title: Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study.
abstract: BACKGROUND
  Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability. Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers.
  
  
  OBJECTIVE
  To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a major depressive episode.
  
  
  METHODS
  Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE).
  
  
  METHODS
  Community and hospital psychiatry departments.
  
  
  METHODS
  Participants included 5635 adults with an ongoing major depressive episode.
  
  
  METHODS
  The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression.
  
  
  RESULTS
  A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P < .001) with bipolarity were observed for family history of mania/hypomania and multiple past mood episodes. The bipolarity specifier additionally identified significant associations for manic/hypomanic states during antidepressant therapy, current mixed mood symptoms, and comorbid substance use disorder.
  
  
  CONCLUSIONS
  The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is recommended before deciding on treatment.
authors.affiliation: The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.forename: Alex
authors.initials: A
authors.lastname: Gamma
authors.forename: Allan H
authors.initials: AH
authors.lastname: Young
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs