is usually the initial diagnosis, at the expense of bipolar disorder. We will have to revise and broaden the definition of bipolar disorder; this will have a great impact on rates of prevalence and comorbidity and on treatment. Estimates of the burden and costs of the disorder will have to be corrected upwards. This process could take at least, another 10 years. The forthcoming DSM-V and ICD-11 may not, yet, be in a position to solve the serious diagnostic problem, because the data for the necessary revision are sparse. The second, SAR405838 eternal,
problem remains, “what is a case?”107-109 Inhibitors,research,lifescience,medical on the continuum on hypomania scales/checklists from healthy to ill. No definitive answer to this question has yet. been found. However, this is nothing to be ashamed of: in medicine the norms for pathological blood pressure have changed repeatedly. A clear cutoff is probably always to a certain extent, questionable, neglecting the normal interindividual Inhibitors,research,lifescience,medical variation of the population. It is conceptually important, to add dimensional measures for depression, hypomania, and anxiety to the categorical approach Inhibitors,research,lifescience,medical in classifying mood disorders110 and not, base expensive biological and clinical research exclusively on diagnostic
categories whose definitions have a short, halflife. Finally, we need long-term treatment studies focusing on the potential effects of mood stabilizers and atypical neuroleptics against dementia, suicide, and vascular mortality. Selected abbreviations and acronyms ADHD attention deficit-hyperactivity Inhibitors,research,lifescience,medical disorder BPD bipolar disorder
MDD major depressive disorder MDE major depressive episode SUD substance-use disorder
Community and clinic-based studies have documented a high lifetime prevalence of psychiatric and medical comorbidity in bipolar disorder. For example, the National Comorbidity Survey reported that 95 % of respondents with bipolar disorder also met, criteria for three or more additional lifetime psychiatric disorders.1,2 In keeping with the view that Inhibitors,research,lifescience,medical individuals with bipolar disorder are susceptible to comorbid general medical disorders, the Canadian Community Health Survey documented significantly higher rates of cardiometabolic, respiratory, neurological, and infectious disorders in individuals with bipolar disorder.3 The hazardous effects of psychiatric and medical comorbidity provide the impetus for timely detection, diagnosis, treatment, and management of comorbidity in the bipolar population. For example, co-occurring disorders in bipolar disorder arc associated with MTMR9 more severe subtypes (eg, mixed states), an earlier age at. onset, an intensification of symptoms, poor symptomatic and functional recovery, suicidal behavior, diminished response to pharmacological treatment, decreased quality of life, as well as an unfavorable course and outcome.1,4-6 Moreover, mortality studies indicate that medical comorbidity (eg, cardiovascular disease) is the most, frequent, specific cause of premature mortality in the bipolar population.