Bipolar disorder, one of the most common severe mental illnesses, includes
type 1 (with mania and usually recurrent depression) and type 2 (recurrent
major depression with hypomania).1,2 Lifetime
prevalence for type 1 bipolar disorder is approximately 1%, but inclusion
of more broadly defined conditions increases this rate to 2% to 5%.3 Bipolar disorder can begin in childhood or adolescence,4 continues throughout life, and is extraordinarily
costly—financially as well as clinically and socially.5 The
course of bipolar disorder is episodic but highly variable, with potential
for high levels of severity and recurrence intensity, disproportionately high
depressive morbidity, and comorbidity with substance abuse and anxiety disorders.3 Bipolar depression can be present during 20% to 30%
of patients' time, even during prophylactic treatment,6- 8 and
is closely associated with disability and mortality.3,9,10 Bipolar
disorder proves fatal in a high proportion of patients from complications
of risk-taking behavior, comorbid stress-sensitive medical illnesses, and
especially suicide.3,9,10 These
characteristics mark bipolar disorder as a major unsolved public health challenge.
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