Letter to the Editor
Sir: Kupfer et al. reported very important findings on the clinical features of a large sample of bipolar case registry patients. The authors reported that the median age at onset was 17.5 years, that family history (not using research-level family history methodology) of bipolar disorder was present in 54.0% of patients, and that 64% of the patients were unemployed (indicating severe impairment). The authors stressed that the high level of impairment could result from inadequate treatment of depression (maybe for fear of inducing mania).
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