Predominent polarity

What is predominent polarity?
Bipolar disorder is characterised by recurrent episodes of depression and mania, hypomania, or mixed symptoms. Some, but not all, people with bipolar disorder show a predominance of either depression or manic episodes.
A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including one of the first two): intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes in appetite; loss of energy; difficulty concentrating, remembering or making decisions; and/or thoughts of death or suicide.
A manic episode is a period of at least one week when a person is high spirited or irritable in an extreme way most of the day for most days. A manic episode involves changes in normal behaviour such as showing exaggerated self-esteem or grandiosity, less need for sleep, talking more than usual, talking more loudly and quickly, being easily distracted, doing many activities at once, scheduling more events in a day than can be accomplished, embarking on risky behaviour, uncontrollable racing thoughts, and/or quickly changing ideas or topics. These changes in behaviour are significant and clear to friends and family and are severe enough to cause major dysfunction.
A hypomanic episode is similar to a manic episode but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes, and the person is still able to function.
What is the evidence for predominent polarity?
Moderate to high quality evidence suggests mania and depression predominance is similar in studies assessing symptoms retrospectively. However, mania episodes were less prevalent than depression episodes when episodes are measured prospectively over the course of bipolar disorder.
Factors associated with depression predominance are; type II bipolar disorder, melancholia symptoms, a depressive onset of illness, suicide attempts, mixed episodes, delayed diagnosis of bipolar disorder, and being married. Factors associated with mania predominance are; type I bipolar disorder, a mania onset of illness, onset of illness with psychotic features, younger onset of illness, and substance use.
June 2020
Fact Sheet Technical Commentary
NeuRA Libraries
-
Bipolar Disorders Library
- Assessment and diagnosis
-
Signs and symptoms
- General signs and symptoms
-
Cognition
- Attention
- Cognition and bipolar type
- Cognition and functioning
- Cognition and symptoms
- Cognition in bipolar versus depression
- Cognition in bipolar versus schizophrenia
- Cognition in children with bipolar disorder
- Cognition in first-episode bipolar disorder
- Cognition in late-life bipolar disorder
- Cognition in relatives
- Decision making
- Episodic future thinking
- Executive functioning
- Impulsivity
- Insight
- IQ and general cognition
- Language
- Learning
- Memory
- Metacognition
- Processing speed
- Reasoning
- Social cognition
- Visuospatial ability
-
Treatments
-
Physical
- Non-pharmaceutical
-
Pharmaceutical
- Mood stabilisers
- Antidepressants
- Antipsychotics
- Adjunctive and alternative treatments
-
Treatments for specific symptoms and populations
- Treatments during pregnancy and breastfeeding
- Treatments for aggression and agitation
- Treatments for bipolar II disorder
- Treatments for bipolar versus unipolar depression
- Treatments for children
- Treatments for cognitive symptoms
- Treatments for dual diagnosis
- Treatments for elderly patients
- Treatments for first-episode bipolar disorder
- Treatments for high-risk groups
- Treatments for medication resistance
- Treatments for mixed states
- Treatments for rapid cycling
- Treatments for relapse prevention
- Treatments for suicide and self-harm
- Other
- Psychosocial
-
Physical
-
Risk factors and antecedents
- Antecedents
-
Non-genetic risk factors
- Adult life events
- Childbirth
- Childhood adversity
- Environmental toxins
- Ethnicity
- Familial factors
- Infectious agents
- Maternal diet during pregnancy
- Maternal illness during pregnancy
- Migration
- Obstetric complications
- Parental age
- Parental education
- Parental psychological factors
- Rheumatoid arthritis
- Sibship
- Socioeconomic status
- Substance use
- Traumatic brain injury
- Urbanicity
- Winter birth
-
Illness course and outcomes
- Absconding
- Age at onset
- Attitudes to medication
- Creativity
- Criminal offending, aggression and violence
- Criminal victimisation
- Cultural differences
- Dietary intake
- Drug and alcohol use
- Employment
- First-episode bipolar disorder
- Functional outcomes
- Homelessness
- Hope
- Menopause
- Mortality
- Parenthood
- Pathways to care
- Pediatric bipolar disorder
- Physical activity
- Physical health monitoring
- Quality of care
- Quality of life
- Recovery
- Relapse
- Relationships
- Religiosity
- Smoking
- Stigma
- Suicide and self-harm
- Treatment non-adherence
- Treatment resistance
- Insights for families
-
Physical features
-
Functional changes
- Body functioning
-
Biochemical changes
- Brain pH and lactate
- Calcium
- Complex I and IV
- Dopamine
- GABA
- Gut microbiota
- Homocysteine
- Hypothalamic-pituitary-adrenal axis
- Infectious agents
- Inflammation and immune system dysfunction
- Insulin-like growth factor
- Lipids
- Neurometabolites
- Neuropeptides
- Neurotrophins
- NMDA receptor function
- Oxidative stress
- S100 proteins
- Serotonin
- Uric acid
- Vitamin B
- Cerebral blood flow and metabolism
- Electrophysiology
- Structural changes
-
Functional changes
-
Co-occurring conditions
- Mental disorders
-
Physical disorders
- Asthma
- Blood disorders
- Cancer
- Cerebrovascular disease
- Dementia
- Diabetes
- Digestive disorders
- Epilepsy
- Fibromyalgia
- Heart disease
- Infectious diseases
- Metabolic syndrome
- Multiple sclerosis
- Musculoskeletal and connective tissues
- Obesity
- Optical alterations
- Osteoporosis
- Pain and migraine
- Parkinson’s disease
- Peripheral vascular disease
- Premenstrual syndrome
- Respiratory disease
- Sleep apnea
- Thyroid disorders
- Visual impairment
- Wilson’s disease
- Substance use
- Epidemiology
- General information
-
Post-Traumatic Stress Disorder Library
-
Schizophrenia Library
- Assessment and diagnosis
-
Signs and symptoms
-
General signs and symptoms
- Dermatoglyphics
- Disorganised symptoms
- Dissociation
- Early detection
- Functional laterality
- Minor physical anomalies
- Morphometrics
- Movement disorders
- Negative symptoms
- Neurological soft signs
- Olfactory functioning
- Pain sensitivity
- Personality and temperament
- Positive symptoms
- Psychotic relapse
- Sleep disturbance
- Temperature regulation
- Voice patterns
-
Cognition
- Attention
- Cognition in high-risk groups
- Cognition in schizophrenia and bipolar disorder
- Cognitive functioning related to symptoms
- Decision making
- Defeatist performance beliefs
- Episodic future thinking
- Executive functioning
- Impulsivity
- Information processing
- Insight
- IQ
- Language
- Learning
- Memory
- Metacognition
- Psychomotor ability
- Reasoning ability
- Rigidity
- Social cognition
- Time perception
- Tone perception
- Visuospatial ability
-
General signs and symptoms
-
Treatments
-
Physical
-
Pharmaceutical
-
First-generation antipsychotics
- All antipsychotics versus placebo
- Benperidol
- Bromperidol
- Chlorpromazine
- Droperidol
- First versus second generation
- Flupentixol
- Fluphenazine
- Fluspirilene
- Haloperidol
- Levomepromazine
- Loxapine
- Metiapine
- Molindone
- Penfluridol
- Perazine
- Perphenazine
- Pimozide
- Piperacetazine
- Pipotiazine
- Sulpiride
- Thioridazine
- Trifluoperazine
- Zuclopenthixol
-
Side effects
- Blood disorders
- Bone density
- Cancer
- Cardiometabolic changes and weight gain
- Catatonia
- Constipation
- Dysphagia
- Extrapyramidal
- Hyperprolactinaemia
- Hypersalivation
- Hyponatraemia
- Mortality
- Neuroleptic malignant syndrome
- Neutropenia
- Oculogyric crisis
- Pancreatitis
- Polycystic ovarian syndrome
- Sedation
- Seizures
- Sexual dysfunction
- Thyroid dysfunction
-
Second-generation antipsychotics
- All antipsychotics versus placebo
- Amisulpride
- Aripiprazole
- Asenapine
- Blonanserin
- Brexpiprazole
- Cariprazine
- Carpipramine
- Clocapramine
- Clotiapine
- Clozapine
- First versus second generation
- Iloperidone
- Lurasidone
- Mosapramine
- Olanzapine
- Paliperidone
- Perospirone
- Quetiapine
- Remoxipride
- Risperidone
- Second versus second generation
- Sertindole
- Ziprasidone
- Zotepine
-
Side effects
- Blood disorders
- Bone density
- Cancer
- Cardiometabolic changes and weight gain
- Catatonia
- Constipation
- Dysphagia
- Extrapyramidal
- Hyperprolactinaemia
- Hypersalivation
- Hypomania
- Hyponatraemia
- Mortality
- Neuroleptic malignant syndrome
- Neutropenia
- Oculogyric crisis
- Pancreatitis
- Polycystic ovarian syndrome
- Sedation
- Seizures
- Sexual dysfunction
- Thyroid dysfunction
-
Adjunctive treatments
- Adenosine modulators
- Amphetamines
- Analeptics
- Anti-inflammatory
- Anticholinergic
- Anticonvulsants
- Anticraving agents
- Antidepressants
- Benzodiazepines
- Beta blockers
- Calcium channel blockers
- Cannabinoids
- Catecholamines
- Cholinergic medications
- Cholinesterase inhibitors
- Erythropoietin
- Essential fatty acids
- Estrogen
- GABA agonists
- GHB
- Glutamate receptor modulators
- Herbal medicines
- Mood stabilisers
- Oxytocin
- Promethazine
- Serotonin modulators
- Sodium nitroprusside
- Statins
- Testosterone
- Alternative treatments
-
Treatments for specific symptoms and populations
- Treatments during pregnancy and breastfeeding
- Treatments for aggression and agitation
- Treatments for childhood and early-onset schizophrenia
- Treatments for cognitive symptoms
- Treatments for constipation
- Treatments for depressive symptoms
- Treatments for dual diagnosis
- Treatments for elderly people and people with late-onset schizophrenia
- Treatments for first-episode psychosis
- Treatments for high-risk groups
- Treatments for hyperprolactinaemia
- Treatments for hypersalivation
- Treatments for medication non-adherence
- Treatments for medication-resistant schizophrenia
- Treatments for movement disorders
- Treatments for negative symptoms
- Treatments for relapse prevention
- Treatments for schizoaffective disorder
- Treatments for sexual dysfunction
- Treatments for sleep disturbance
- Treatments for smoking cessation
- Treatments for social functioning
- Treatments for weight gain
- Other pharmaceutical topics
-
First-generation antipsychotics
- Non-pharmaceutical
-
Pharmaceutical
-
Psychosocial
-
Therapies
- Acceptance and commitment therapy
- Animal-assisted therapy
- Art and drama therapies
- Avatar therapy
- Case management
- Cognitive behavioural therapy
- Community care
- Cost
- Crisis intervention
- Crisis planning
- Dance therapy
- Day centres and day hospitals
- Dialectical behavioural therapy
- Distraction techniques
- Educational therapies
- Enriched intervention
- Family intervention
- Genetics counselling
- Group therapy
- Home-based care
- Hypnosis
- Inpatient and outpatient care
- Integrated care
- Life skills programs
- Metacognitive training
- Mindfulness
- Monetary incentives
- Morita therapy
- Music therapy
- Nidotherapy
- Open dialogue approach
- Peer support
- Physical restraint
- Prevention programs
- Problem solving skills training
- Psychodynamic psychotherapy
- Shared decision making
- Strengths-based delivery
- Supported housing
- Supportive therapy
- Telemental health
- Therapeutic relationship
- Token economies
- Trauma-focused therapies
- User-held records
- Virtual reality
-
Therapies for specific symptoms and populations
- Therapies for childhood onset and early onset schizophrenia
- Therapies for cognition
- Therapies for dual diagnosis
- Therapies for fathers with schizophrenia
- Therapies for first-episode psychosis
- Therapies for insight
- Therapies for internalised stigma
- Therapies for mothers with schizophrenia
- Therapies for negative symptoms
- Therapies for positive symptoms
- Therapies for PTSD symptoms
- Therapies for quality of life
- Therapies for smoking
- Therapies for social functioning
- Therapies for treatment non-adherence
- Therapies for treatment resistance
- Therapies for unemployment
- Therapies for weight gain
- Treatments for high-risk groups
-
Therapies
-
Physical
-
Risk factors and antecedents
-
Antecedents
- Attention dysfunction
- Autonomic nervous system anomalies
- Behavioural disturbances and psychopathology
- Dermatoglyphic anomalies
- Eye tracking anomalies
- Face emotion processing anomalies
- Height and body mass index
- IQ and academic performance
- Mild physical anomalies
- Motor dysfunction
- Olfactory identification deficits
- Sleep disturbance
- Speech and hearing deficits
- Stress responsivity anomalies
-
Non-genetic risk factors
- Adult life events
- Childhood adversity
- Congenital rubella syndrome
- Environmental toxins
- Ethnicity
- Family relationships
- Famine
- Genetic and non-genetic risk
- Infectious agents
- Latitude, climate and winter birth
- Marital status
- Maternal diet and body mass index
- Maternal illness during pregnancy
- Migration
- Obstetric complications
- Parental age at birth
- Parental education
- Parental psychological factors
- Sex differences
- Sibship
- Social capital
- Socioeconomic status
- Substance use
- Traumatic brain injury
- Urban environment
- Genetic risk factors
-
Antecedents
-
Illness course and outcomes
- Absconding
- Age at onset
- Childhood and early-onset schizophrenia
- Creativity
- Criminal offending, aggression and violence
- Criminal victimisation
- Cultural differences
- Diet
- Drug and alcohol use
- Duration of untreated psychosis
- Duration of untreated psychosis and outcomes
- Electronic device use
- Employment
- First-episode psychosis
- Functional outcomes
- Homelessness
- Hope
- Late-onset schizophrenia
- Loneliness
- Mortality
- Parenthood
- Pathways to care
- Physical activity
- Physical health monitoring
- Psychotic relapse
- Quality of care
- Quality of life
- Relationships
- Religiosity
- Remission and recovery
- Sex differences
- Smoking
- Stigma and attitudes towards mental health
- Suicide and self-harm
- Treatment adherence
- Treatment-resistance
- Insights for families
-
Physical features
-
Functional changes
- Body functioning
-
Biochemical changes
- Brain pH and lactate
- cAMP
- Cholesterol
- Dopamine
- Endocannabinoids
- GABA
- Hormonal changes
- Hypothalamic-pituitary-adrenal axis
- Infectious agents
- Inflammation and the immune system
- Lipids
- Melatonin
- Melatonin
- Neurometabolites
- Neuropeptides
- Neurotrophins
- Nitric oxide
- NMDA receptor function
- Oxidative stress
- S100 Proteins
- Serotonin
- Synaptic proteins
- Trace elements
- Vascular endothelial growth factor
- Vitamin B
- Vitamin D
- Cerebral blood flow and metabolism
- Electrophysiology
- Structural changes
- Brain regions
-
Functional changes
-
Co-occurring conditions
- Mental disorders
-
Physical disorders
- Auditory system dysfunction
- Autoimmune diseases
- Blood disorders
- Cancer
- Cerebrovascular disease
- Dementia
- Dental disease
- Diabetes
- Digestive disorders
- Epilepsy
- Heart disease
- Infectious diseases
- Metabolic syndrome
- Musculoskeletal and connective tissues
- Obesity
- Optical alterations
- Peripheral vascular disease
- Polycistic ovary syndrome
- Postoperative complications
- Reproductive and urological disorders
- Respiratory system dysfunction
- Sexual dysfunction
- Skin disorders
- Sleep apnea
- Thyroid disorders
- Underweight
- Substance use
- Epidemiology
- General information
-
Podcast Library
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.