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翱肠迟辞产别谤听10, 2023

Diagnosis and Treatment of Bipolar Disorder: A Review

Andrew A.听Nierenberg,听MD1,2; Bruno听Agustini,听MD, PhD3; Ole听K枚hler-Forsberg,听MD, PhD1,4,5,6; et al 颁谤颈蝉迟颈苍补听颁耻蝉颈苍,听惭顿2,7; 顿辞耻驳濒补蝉听碍补迟锄,听笔丑顿1,2; Louisa G.听Sylvia,听PhD1,2; 础尘测听笔别迟别谤蝉,听笔丑顿1,2; Michael听Berk,听MD, PhD3,8
Author Affiliations Article Information
  • 1Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Deakin University, IMPACT 鈥� the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
  • 4Department for Affective Disorder, Aarhus University Hospital, Aarhus, Denmark
  • 5Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
  • 6Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  • 7Depression Clinical and Research Program, Massachusetts General Hospital, Boston
  • 8Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
JAMA. 2023;330(14):1370-1380. doi:10.1001/jama.2023.18588
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Abstract

Importance听 Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide.

Observations听 Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014%鈥塱n the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide.

Conclusions and Relevance听 Bipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.

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