Bipolar spectrum disorders. New perspectives.
OBJECTIVE
To review new perspectives on diagnosis, clinical features, epidemiology, and treatment of bipolar II and related disorders.


METHODS
Articles were identified by searching MEDLINE and ClinPSYCH from January 1994 to August 2001 using the key words bipolar disorder, type II or 2; hypomania; spectrum; or variants. Reference lists from articles were reviewed. Overall, the quality of evidence was not high; we found no randomized controlled trials that specifically addressed bipolar II or bipolar spectrum disorders (BSDs).


RESULTS
Characterized by elevated mood cycling with depression, BSDs appear to be much more common than previously thought, affecting up to 30% of primary care patients presenting with anxiety or depressive symptoms. Hypomania, the defining feature of bipolar II disorder, is often not detected. Collateral information, semistructured interviews, and brief screening instruments could improve diagnosis. Antidepressants should be used with caution. The newer mood stabilizers or combinations of mood stabilizers might be the treatments of choice in the future.


CONCLUSIONS
Family physicians, as primary providers of mental health care, should try to recognize and treat BSDs more frequently. These disorders are becoming increasingly common in primary care populations.
Piver
Andre
A
Nelson Mental Health Centre, Kootenay Lake Regional Hospital, Nelson, BC. steele_piver@netidea.com
Yatham
Lakshmi N
LN
Lam
Raymond W
RW
D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005194:Family Practice; D006801:Humans; D015995:Prevalence; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents