Bipolar Disorder: An Annotated Bibliography

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved
challenge. International journal of bipolar disorders, 8(1), 1-13.
Purpose of the Study
Depression in patients diagnosed with bipolar disorder presents various complexities. The
present study aimed at expounding on the challenges that bipolar disorder presents. The study
went further to examine available treatment options as well as the risks associated with various
treatment options. The effect of various drugs that have been proposed as potential cures for
bipolar depression was examined. The central aim of the study is to holistically look at bipolar
disorder.
Methods
The study employed a metanalysis of existing literature. Various research articles written
on the issue of bipolar depression were analyzed. Conflicting perspectives from existing
literature were done. The aim was to analyze the current status of bipolar depression as well as
the diagnostic tools that are presently in use. Over a hundred peer-reviewed research articles that
met the criteria were selected. They were then grouped under various themes.
Key Findings
Depression remains a significant challenge in bipolar patients. Depression remains one of
the major illnesses in bipolar patients that is unresolved. It is linked to high levels of morbidity as
well as mortality. Patients with bipolar depression are at high risk of committing suicide. The
risk of suicide in bipolar depression patients exceeds that of the general population by 20-fold. In

3
addition, bipolar depression is associated with depressive phases and mixed psychotic symptoms.
Various treatments have been proposed, including the use of lithium. However, the treatment of
bipolar disorder has not been investigated fully. There are many research gaps in this area. All
treatments that have been suggested are associated with high levels of adverse effects.
Reflection
The source is useful to my study of bipolar depression because it illuminates various
research gaps that exist. I had not thought about the treatment of bipolar depression as well as the
complexities associated with the condition. The study gives a holistic overview of the topic and
sparks my interest even further. I would like to contribute to the existing research and ensure that
a better understanding of the condition is achieved.
Freitag, S., Kapoor, S., & Lamis, D. A. (2022). Childhood maltreatment, impulsive aggression,
and suicidality among patients diagnosed with bipolar disorder. Psychological Trauma:
Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001218
Purpose of the Study
The purpose of the study was to explore the relationship between different types of
childhood maltreatment to suicidality and impulsive aggression among bipolar patients.
Method
One hundred fifty-nine low-income patients were recruited into the study. All patients
had to have bipolar to be eligible for the study. The researchers then evaluated different types of
childhood maltreatment, namely sexual, physical, and emotional, and they are associated with
impulsive aggression among the sample selected for the study. The researchers then examined

4
the relationship between suicidality and impulsive aggression. They then tested how impulsive
aggression mediates the relationship between childhood maltreatment and suicidality.
Key Findings
The researchers found that impulsive aggression is a key mediator in the relationship
between childhood sexual abuse and childhood emotional abuse. However, when they studied
physical abuse during childhood as an independent variable, they found that impulse aggression
did not mediate the relationship between suicidality and impulsive aggression. The study
concluded that impulsive aggression has a huge and wide-ranging impact on suicidality among
bipolar patients who had experienced trauma in their childhood. The researchers also found that
childhood trauma among bipolar patients is a correlate of depression, increased hospitalization
rates, and rapid cycling. They recommended that future research focus on ways to reduce
suicidality cases among bipolar patients who went through trauma as children.
Reflection
The article is a useful resource in its association between suicidality, depression, and
bipolar disorder. It introduces another dynamic in the study of bipolar depression, which is
childhood trauma. Thus, when looking at possible causes of bipolar depression, then childhood
trauma is a potential cause that should be widely explored.
Hu, S., Li, A., Huang, T., Lai, J., Li, J., Sublette, M. E., … & Xu, Y. (2019). Gut microbiota
changes in patients with bipolar depression. Advanced Science, 6(14), 1900752.
Purpose of the Study

5
The study aimed at providing data to primary caregivers on differentiating patients with
unipolar depression from those with bipolar depression. Primary care is one of the key areas
where depression occurs. There is a high risk of misdiagnosis of bipolar depression. While
bipolar disorder is defined as manic, hypomanic, and depression, one of the main symptoms that
present in many patients is depression. There is, therefore, a need to differentiate bipolar
depression from other conditions.
Methods
The study is qualitative and relies on a metanalysis to draw conclusions on the topic. A
search of the terms “bipolar disorder” and “primary care” was conducted on PubMed. The study
yielded 239 results. Further searches were conducted using the terms prevalence, burden of
bipolar disorder on caregivers, and quality of life. The articles included were ones published over
the past five years and written in the English language. Articles that were relevant to the study
were handpicked.
Key Findings
One of the key conclusions that researchers found is that differentiating bipolar
depression from other ailments is key in the management of bipolar depression. It is important
for patients to be diagnosed with major depressive disorder after the bipolar depression has been
ruled out. A look at the patient’s history coupled with contemporary screening should be
conducted before a diagnosis is reached. Misdiagnosis can have various adverse implications,
including the wrong therapy treatment as well as delaying the implementation of the correct
treatment. Primary caregivers such as nurses should remain updated on developments in bipolar
depression to come up with effective interventions.

6

Reflection
This study brings onboard a new area that I had not considered in my initial evaluation of
the topic. How would bipolar depression be differentiated from unipolar depression? The article
attempts to analyze this in a holistic manner. A different methodology can be applied on the
same to contribute to the existing research.
Kapczinski, N. S., Narvaez, J. C., Magalhaes, P. V., Bücker, J., Peuker, A. C., Loredo, A. C., …
& Gama, C. S. (2016). Cognition and functioning in bipolar depression. Brazilian
Journal of Psychiatry, 38, 201-206.
Purpose of the Study
The study aimed at evaluating cognition and functioning in patients with bipolar
depression. Depressive symptoms are common in patients with bipolar disorder. It is important
to evaluate the functioning of patients with bipolar depression.
Methods
The study relied on a sample of one hundred patients diagnosed with bipolar depression.
Seventy-eight of these patients were female. In addition, 70 individuals were also selected to act
as the control group. The control group was paired with the treatment group using similar factors
such as age and education level. Functioning on a cognitive level was evaluated using a
neuropsychological test battery. Functioning, in general, was evaluated by the use of the
Functioning Assessment Short Test.
Key Findings

7
Severe depression in bipolar patients was linked to high levels of cognitive dysfunction.
Further depression was seen to be a predictor of low levels of executive function. Patients with
severe forms of depression were seen to be poor at global functioning compared to patients with
moderate levels of depression. These patients also showed very poor working memory and
declined levels of executive functioning.
Reflection
This research highlights the need to study bipolar depression. The disorder is associated
with poor cognitive functioning. The implication is that there is a need to ensure that the
condition is understood in better terms since this would help in the designing of effective ways to
address the condition and the symptoms as well.
Keramatian, K., Pinto, J. V., Schaffer, A., Sharma, V., Beaulieu, S., Parikh, S. V., & Yatham, L.
N. (2022). Clinical and demographic factors associated with delayed diagnosis of bipolar
disorder: Data from Health Outcomes and Patient Evaluations in Bipolar Disorder
(HOPE-BD) study. Journal of Affective Disorders, 296, 506-513.
Purpose of the Study
The study aimed at examining whether genetic factors affect the course of disease among
patients with bipolar disorder. Thus, the researchers examined polygenic scores for major
psychiatric disorders and their associations to prolonged hospital stays and severity of illness.
Methods
The researchers performed polygenic score analysis on data collected from four groups or
cohorts that took part in the study. They tested the genetic risk in bipolar disorder, major

8
depression, or schizophrenia. The researchers analyzed data from participants with bipolar
disorder whose illnesses had lasted for five years and above. They assessed the severity of the
illness by analyzing the number and duration of hospitalizations among the participants. They
were specifically interested in the number of hospitalizations in a mental facility.
Key Findings
The researchers found that the rate and duration of hospitalizations differed significantly
between the four cohorts that took part in the study. However, they noted that there was no
significant variation in the severity of disease among participants in all the cohorts. The study
found that patients who experienced a chronic illness and had residual symptoms had prolonged
and frequent hospitalizations compared to those who recorded a good recovery rate.
Reflection
Bipolar disorder is highly heritable. The study showed that 75% of the phenotypic
variation in the manifestation of the disorder could be attributed to factors in a person’s genes,
and a significant portion can be explained by variations common in people’s genes. The study,
however, did not explain whether bipolar depression has any association with genetic factors.
Thus, this leaves a study gap that can be explored. In the study, I will seek to explore the extent
to which bipolar depression is associated with genes and the extent to which it is attributed to an
individual’s environment.
Lengvenyte, A., Aouizerate, B., Aubin, V., Loftus, J., Marlinge, E., Belzeaux, R., … & Olié, E.
(2022). Violent suicide attempt history in elderly patients with bipolar disorder: The role
of sex, abdominal obesity, and verbal memory: Results from the FACE-BD cohort

9
(FondaMental Advanced center of Expertise for Bipolar Disorders). Journal of affective
disorders, 296, 265-276.
Purpose of the Study
The study aimed at assessing the relationship between abdominal obesity and cognition
and the violent suicide attempt (SA) among individuals living with bipolar disorder. The
researchers recognized that bipolar disorder is a lifelong condition that is associated with a high
risk of cognitive impairment and obesity. Patients also depict suicidal behaviors and face a high
risk of depression or what is commonly referred to as a bipolar depression.
Methods
The researchers extracted data on 619 euthymic bipolar disorder patients that had been
included in the FondaMnetal Advanced center of Expertise for Bipolar Disorders 50 or more
years ago. The suicide attempt history information was based on self-reports provided by
patients. The researchers then conducted “Cross-sectional clinical, cognitive, and metabolic
assessments” (Lengvenyte et al., 2022).
Key Findings

The researchers found that there was an association between a higher waist
circumference and violent suicide attempts. Abdominal obesity and large waist circumference
were associated with violent suicide attempts, and there were no observed variations based on
participant’s sex, anxiety disorder, or type of bipolar disorder. The association was also
independent of depression among the patients. Thus, violent suicide attempt was linked to
abdominal obesity in depressed as well as no-depressed bipolar patients.

10

Reflection

Individuals with bipolar die due to suicide at a rate of 20-30 times more frequently
compared to their counterparts in the general population. The findings of this study are useful to
my study on bipolar depression as they introduce a new perspective on the relationship between
bipolar depression and suicide. It is evident that other than depression, other factors such as
abdominal obesity and a high waist circumference also cause suicide. Thus, the higher suicide
rates among bipolar patients can be accounted for by many other factors other than depression or
the mental health status of these patients.
McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and
unmet needs of a complex disorder. Current medical research and opinion, 35(11), 1993-
2005.
Purpose of the Study
The aim of the study was to review the clinical aspects of bipolar depression. Bipolar
depression is treated in primary care, and this means that there is a need to analyze clinical
aspects of the disorder. The disorder is associated with serious symptoms, including suicidal
ideation, and the implication is a better understanding of the same can help in designing effective
primary care interventions.
Methods
The study conducted a meta-analysis of existing literature, and articles that provide
important data on the same were selected. A detailed literature search was conducted, and the
terms that were used in the search were “bipolar depression” and “bipolar disorder.”

11

Key Findings
In bipolar patients, bipolar depression is a significant marker of lack of wellbeing.
Symptomatic episodes of bipolar depression result in high morbidity as well as mortality in
bipolar disorder patients. Bipolar depression is linked to high levels of dysfunction in bipolar
patients. It results in psychological impairment and can result in declined productivity. Patients
with bipolar depression are not able to continue with daily activities such as work. There is a
high prevalence of delayed diagnosis as well as misdiagnosis. The two can be attributed to
overlapping symptoms that exist. There are various comorbidities associated with bipolar
depression. These comorbidities include cardiovascular disease as well as psychiatric
comorbidities such as anxiety disorder.
Reflection
The study contributes to my interest in the area of bipolar depression by complementing
the knowledge I have on the same. There is a high level of misdiagnosis and late diagnosis in
bipolar depression patients. To this end, research is needed in the field to eliminate the
uncertainties that create the problems of misdiagnosis and late diagnosis. My aim is to contribute
to this research gap.
Mutz, J., Young, A. H., & Lewis, C. M. (2022). Age-related changes in physiology in individuals
with bipolar disorder. Journal of affective disorders, 296, 157-168.
Purpose of the study
The study aimed at examining the causes of a reduced life expectancy among people with
bipolar. The study was based on the observation that people with bipolar sometimes experiences
accelerated biological aging and, in some instances, reduced life expectancy.

12

Theoretical Framework
The researchers did not use any theories n completing their research. However, the study
was informed by the generalized additive models (GAMS). These are flexible approaches for
modeling that allowed the researcher to capture the key relationships in the variables being
studied. The aim is to achieve maximum goodness-of-fit while maintaining the fitted curve’s
parsimony. The researchers used two models, the adjusted model, and the unadjusted model, for
the physiological measure.
Methodology
More than 500,000 participants were recruited by the UK Biobank during the study. The
participants were aged 37-73, and the study was conducted between 2006 and 2010. GAM
models were used to examine how body composition, age, heel bone mineral density, grip
strength, and cardiovascular function were all associated.
Key Findings
The researchers found statistically significant variations in the participants’ blood
pressure, pulse rate, and body composition. Differences in other aspects that were studied, such
as heel bone strength and cardiovascular, were limited. The researchers concluded that there are
small to moderate differences in physiological changes related to age between healthy controls
and individuals with bipolar disorder. They recommend screening among bipolar patients for
metabolic and cardiovascular health to mitigate excess mortality.
Reflection

13
Overall, the article is a useful resource in understanding bipolar and the health challenges
that individuals with bipolar may face. When a physician understands these conditions, it
becomes easy to assist these patients and provide services that help them live a high-quality life,
consequently avoiding depression.
Palmius, N., Tsanas, A., Saunders, K. E., Bilderbeck, A. C., Geddes, J. R., Goodwin, G. M., &
De Vos, M. (2017). Detecting bipolar depression from geographic location data. IEEE
Transactions on Biomedical Engineering, 64(8), 1761-1771.
Purpose of the Study
The study aimed at evaluating depression in bipolar patients. Bipolar disorder affects
approximately two to four percent of the general population. The condition is typically
characterized by elation (mania) and depression. Early identification of bipolar depression can
help in treatment. The study aimed at understanding the connection between movement and
depression bipolar patients.
Methods
The study relied on the collection of geolocation movements that were obtained through
mobile phones. The geolocation recordings were anonymized to ensure that the privacy of the
participants was protected. The study recruited 22 bipolar depression patients, with data being
obtained from 14 of the 22 participants. The patients reported the presentation of depression
using a weekly questionnaire. The recorded location data was then processed to eliminate data
that was deemed to be un-useful. Linear regression was then carried out to further refine the data
as well draw conclusions.
Key Findings

14
The study concluded that there is a strong link between geographic movements and
depression in bipolar patients. Location is thus a strong marker of bipolar depression.
Geographic locations alone can be used to detect depression in bipolar patients.
Reflection
The study is promising and examines bipolar depression in a unique light offering
valuable perspectives in the process. The findings indicate that geolocation is one of the best
predictors of mood states. I had not considered this and will seek to evaluate this further in my
study. Self-management can be based on geolocation, and this is one of the main contributions of
this study. Testing this proposition in a diffract community can help strengthen the conclusions
reached.
Richard-Lepouriel, H., Aubry, J.-M., & Favre, S. (2022). Is Coping with Stigma by Association
Role-Specific for Different Family Members? A Qualitative Study with Bipolar Disorder
Patients’ Relatives. Community Mental Health Journal, 58(1), 179–192.
https://doi.org/10.1007/s10597-021-00809-6
Purpose of the Study
The study aimed at examining the stigma-related experiences of family members taking
care of or living with individuals with bipolar disorder. The researchers wanted to establish how
the family members coped with public stigma and social isolation widely associated with people
with bipolar disorder.
Methods

15
The qualitative study was conducted, and an in-depth interview approach was used. The
sample selected for the study included 21 relatives who, at the time of the study, were living with
patients with bipolar disorder. The sample was made up of 67% women with a mean age of 53
years. During the interview, the participants were asked open-ended questions that aimed at
collecting data on three main areas, namely the participants’ experiences of associative stigma,
their awareness of the public stigma associated with bipolar, and their ways of coping with
stigma by association (SBA).
Key Findings
The researchers found that SBA was experienced by 70% of the participants, and 30%
said that they never experienced it. During the study, siblings, partners, and siblings of people
with bipolar indicated that they have had to deal with SBA, and the effect is often mediated by
the roles they play within their families. Results from the study showed that members of the
public blamed family members and great parents for the mental illnesses of people living with
bipolar. Such attitudes exert pressure on family members and sometimes pushes them to
depression.
Reflection
The method used in the study, specifically in-depth interview, is effective in collecting
data for such a study. It allows for the collection of a wide variety of data. The study is thus
useful in m study as the method will come in handy when collecting data during the dissertation.

16

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved
challenge. International journal of bipolar disorders, 8(1), 1-13.
Freitag, S., Kapoor, S., & Lamis, D. A. (2022). Childhood maltreatment, impulsive aggression,
and suicidality among patients diagnosed with bipolar disorder. Psychological Trauma:
Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001218
Hu, S., Li, A., Huang, T., Lai, J., Li, J., Sublette, M. E., … & Xu, Y. (2019). Gut microbiota
changes in patients with bipolar depression. Advanced Science, 6(14), 1900752.
Kapczinski, N. S., Narvaez, J. C., Magalhaes, P. V., Bücker, J., Peuker, A. C., Loredo, A. C., …
& Gama, C. S. (2016). Cognition and functioning in bipolar depression. Brazilian
Journal of Psychiatry, 38, 201-206.
Keramatian, K., Pinto, J. V., Schaffer, A., Sharma, V., Beaulieu, S., Parikh, S. V., & Yatham, L.
N. (2022). Clinical and demographic factors associated with delayed diagnosis of bipolar
disorder: Data from Health Outcomes and Patient Evaluations in Bipolar Disorder
(HOPE-BD) study. Journal of Affective Disorders, 296, 506-513.
Lengvenyte, A., Aouizerate, B., Aubin, V., Loftus, J., Marlinge, E., Belzeaux, R., … & Olié, E.
(2022). Violent suicide attempt history in elderly patients with bipolar disorder: The role
of sex, abdominal obesity, and verbal memory: Results from the FACE-BD cohort
(FondaMental Advanced center of Expertise for Bipolar Disorders). Journal of affective
disorders, 296, 265-276.

17
McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and
unmet needs of a complex disorder. Current medical research and opinion, 35(11), 1993-
2005.
Mutz, J., Young, A. H., & Lewis, C. M. (2022). Age-related changes in physiology in individuals
with bipolar disorder. Journal of affective disorders, 296, 157-168.
Palmius, N., Tsanas, A., Saunders, K. E., Bilderbeck, A. C., Geddes, J. R., Goodwin, G. M., &
De Vos, M. (2017). Detecting bipolar depression from geographic location data. IEEE
Transactions on Biomedical Engineering, 64(8), 1761-1771.
Richard-Lepouriel, H., Aubry, J.-M., & Favre, S. (2022). Is Coping with Stigma by Association
Role-Specific for Different Family Members? A Qualitative Study with Bipolar Disorder
Patients’ Relatives. Community Mental Health Journal, 58(1), 179–192.
https://doi.org/10.1007/s10597-021-00809-6