Bipolar disorder
BD
Research on manic, hypomanic, and depressive episodes, functioning between episodes, and genetic associations.
Research question
How consistent are genetic associations for bipolar disorder subtypes when cohorts apply the same assessment criteria?
Findings
Course between episodes
NICE guidance on bipolar disorder considers episodic changes in mood and activity, symptoms between episodes, patterns of relapse, and family history.
Genomic data from 79 cohorts
A genomic analysis combined 79 cohorts of diverse genetic ancestries, with 158,036 bipolar disorder cases and 2,796,499 controls, and identified 298 loci associated with bipolar disorder.
Residual symptoms and recurrence after recovery
The multisite observational STEP-BD study followed 858 participants who entered with symptoms and subsequently recovered. Residual depressive or manic symptoms at recovery were associated with an earlier depressive recurrence.
One-year recovery from bipolar depression
Both groups in a STEP-BD randomized trial of 293 outpatients received pharmacotherapy. Over one year, 64.4% of participants assigned to intensive psychotherapy and 51.5% assigned to brief psychoeducation met the study’s recovery criteria.
Brain structure changes on repeated MRI
ENIGMA compared repeat MRI scans from 307 people with bipolar disorder and 925 controls. Ventricular volume increased faster on average in the bipolar group. Within that group, more manic or hypomanic episodes were associated with faster cortical thinning, mainly in prefrontal regions.
Psychosocial functioning in euthymic outpatients
In a multicenter randomized trial of 239 euthymic outpatients with bipolar disorder, blinded raters measured psychosocial functioning over 21 weeks. Functional remediation led to greater improvement than usual care, while the comparison with psychoeducation was statistically inconclusive. Of those randomized, 183 completed the treatment phase.
Severe episodes after childbirth
A meta-analysis combined 37 reports covering 5,700 deliveries among 4,023 patients with histories of bipolar disorder or postpartum psychosis. In the bipolar disorder subgroup, the estimated risk of a severe postpartum episode was 17% (95% CI 13–21%). Follow-up periods and definitions of relapse varied across studies.
Limitations
Cohorts identified cases through clinical interviews, medical records, registries, questionnaires, or self-report. These definitions matter when interpreting pooled results.
Original sources
Bipolar disorder: assessment and management (CG185)
National Institute for Health and Care Excellence
Genomics yields biological and phenotypic insights into bipolar disorder
Kevin S. O’Connell et al.
Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
Roy H. Perlis et al.
Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program
David J. Miklowitz et al.
Longitudinal Structural Brain Changes in Bipolar Disorder: A Multicenter Neuroimaging Study of 1232 Individuals by the ENIGMA Bipolar Disorder Working Group
Christoph Abé et al.
Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study
Carla Torrent et al.
Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis
Richard Wesseloo et al.