麻豆传媒

The major differences between bipolar I and bipolar II disorder were highlighted in a presentation at the 2022 Neuroscience Education Institute (NEI) Congress. The aim of the presentation was to identify the differences in the clinical presentation and diagnostic criteria associated with each disorder, and to determine the most effective pharmacologic treatments for each one.

In this exclusive 麻豆传媒 video, Roger McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto, discusses the key points from his presentation.

Following is a transcript of his remarks:

Bipolar disorders are a group of disorders, and the most recognized subtypes are bipolar I/bipolar II. In bipolar I, it is characterized by mania, in bipolar II disorders, hypomania and depression. Historically, we've given most of our attention to bipolar I, and historically there's been a kind of tacit assumption that bipolar II is a milder form of bipolar disorder. It turns out that's not true.

Bipolar II disorder, of course, does not have mania. It's hypomania, that's milder. But we look at the number of episodes, the duration of episodes, the severity of episodes of depression -- they're much more problematic in bipolar II. Moreover, people with bipolar II disorder are more likely to have rapid cycling, comorbidities, and more recently we've learned higher suicide completion rates. So taken together, bipolar II disorder is as severe and as significant as is bipolar I.

But here's the part that's so critical. The FDA's only approved two treatments for bipolar II disorder -- Seroquel [quetiapine], it's extended release, as well as Caplyta (lumateperone). So we have five treatments, not many, for bipolar I and only two for bipolar II -- so, not many. And this is something we need to have more research on for sure.

A great majority of people who have bipolar I or bipolar II disorder are misdiagnosed. And if they are diagnosed, usually it is 5, 7, 10 years after the illness began. Often with a whole assortment of erroneous diagnoses. Bipolar II disorder has even a longer runway before the time from [when] symptoms start to getting the diagnosis correct. So we need to do much better at getting the diagnosis not only accurate, but also timely. And that's why we believe that all depressed patients, regardless of what setting people work in, should be screened for bipolar disorder I and II, because depressive episodes are the most common presentation of bipolar disorder. And that's why people come to see care providers.

And they can go to a website: . This is a website that can download the rapid mood screener, which has been validated as a screening tool for bipolar I and more recently, bipolar II disorder. And it's a screening tool that is brief, patient administered, sensitive, [and has] good negative predictive value. We think it offers some advantages over existing screening tools for bipolar, and we hope it can be incorporated into routine practice.

So a screening tool is not a diagnostic tool, but it increases or decreases suspicion. And this has been, frankly, the great unmet need in bipolar. You cannot give people the appropriate treatment unless you have the appropriate diagnosis. And too many people, the majority, are not getting that diagnosis accurate or timely.

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