Predominant polarity as a course specifier for bipolar disorder: a systematic review

Carvalho, Andre F., McIntyre, Roger S., Dimelis, Dimos, Gonda, Xenia, Berk, Michael, Nunes-Neto, Paulo R., Cha, Danielle S., Hyphantis, Thomas N., Angst, Jules and Fountoulakis, Konstantinos N. 2014, Predominant polarity as a course specifier for bipolar disorder: a systematic review, Journal of affective disorders, vol. 163, pp. 56-64, doi: 10.1016/j.jad.2014.03.035.

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Title Predominant polarity as a course specifier for bipolar disorder: a systematic review
Author(s) Carvalho, Andre F.
McIntyre, Roger S.
Dimelis, Dimos
Gonda, Xenia
Berk, MichaelORCID iD for Berk, Michael
Nunes-Neto, Paulo R.
Cha, Danielle S.
Hyphantis, Thomas N.
Angst, Jules
Fountoulakis, Konstantinos N.
Journal name Journal of affective disorders
Volume number 163
Start page 56
End page 64
Total pages 9
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2014-07
ISSN 0165-0327
Keyword(s) bipolar disorder
predominant polarity


Predominant polarity (PP) is a proposed course specifier for bipolar disorder, which was not incorporated in the DSM-5 as a descriptor for the nosology of bipolar disorder (BD). Here we perform a systematic review of original studies about PP. 

A computerized search of MEDLINE/Pubmed, EMBASE and Web of Science databases from inception to October 6th, 2013 was performed with keywords, including ‘bipolar disorder’, ‘polarity’ and ‘predominant polarity’.

A total of 19 studies met inclusion criteria. A unifying definition and conceptualization for PP is lacking. A PP is found in approximately half of BD patients. Most studies that included type I BD patients found the manic PP to be more prevalent, while studies that included type II BD participants found a higher prevalence of depressive PP. The depressive PP has been consistently associated with a depressive onset of illness, a delayed diagnosis of BD, type II BD and higher rates of suicidal acts. The manic PP is associated with a younger onset of illness, a first episode manic/psychotic and a higher rate of substance abuse. Evidence suggests that PP may influence responses to acute treatment for bipolar depression. Furthermore, evidences indicate that PP should be considered for the selection of maintenance treatments for BD.

There are few prospective studies on PP. There were disparate definitions for PP across studies.

The concept of PP provides relevant information for clinicians. Future studies should investigate the genetic and biological underpinnings of PP.
Language eng
DOI 10.1016/j.jad.2014.03.035
Field of Research 110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 920410 Mental Health
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2014, Elsevier
Persistent URL

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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