Indeed, such symptoms can be so mild that they are frequently missed by patients and relatives as well as clinicians, often being regarded as just a relative, and positive, change in mood in relation to debilitating depression [Smith et al. 2010; Bauer and Pfennig, 2005]. The Zurich criteria [Angst et al. 2003], which are based on a 20-year
prospective community cohort study, highlight that the nature of Inhibitors,research,lifescience,medical the symptoms is of more relevance than their duration, and importance should be attributed to even very brief ‘highs’ once the core criteria of pathological mood elevation are met. Although bipolar disorder is defined by the occurrence of mania and hypomania and is frequently conceptualized in terms of episodic mood elevation Inhibitors,research,lifescience,medical by clinicians, depressive episodes and symptoms tend to dominate the course of the illness: they occur more frequently, last longer and lead to a greater proportion of the psychosocial disability [Bond et al. 2010; Frye, 2011; Sidor and Macqueen, 2010; Van Lieshout and Macqueen, 2010; Geddes et al. 2009; Ghaemi et al. 2008; Inhibitors,research,lifescience,medical Bowden, 2005; Gijsman et al. 2004; Judd et al. 2002]. Work
by Judd and colleagues suggests that, in bipolar I, patients are well or asymptomatic for 53% of the time, and that during the time they are unwell manic or PD0325901 price hypomanic states only account for 20% of the time (mixed states 13%, depressive states 67%) [Judd et al. 2003, 2002]. Inhibitors,research,lifescience,medical This is even starker in bipolar II, in which during the 54% of the time patients are unwell hypomanic states only account for 2% of the illness and depression accounts for 94% (mixed states taking up the remaining 4%). Kessler and colleagues highlighted the fact that work days lost per ill worker per year among patients with BPAD was greater than among those with unipolar major depression; the difference was driven primarily by recurrent depression, not mania Inhibitors,research,lifescience,medical [Kessler et al. 2006].
Furthermore, it typically takes longer to achieve remission in depressive than in manic phases of illness, although mixed/cycling individuals take longer again [Berk et al. 2005]. With such figures it is apparent that, Fossariinae in bipolar disorders depression is the major problem, but its accurate diagnosis and appropriate management, even when identified, has been suggested to be one of the most challenging fields in contemporary psychiatry, with a dearth of established guidelines and licensed treatments [Fountoulakis, 2010; Frye, 2011; Smith et al. 2011; Suppes et al. 2010]. The clinical problems Bipolar depression is clinically missed Recognizing bipolar depression is a major challenge to most clinicians [Fountoulakis, 2010; Smith et al. 2011; Suppes et al. 2010; Sachs, 1996].