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Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review

BACKGROUND: Bipolar disorder (BD) is a serious and recurring condition that affects approximately 2.4% of the global population. About half of BD sufferers have an illness course characterized by either a manic or a depressive predominance. This predominant polarity in BD may be differentially assoc...

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Autores principales: Carvalho, Andre F., Quevedo, João, McIntyre, Roger S., Soeiro-de-Souza, Márcio G., Fountoulakis, Konstantinos N., Berk, Michael, Hyphantis, Thomas N., Vieta, Eduard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368897/
https://www.ncbi.nlm.nih.gov/pubmed/25522415
http://dx.doi.org/10.1093/ijnp/pyu079
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author Carvalho, Andre F.
Quevedo, João
McIntyre, Roger S.
Soeiro-de-Souza, Márcio G.
Fountoulakis, Konstantinos N.
Berk, Michael
Hyphantis, Thomas N.
Vieta, Eduard
author_facet Carvalho, Andre F.
Quevedo, João
McIntyre, Roger S.
Soeiro-de-Souza, Márcio G.
Fountoulakis, Konstantinos N.
Berk, Michael
Hyphantis, Thomas N.
Vieta, Eduard
author_sort Carvalho, Andre F.
collection PubMed
description BACKGROUND: Bipolar disorder (BD) is a serious and recurring condition that affects approximately 2.4% of the global population. About half of BD sufferers have an illness course characterized by either a manic or a depressive predominance. This predominant polarity in BD may be differentially associated with several clinical correlates. The concept of a polarity index (PI) has been recently proposed as an index of the antimanic versus antidepressive efficacy of various maintenance treatments for BD. Notwithstanding its potential clinical utility, predominant polarity was not included in the DSM-5 as a BD course specifier. METHODS: Here we searched computerized databases for original clinical studies on the role of predominant polarity for selection of and response to pharmacological treatments for BD. Furthermore, we systematically searched the Pubmed database for maintenance randomized controlled trials (RCTs) for BD to determine the PI of the various pharmacological agents for BD. RESULTS: We found support from naturalistic studies that bipolar patients with a predominantly depressive polarity are more likely to be treated with an antidepressive stabilization package, while BD patients with a manic-predominant polarity are more frequently treated with an antimanic stabilization package. Furthermore, predominantly manic BD patients received therapeutic regimens with a higher mean PI. The calculated PI varied from 0.4 (for lamotrigine) to 12.1 (for aripiprazole). CONCLUSIONS: This review supports the clinical relevance of predominant polarity as a course specifier for BD. Future studies should investigate the role of baseline, predominant polarity as an outcome predictor of BD maintenance RCTs.
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spelling pubmed-43688972015-09-01 Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review Carvalho, Andre F. Quevedo, João McIntyre, Roger S. Soeiro-de-Souza, Márcio G. Fountoulakis, Konstantinos N. Berk, Michael Hyphantis, Thomas N. Vieta, Eduard Int J Neuropsychopharmacol Review BACKGROUND: Bipolar disorder (BD) is a serious and recurring condition that affects approximately 2.4% of the global population. About half of BD sufferers have an illness course characterized by either a manic or a depressive predominance. This predominant polarity in BD may be differentially associated with several clinical correlates. The concept of a polarity index (PI) has been recently proposed as an index of the antimanic versus antidepressive efficacy of various maintenance treatments for BD. Notwithstanding its potential clinical utility, predominant polarity was not included in the DSM-5 as a BD course specifier. METHODS: Here we searched computerized databases for original clinical studies on the role of predominant polarity for selection of and response to pharmacological treatments for BD. Furthermore, we systematically searched the Pubmed database for maintenance randomized controlled trials (RCTs) for BD to determine the PI of the various pharmacological agents for BD. RESULTS: We found support from naturalistic studies that bipolar patients with a predominantly depressive polarity are more likely to be treated with an antidepressive stabilization package, while BD patients with a manic-predominant polarity are more frequently treated with an antimanic stabilization package. Furthermore, predominantly manic BD patients received therapeutic regimens with a higher mean PI. The calculated PI varied from 0.4 (for lamotrigine) to 12.1 (for aripiprazole). CONCLUSIONS: This review supports the clinical relevance of predominant polarity as a course specifier for BD. Future studies should investigate the role of baseline, predominant polarity as an outcome predictor of BD maintenance RCTs. Oxford University Press 2015-01-29 /pmc/articles/PMC4368897/ /pubmed/25522415 http://dx.doi.org/10.1093/ijnp/pyu079 Text en © The Author 2015. Published by Oxford University Press on behalf of CINP. http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Review
Carvalho, Andre F.
Quevedo, João
McIntyre, Roger S.
Soeiro-de-Souza, Márcio G.
Fountoulakis, Konstantinos N.
Berk, Michael
Hyphantis, Thomas N.
Vieta, Eduard
Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review
title Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review
title_full Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review
title_fullStr Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review
title_full_unstemmed Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review
title_short Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review
title_sort treatment implications of predominant polarity and the polarity index: a comprehensive review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368897/
https://www.ncbi.nlm.nih.gov/pubmed/25522415
http://dx.doi.org/10.1093/ijnp/pyu079
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