Cited by 389Bipolar Disorder and TreatmentPersonality Disorders and PsychopathologyMental Health Research Topics

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Long-term symptomatic status of bipolar I vs. bipolar II disorders

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Judd, Lewis L., Schettler, Pamela J., Akiskal, Hagop S., Maser, Jack, Coryell, William, Solomon, David, Endicott, Jean, Keller, Martin·2003·The International Journal of Neuropsychopharmacology

DOI 10.1017/s1461145703003341

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Abstract

Weekly affective symptom severity and polarity were compared in 135 bipolar I (BP I) and 71 bipolar II (BP II) patients during up to 20 yr of prospective symptomatic follow-up. The course of BP I and BP II was chronic; patients were symptomatic approximately half of all follow-up weeks (BP I 46.6% and BP II 55.8% of weeks). Most bipolar disorder research has concentrated on episodes of MDD and mania and yet minor and subsyndromal symptoms are three times more common during the long-term course. Weeks with depressive symptoms predominated over manichypomanic symptoms in both disorders (31) in BP I and BP II at 371 in a largely depressive course (depressive symptoms=59.1% of weeks vs. hypomanic=1.9% of weeks). BP I patients had more weeks of cyclingmixed polarity, hypomanic and subsyndromal hypomanic symptoms. Weekly symptom severity and polarity fluctuated frequently within the same bipolar patient, in which the longitudinal symptomatic expression of BP I and BP II is dimensional in nature involving all levels of affective symptom severity of mania and depression. Although BP I is more severe, BP II with its intensely chronic depressive features is not simply the lesser of the bipolar disorders; it is also a serious illness, more so than previously thought (for instance, as described in DSM-IV and ICP-10). It is likely that this conventional view is the reason why BP II patients were prescribed pharmacological treatments significantly less often when acutely symptomatic and during intervals between episodes. Taken together with previous research by us on the long-term structure of unipolar depression, we submit that the thrust of our work during the past decade supports classic notions of a broader affective disorder spectrum, bringing bipolarity and recurrent unipolarity closer together. However the genetic variation underlying such a putative spectrum remains to be clarified.

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Authors: Judd, L. L., Schettler, P. J., Akiskal, H. S., Maser, J., Coryell, W., Solomon, D., Endicott, J., & Keller, M.
Affiliations: University of California San Diego (US)
National Institute of Mental Health (US)
Corresponding author: Judd, Lewis L.
ORCID: Schettler, Pamela J.
Coryell, William
Keller, Martin
Venue: The International Journal of Neuropsychopharmacology
Publisher: Oxford University Press (OUP)
Published: 2003-06
Volume: 6
Issue: 2
Pages: 127-137
ISSN: 1461-1457 (ISSN-L)
1469-5111
DOI: 10.1017/s1461145703003341
OpenAlex: W2119349901
Cited by: 389
References: 30
Citations by year: 2026: 9 · 2025: 7 · 2024: 17 · 2023: 10 · 2022: 14 · 2021: 11 · 2020: 15 · 2019: 27 · 2018: 18 · 2017: 15 · 2016: 22 · 2015: 21 · 2014: 23 · 2013: 22 · 2012: 24
FWCI: 8.57
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: The International Journal of Neuropsychopharmacology (publishedVersion)
PubMed (publishedVersion)
Funders: University of California, San Diego
National Institute of Mental Health (R01MH025478)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: bipolar I disorder, bipolar II disorder, depressive symptoms, hypomanic symptoms, subsyndromal symptoms, chronic depression, major depressive disorder
MeSH terms: Adolescent, Adult, Aged, Bipolar Disorder, Female, Follow-Up Studies, Humans, Long-Term Care, Male, Middle Aged, Psychiatric Status Rating Scales

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Long-term symptomatic status of bipolar I vs. bipolar II disorders

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