{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:29:45Z","timestamp":1790918985097,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2011,12,21]],"date-time":"2011-12-21T00:00:00Z","timestamp":1324425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2012,4]]},"abstract":"<jats:p>Baldessarini RJ, Undurraga J, V\u00e1zquez GH, Tondo L, Salvatore P, Ha K, Khalsa H\u2010MK, Lepri B, Ha TH, Chang JS, Tohen M, Vieta E. Predominant recurrence polarity among 928 adult international bipolar I disorder patients.<\/jats:p><jats:p><jats:bold>Objective:\u2002<\/jats:bold> To test the hypothesis that patients with bipolar disorder (BPD) differ demographically and clinically within subgroups based on the predominant\u2010polarity of major recurrences.<\/jats:p><jats:p><jats:bold>Method:\u2002<\/jats:bold> We tested factors for association with predominantly (\u22652\u2003:\u20031) depressive vs. mania\u2010like episodes with 928 DSM\u2010IV type\u2010I BPD subjects from five international sites.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> Factors preliminarily associated with predominant\u2010depression included: electroconvulsive treatment, longer latency\u2010to\u2010BPD diagnosis, first episode depressive or mixed, more suicide attempts, more Axis\u2010II comorbidity, ever having mixed\u2010states, ever married, and female sex. Predominant\u2010mania was associated with: initial manic or psychotic episodes, more drug abuse, more education, and more family psychiatric history. Of the 47.3% of subjects without polarity\u2010predominance, risks for all factors considered were intermediate. Expanding the definition of polarity\u2010predominance to \u226551% added little, but shifting mixed\u2010states to \u2018predominant\u2010depression\u2019 increased risk of suicidal acts from 2.4\u2010 to 4.5\u2010fold excess over predominant\u2010mania\u2013hypomania, and suicidal risk was associated continuously with increasing proportions of depressive or mixed episodes.<\/jats:p><jats:p><jats:bold>Conclusion:\u2002<\/jats:bold> Subtyping by predominant\u2010polarity yielded predictive associations, including the polarity of first episodes and risk of suicide attempts. Such subtyping may contribute to improve planning of clinical care and to biological studies of BPD.<\/jats:p>","DOI":"10.1111\/j.1600-0447.2011.01818.x","type":"journal-article","created":{"date-parts":[[2011,12,21]],"date-time":"2011-12-21T19:05:36Z","timestamp":1324494336000},"page":"293-302","source":"Crossref","is-referenced-by-count":144,"title":["Predominant recurrence polarity among 928 adult international bipolar I disorder patients"],"prefix":"10.1111","volume":"125","author":[{"given":"R. J.","family":"Baldessarini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Undurraga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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