critical attitude with respect to social behaviour (OR=20.3), increased sex drive (OR=17.7), and excessive self-confidence (OR=12). BP-II were associated with a lack of criticism with regard to social behaviour (OR=12.7) and unusual and/or risky behaviour (OR=10). Spectrum BP were most strongly associated with short term hypomanic episodes, including drug induced episodes (OR=15.8) and lack of criticism (OR=11.8). Early onset of depression (before 25 years of age) increased the risk of all three types of BP (by a factor of 3 to 5).

This was a naturalistic study, in which treatment was uncontrolled.

Results of the study are a voice in the discussion on too narrow criteria defining bipolar affective disorders.