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Nivoli AMA, Pacchiarotti I, Rosa AR, Popovic D, Murru A, Valenti M, Bonnin CM, Grande I, Sanchez-Moreno J, Vieta E, Colom F. Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity. J Affect Disord 2011; 133:443-9. [PMID: 21620480 DOI: 10.1016/j.jad.2011.04.055] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 04/27/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Some clinical differences between gender regarding the course and outcome of bipolar disorders have already been described and some others remain still controversial. AIMS To explore gender differences regarding clinical and socio-demographic characteristics amongst bipolar patients with particular attention to predominant polarity and depressive symptoms. METHOD Data were collected from DSM-IV type I and II bipolar patients (n=604), resulting from the systematic follow-up of the Bipolar Disorders Program, Hospital Clinic of Barcelona, over an average follow-up of 10 years. Socio-demographic and clinical variables were collected in order to detect gender-related differences. RESULTS Bipolar women are more likely than men to show a predominance of depressive polarity as well as a depressive onset whilst men would be more likely to suffer from comorbid substance use disorders. Women significantly have a higher lifetime prevalence of psychotic depression and a higher prevalence of axis II comorbid disorders. Bipolar women are also more likely to have a family history of suicide and a lifetime history of attempted suicide. Suicide attempts are more often violent amongst bipolar men. In a backward logistic regression model, two variables were responsible for most gender-related clinical differences: type of predominant polarity - more likely to be depressive amongst women - (B=-0.794, p=0.027, Exp(B)=0.452; CI= 0.223-0.915), alcohol abuse (B=-1.095, p=0.000, Exp(B)=2990; CI= 1.817-4.919) and cocaine abuse (B=0.784, p=0.033, Exp(B)=2.189; CI= 1.066-4.496) - more prevalent amongst men. CONCLUSION The main characteristic featuring bipolar women is depression, both at illness onset and as a predominant polarity all along the illness course. This may have important diagnostic and therapeutic implications.
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Affiliation(s)
- Alessandra M A Nivoli
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Barnett JH, Huang J, Perlis RH, Young MM, Rosenbaum JF, Nierenberg AA, Sachs G, Nimgaonkar VL, Miklowitz DJ, Smoller JW. Personality and bipolar disorder: dissecting state and trait associations between mood and personality. Psychol Med 2011; 41:1593-1604. [PMID: 21134316 PMCID: PMC10034850 DOI: 10.1017/s0033291710002333] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Some personality characteristics have previously been associated with an increased risk for psychiatric disorder. Longitudinal studies are required in order to tease apart temporary (state) and enduring (trait) differences in personality among individuals with bipolar disorder (BD). This study aimed to determine whether there is a characteristic personality profile in BD, and whether associations between BD and personality are best explained by state or trait effects. METHOD A total of 2247 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder study completed the NEO Five-Factor Inventory administered at study entry, and at 1 and 2 years. RESULTS Personality in BD was characterized by high neuroticism (N) and openness (O), and low agreeableness (A), conscientiousness (C) and extraversion (E). This profile was replicated in two independent samples, and openness was found to distinguish BD from major depressive disorder. Latent growth modeling demonstrated that manic symptoms were associated with increased E and decreased A, and depressed symptoms with higher N and lower E, A, C and O. During euthymic phases, high N and low E scores predicted a future depression-prone course. CONCLUSIONS While there are clear state effects of mood on self-reported personality, personality variables during euthymia predict future course of illness. Personality disturbances in extraversion, neuroticism and openness may be enduring characteristics of patients with BD.
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Affiliation(s)
- J. H. Barnett
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridge Cognition Limited, Cambridge, UK
| | - J. Huang
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - R. H. Perlis
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M. M. Young
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - J. F. Rosenbaum
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - A. A. Nierenberg
- Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G. Sachs
- Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - V. L. Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine and Graduate School of Public Health, WPIC, Pittsburgh, PA, USA
| | - D. J. Miklowitz
- Department of Psychiatry, UCLA Semel Institute, UCLA School of Medicine, Los Angeles, CA, USA
| | - J. W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Ortiz A, Bradler K, Slaney C, Garnham J, Ruzickova M, O'Donovan C, Hajek T, Alda M. An admixture analysis of the age at index episodes in bipolar disorder. Psychiatry Res 2011; 188:34-9. [PMID: 21131056 DOI: 10.1016/j.psychres.2010.10.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 07/19/2010] [Accepted: 10/31/2010] [Indexed: 11/26/2022]
Abstract
The interaction between polarity at onset (PAO) and age at onset (AAO) appears to be important for interpreting results of previous analyses of AAO in bipolar disorder (BD). Using an admixture analysis, we examined independently the distributions of age at first depressive and hypomanic/manic episodes in 379 BD I and II patients. Subsequently, we examined the association of PAO and AAO with specific clinical variables, using parametric and nonparametric analyses. Both depressive and manic onsets showed bimodal distributions. For depressive episodes, the means were: 18.5±4.1 (early onset) and 33.6±10.4 (late onset) years; and for manic episodes 18.9±3.3 (early onset) and 34.8±10.9 (late onset) years. For the overall AAO the best fit was for a mixture of three lognormal distributions (mean±S.D.): 15.5±2.0, 22.8±4.6, and 36.1±10.1years. Overall, an early onset was significantly associated with a chronic course of the disorder, a stronger family history of affective disorder, higher rates of rapid cycling, suicidal behavior, psychotic symptoms, and co-morbid anxiety disorders. Early onset depressive episodes were associated with higher rates of suicidal behavior and anxiety disorders, whereas early onset manic episodes were associated with psychotic symptoms and rapid cycling. Our results suggest the presence of a bimodal distribution of age at onset in BD according to the polarity of the index episode, and denote that an early onset BD, irrespective of polarity, may be a more serious subtype of the disorder.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Pacchiarotti I, Valentí M, Bonnin CM, Rosa AR, Murru A, Kotzalidis GD, Nivoli AMA, Sánchez-Moreno J, Vieta E, Colom F. Factors associated with initial treatment response with antidepressants in bipolar disorder. Eur Neuropsychopharmacol 2011; 21:362-9. [PMID: 21056928 DOI: 10.1016/j.euroneuro.2010.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 10/15/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Controversy in antidepressant (AD) use in bipolar depression relies in its potential induction of mood switches and ineffectiveness. Responders to acute AD add-on treatment maintain response with continued treatment, whilst partial/non-responders fail to reach remission despite continuation treatment. We aimed to identify response predictors to acute AD addition in bipolar depression in order to optimize treatment choice in bipolar depression and avoid unnecessary AD exposure of people unlikely to respond. METHODS Two hundred and twenty-one DSM-IV-TR depressed bipolar - type I and II - patients were treated with AD on an observational study. AD response was defined as an at least 50% drop from baseline of their HDRS17 score after 8weeks of treatment. One hundred and thirty-eight patients (138, 62.4%) fulfilled response criteria (RI) whilst 83 patients (37.6%) did not (NRI). In all cases AD therapy was on top of previously prescribed stabilizers and/or atypical antipsychotics. RESULTS RI patients were more likely to have had previous response to ADs, whereas NRI had a higher number of previous mood switches with ADs during past depressive episodes. Psychotic symptoms were more frequent amongst RI, whilst lifetime history of atypical depression was more frequent amongst NRI. NRI had more total, depressive, and hypomanic, but not manic or mixed, episodes in the past than RI. Analyzed through a logistic regression, higher previous response to ADs and lower rate of past hypomanic episodes in RI were the variables explaining intergroups (RI vs. NRI) differences. DISCUSSION Taking into account the proper caution in the use of Ads in bipolar disorder, there is a subgroup of bipolar patients who might benefit from adjunctive Ads. Looking at specific clinical factors during the course of the illness could help physicians in deciding whether to use an antidepressant in a bipolar depressed patient already treated with mood stabilizers.
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Brietzke E, Moreira CLR, Toniolo RA, Lafer B. Clinical correlates of eating disorder comorbidity in women with bipolar disorder type I. J Affect Disord 2011; 130:162-5. [PMID: 21071093 DOI: 10.1016/j.jad.2010.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 09/22/2010] [Accepted: 10/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report on the presence of current and lifetime eating disorders (ED) in a well-defined sample of 137 female individuals with bipolar disorder type I. METHODS Trained psychiatrists interviewed the patients, and the diagnoses of BD and comorbidities were confirmed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Axis I Disorders. Clinical and demographic characteristics of both groups (group with ED vs. group without ED) were compared. RESULTS Female patients with ED had an earlier onset of BD and an increased number of mood episodes, predominantly depressive. Women in the ED group also had higher rates of comorbidity with substance use disorders and anxiety disorders and reported a history of suicide attempts more frequently than women without ED. CONCLUSION The presence of ED is a correlate of severity of BD type I, and interventions should be developed to minimize distress and suicide risk and to improve treatment outcome.
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Affiliation(s)
- Elisa Brietzke
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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Correlates of first-episode polarity in a French cohort of 1089 bipolar I disorder patients: role of temperaments and triggering events. J Affect Disord 2011; 129:39-46. [PMID: 20855116 DOI: 10.1016/j.jad.2010.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/23/2010] [Accepted: 08/23/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES As only a few studies so far systematically reported on bipolar patients subtyped according to first-episode polarity, we took the opportunity of having at disposal a large sample of bipolar I patients to specify the characteristics of patients included in these subtypes, with a special focus on temperament and triggering events. METHODS A total of 1089 consecutive DSM-IV bipolar I manic inpatients were subtyped in manic onset (MO), depressive onset (DO) and mixed onset (MXO), and assessed for demographic, illness course, clinical, psychometric, comorbidity and temperament characteristics. RESULTS The main characteristics of MO patients were a hyperthymic temperamental predisposition, a first episode triggered by substance abuse and an illness course with pure, severe and psychotic mania. In comparison, DO patients had more depressive temperaments, a first episode triggered by stress and alcohol, an illness course with more episodes, cyclicity, suicide attempts, anxious comorbidity and residual symptoms. Although sharing characteristics with either MO or DO, MXO patients had more mixed episodes and cyclothymic temperament. LIMITATIONS The following are the limitations of this study: retrospective design, bias toward preferential enrolment of MO patients, and lack of information on the number and polarity of lifetime episodes. CONCLUSIONS Findings from this study tend to confirm most of the differences previously evidenced among patients subtyped according to first-episode polarity. Differences found in temperamental predisposition and illness onset triggering events are worth noting and may help target early preventive interventions as well as orientate the search for specific genetic risk factors.
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Kim B, Joo YH, Kim SY, Lim JH, Kim EO. Personality traits and affective morbidity in patients with bipolar I disorder: the five-factor model perspective. Psychiatry Res 2011; 185:135-40. [PMID: 20566218 DOI: 10.1016/j.psychres.2010.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 04/13/2010] [Accepted: 05/28/2010] [Indexed: 01/03/2023]
Abstract
In this study, we aimed to extend the present knowledge regarding the relationship of personality traits, as specified by the five-factor model (FFM), with the affective morbidity of bipolar I disorder. The primary aim of this study is to investigate the association of personality traits with affective morbidity, particularly with hospitalization for depressive, manic, or mixed episodes, in patients with bipolar I disorder. The Revised NEO Personality Inventory was administered to 83 subjects who showed a euthymic mood state. Multivariate Poisson regression analysis was performed to identify associations between five domains of personality and the number of hospitalizations for affective episode(s) (manic, depressive, and mixed state). As a secondary research interest, we attempted to determine personality traits which would be significantly different between subjects with Affective Switch from mania into depression Without Euthymia (ASWE) and non-ASWE. The Neuroticism score was positively associated with the number of hospitalization for depression and the total number of hospitalizations Extraversion and Openness scores showed a negative relationship with the number of hospitalizations for depression and the total number of hospitalizations. We found that ASWE patients showed significantly higher Neuroticism scores than did the non-ASWE group. However, there was no significant association between the hospitalization for manic episode and any particular personality trait based on the FFM. This study reveals that personality traits based on the FFM may contribute to an increased likelihood of depressive morbidity and switch into depression.
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Affiliation(s)
- Byungsu Kim
- Health Promotion Center, Asan Medical Center, Seoul, South Korea.
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Neves FS, Malloy-Diniz LF, Romano-Silva MA, Aguiar GC, de Matos LO, Correa H. Is the serotonin transporter polymorphism (5-HTTLPR) a potential marker for suicidal behavior in bipolar disorder patients? J Affect Disord 2010; 125:98-102. [PMID: 20096463 DOI: 10.1016/j.jad.2009.12.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 11/24/2009] [Accepted: 12/29/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Suicide prediction is a huge challenge for mental health workers. Structured interviews based on epidemiological and clinical factors don't show effectiveness for suicide prevention. Biological markers, such as 5-HTTLPR, could help for identification of potential suicide attempters. METHODS We evaluated 198 bipolar patients and 103 health controls, using a structured interview according to DSM-IV criteria. Genotyping, blind of clinical assessment for identification of S carriers and structured interviews were performed in order to describe clinical and epidemiological factors which could be associated with suicide behavior. Statistical analyses were calculated by the x(2) test and logistic regression model. RESULTS We found that 26.77% and 16.67% had a lifetime history of non violent suicide attempt and violent suicide attempt, respectively. The clinical factors associated with violent and non violent suicide attempt had several differences. Violent suicide attempters had an earlier illness onset and had a higher number of psychiatric comorbidities (borderline personality disorder, panic disorder and alcoholism). The frequency of S allele carriers was higher only in those patients who had made a violent suicide attempt in their lifetime (x(2)=16.969; p=0.0001). In a logistic regression model including these factors, S allele carrier (5-HTTLPR) was the only factor associated with violent suicide attempt. LIMITATIONS Sample size and retrospective assessment of suicide behavior history are the limitations of this study. CONCLUSIONS Our study showed that serotonin polymorphism (5-HTTLPR) is strongly associated with violent suicidal behavior in BD patients. If confirmed, our results could be an important step to create a genetic tool for long-term suicide prediction.
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Affiliation(s)
- Fernando Silva Neves
- Department of Mental Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci 2010; 260:385-91. [PMID: 19911248 DOI: 10.1007/s00406-009-0085-2] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
The aim of this naturalistic study was to evaluate the potential influence of the duration of untreated illness (DUI)--defined as the time elapsed between the occurrence of the first mood episode and the first adequate pharmacological treatment with mood stabilizers--on the clinical course of bipolar disorder (BD). Three hundred and twenty outpatients (n = 320) with a DSM-IV diagnosis of BD--either Type I or Type II--were interviewed; their clinical features were collected and they were naturalistically followed-up for 5 years. At the end of the follow-up observation, the sample was subdivided into two groups: one group with a DUI < or =2 years (n = 65) and another group with a DUI >2 years (n = 255). The main demographic and clinical variables were analyzed and compared between the two subgroups of patients using chi-square tests for dichotomous variables or Mann-Whitney U tests for continuous variables. Patients with a longer DUI showed a higher frequency of suicide attempts (Z = -2.11, P = 0.035), a higher number of suicide attempters (chi(2) = 4.13, df = 1, P = 0.04), and a longer duration of illness (Z = -6.79, P < 0.0001) when compared to patients with a shorter DUI. Moreover, patients with a longer DUI had a depressive first episode more frequently than patients with a shorter DUI (chi(2) = 11.28, df = 2, P = 0.004). A further analysis performed dividing the total sample into two subgroups on the basis of a DUI of 6 years (corresponding to the median value of the DUI in the study sample) confirmed prior findings. Results indicate a potential association between a longer DUI and a worse outcome in BD, particularly in terms of suicidality, and confirm the clinical relevance of early diagnosis and pharmacological intervention with mood stabilizers in BD.
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González-Pinto A, Alberich S, Barbeito S, Alonso M, Vieta E, Martínez-Arán A, Saenz M, López P. Different profile of substance abuse in relation to predominant polarity in bipolar disorder: The Vitoria long-term follow-up study. J Affect Disord 2010; 124:250-5. [PMID: 19959240 DOI: 10.1016/j.jad.2009.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a need for comparisons of long-term outcomes in bipolar disorder patients with predominantly manic symptoms vs. predominantly depressive symptoms, especially the course of comorbid alcohol/substance abuse. METHOD A naturalistic sample of bipolar I patients (n=120) was followed prospectively for up to 10years. At baseline, number and polarity of past episodes were used to classify patients as predominantly manic or predominantly depressive if there were more manic or more depressive episodes, respectively. 25 patients were excluded from the analyses. Outcomes including episodes, hospitalisations and suicide attempts were recorded at bimonthly visits. Mixed effects models compared the course of alcohol and other substance abuse in predominantly manic vs. depressive patients. RESULTS Of the 95 patients analyzed, 44 (46.3%) had predominantly manic episodes and 51 (53.7%) had predominantly depressive episodes. At baseline, the predominantly depressive group had more history of suicide attempts (45.1% vs. 20.5%; p=0.021) and more family history of affective disorders (64.7% vs. 38.6%; p=0.020), but they had fewer previous hospitalisations than the manic group (mean 0.38 vs. 0.50; p=0.025). During the 10-year follow-up, the predominantly depressive group was associated with more episodes (p=0.001), more hospitalisations (p=0.004) and more suicide attempts (p=0.002). At baseline, there were no differences between the manic and depressive groups in the frequency of alcohol abuse (43.2% and 35.3%, p=0.565) or other substance abuse (13.6% and 9.8%, p=0.794). During the 10-year follow-up, the frequency of alcohol and other substance abuse decreased significantly in the manic group only, after controlling by age at onset and civil (marital) status. CONCLUSION Long-term clinical outcomes differ between predominantly manic vs. depressive bipolar patients, with the predominantly depressive group having a worse prognosis and maintained alcohol and other substance abuse. These differences should be considered when designing treatment approaches for bipolar patients with comorbid alcohol/substance abuse.
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Affiliation(s)
- Ana González-Pinto
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Hospital Santiago Apóstol, University of the Basque Country, Vitoria, Spain.
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Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: a naturalistic study. Int Clin Psychopharmacol 2010; 25:172-9. [PMID: 20305566 DOI: 10.1097/yic.0b013e3283384c74] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study was designed to investigate and compare demographic and clinical features with specific emphasis on age at onset, age at first treatment and, in particular, on duration of untreated illness (DUI), in patients with different mood and anxiety disorders. Study sample included 729 outpatients with the following diagnoses: major depressive disorder (n=181), bipolar disorder type I (BD I, n=115) and II (BD II, n=186), generalized anxiety disorder (n=100), panic disorder (n=96), and obsessive-compulsive disorder (n=51). Main demographic and clinical variables of the sample were compared among the diagnostic groups using one-way analysis of variance or chi tests. The diagnostic groups showed significant differences in relation to age at onset and age at first pharmacological treatment and in relation to latency to treatment. In particular, patients with major depressive disorder showed the shortest DUI (39.08 months), whereas patient with BD II showed the longest DUI (97.2 months) in comparison with the other groups. Within the group with anxiety disorders (F=7.512, P<0.001), patients with panic disorder showed the shortest DUI (44.35 months), whereas patients with obsessive-compulsive disorder showed the longest DUI (90.57 months). The present findings suggest that patients with different mood and anxiety disorders show significant differences in terms of age at onset, age at first treatment and, consequently, DUI, which potentially reflect different reasons influencing treatment delay.
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Besnier N, Fakra E, Kaladjian A, Adida M, Maurel M, Azorin JM. [Depressive onset episode of bipolar disorder: clinical and prognostic considerations]. Encephale 2010; 36 Suppl 1:S18-22. [PMID: 20141803 DOI: 10.1016/s0013-7006(10)70005-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Both retrospective and high-risk individuals prospective studies show that a high percentage of patients experience one or more depressive episodes previous the diagnosis of bipolar disorder. Depressive onset bipolar disorders begin earlier than the ones with a manic onset, have a higher duration, a chronic course with frequent recurrences, a depressive dominant polarity, a higher lifetime rate of suicidal behaviour, less psychotic symptoms and more rapid cycling. A relation between frequent rapid cycling and previous prescription of antidepressants was suggested but not rigorously demonstrated. Thus, a high percentage of patients presenting a first depressive episode will later develop bipolar disorder. Several risk factors of bipolarity have been identified and might be detected during each depressive episode by using standardised evaluations and family interviews, if necessary. Among them, an early age at first episode, frequent recurrences, a family history of bipolar disorder, atypical features and hypomanic symptoms are particularly associated with the subsequent development of a bipolar disorder. The impact of a high risk of bipolarity on drug prescription is unclear ; however, one can strongly recommend to intensifying clinical monitoring and to proposing adjunctive psychoeducation.
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Affiliation(s)
- N Besnier
- Pôle de Psychiatrie Adultes, CHU Sainte Marguerite, 13009 Marseille.
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Gomes FA, Kauer-Sant'Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha A, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder. Acta Neuropsychiatr 2010; 22:63-7. [PMID: 25385031 DOI: 10.1111/j.1601-5215.2010.00452.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED Gomes FA, Kauer-Sant'Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha Â, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder. OBJECTIVE There is a paucity of data about risk factors for suicide attempts in bipolar disorder. The aim of this study is to examine the association between suicide attempts and obesity in people with bipolar disorder. METHODS Two hundred fifty-five DSM-IV out-patients with bipolar disorder were consecutively recruited from the Bipolar Disorder Program at Hospital das Clínicas de Porto Alegre and the University Hospital at the Universidade Federal de Santa Maria, Brazil. Diagnosis and clinical variables were assessed with Structured Clinical Interview for DSM-IV-axis I (SCID I) and Program structured protocol. History of suicide attempts was obtained from multiple information sources including patients, relatives and review of medical records. Patients with body mass index (BMI) ≥ 30 were classified as obese. RESULTS Over 30% of the sample was obese and over 50% had a history of suicide attempt. In the multivariate model, obese patients were nearly twice (OR = 1.97, 95% CI: 1.06-3.69, p = 0.03) as likely to have a history of suicide attempt(s). CONCLUSION Our results emphasise the relevance of obesity as an associated factor of suicide attempts in bipolar disorder. Obesity may be seen as correlate of severity and as such, must be considered in the comprehensive management of bipolar patients.
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Affiliation(s)
- Fabiano A Gomes
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Márcia Kauer-Sant'Anna
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro V Magalhães
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felice N Jacka
- 2Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong, Australia
| | - Seetal Dodd
- 2Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong, Australia
| | - Clarissa S Gama
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angelo Cunha
- 3University Hospital, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Michael Berk
- 2Department of Clinical and Biomedical Sciences, University of Melbourne, Geelong, Australia
| | - Flávio Kapczinski
- 1Bipolar Disorders Program and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Colom F, Reinares M, Pacchiarotti I, Popovic D, Mazzarini L, Martínez-Arán A, Torrent C, Rosa A, Palomino-Otiniano R, Franco C, Bonnin CM, Vieta E. Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis. Acta Neuropsychiatr 2010; 22:50-3. [PMID: 25385029 DOI: 10.1111/j.1601-5215.2010.00450.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Colom F, Reinares M, Pacchiarotti I, Popovic D, Mazzarini L, Martínez-Arán A, Torrent C, Rosa A, Palomino-Otiniano R, Franco C, Bonnin CM, Vieta E. Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis. OBJECTIVE One of the main utilities of staging in bipolar disorder is enhancing the formulation of pharmacological and non-pharmacological treatment strategies. Hence, it is essential to ascertain whether the number of previous episodes influences treatment response. Hereby, we present a 5-year post hoc study on the efficacy of group psychoeducation for bipolar disorders according to the number of previous episodes. METHODS For this subanalysis, we have compared the 5-year outcome of 120 euthymic psychoeducated versus non-psychoeducated bipolar patients according to the number of previous episodes at study entry. RESULTS Patients with more than seven episodes at study entry did not show any significant improvement with psychoeducation according to time to recurrence. Patients with more than 14 episodes did not benefit from psychoeducation in terms of a reduction of time spent ill. Patients with 7 or 8 episodes showed a benefit in terms of fewer days spent in hypomania, depression, mixed episodes or any episodes but not mania, while patients with 9-14 episodes showed a benefit in terms of fewer days spent in hypomania and depression but not in mixed states or mania. Only patients who presented up to 6 episodes showed reduction in time spent in any episode polarity. CONCLUSION The number of previous episodes clearly worsens response to psychoeducation, perhaps in a more subtle way than that observed with other psychological therapies. Psychoeducation should be delivered as soon as possible in the illness course, supporting the idea of early intervention.
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Affiliation(s)
- Francesc Colom
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - María Reinares
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Dina Popovic
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Lorenzo Mazzarini
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Carla Torrent
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Adriane Rosa
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Carolina Franco
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Caterina M Bonnin
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- 1Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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Kaladjian A, Fakra E, Adida M, Besnier N, Maurel M, Azorin JM. Polarité maniaque du premier épisode d’un trouble bipolaire : aspects cliniques et pronostiques. Encephale 2010; 36 Suppl 1:S13-7. [DOI: 10.1016/s0013-7006(10)70004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Licanin I, Ducic A, Masic I. Rate of bipolar affective disorder registered according to total pattern of morbidity at psychiatry clinic in sarajevo from 2006-2008. Mater Sociomed 2010; 22:81-4. [PMID: 24493981 PMCID: PMC3813547 DOI: 10.5455/msm.2010.22.81-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 04/11/2010] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Affective disorders were known even in ancient times. Today is the official name of the ICD-10 bipolar affective disorder (F31) and represent sub category of mood disorders (affective disorders) with code F30-F39. GOAL The aim of this study was to examine and display the frequency of bipolar disorders in the total number of patients at the Psychiatric Clinic in the period 2006-2008, in order to examine the demographic profile of patients and to determine the length of hospitalization. One of the goals is also to show the number of patients with bipolar disorder compared to all other patients in the group F30-39, with respect to the research period. PATIENTS AND METHODS During the research is used a retrospective-prospective study of clinical-epidemiological character. The study included all 3713 patients with different diagnoses, which were hospitalized at the Psychiatric Clinic of the Clinical Center in Sarajevo in the period from January 1st 2006 to December 31st 2008. From the total number of 3713 respondents selected are those with bipolar affective disorder, 63 (1.7%). The diagnosis was set according to ICD-10 Classification (F30-39). RESULTS Of the total number of patients 3713, there were 63 (1.7%) subjects with BD. From this number in 2006 was 21 (1.6%); in 2007-20 (1.7%), and in 2008-22 (1.7%) Patients with F31.1 was present in 2006 year as 5 (23.9%) cases and in 2007 the dominant group consists of respondents with F31.2-8 (40%), while in 2008 patients with F31.2 had 7 cases (31, 8%). The average duration of hospitalization in 2006 amounted to 43.7 days in 2007 to 40.9 and in 2008 to 37 days. CONCLUSION Bipolar disorder is often incorrectly diagnosed as is also possible in this study given the small percentage of the disorder in relation to the total number of patients. Bipolar disorder has a direct impact on the quality of life of patients. Because of these facts, timely diagnosis and appropriate treatment are very important, and as a result, their suicide prevention.
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Affiliation(s)
- Ifeta Licanin
- Psychiatric Clinic, Clinical Center of University of Sarajevo , Bosnia and Herzegovina
| | - Amra Ducic
- Psychiatric Clinic, Clinical Center of University of Sarajevo , Bosnia and Herzegovina
| | - Izet Masic
- Medical Faculty, University of Sarajevo , Bosnia and Herzegovina
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Mazzarini L, Pacchiarotti I, Colom F, Sani G, Kotzalidis GD, Rosa AR, Sanna L, De Rossi P, Girardi N, Bonnin CM, Sanchez-Moreno J, Vazquez GH, Gasto C, Tatarelli R, Vieta E. Predominant polarity and temperament in bipolar and unipolar affective disorders. J Affect Disord 2009; 119:28-33. [PMID: 19346002 DOI: 10.1016/j.jad.2009.03.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 03/20/2009] [Accepted: 03/20/2009] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Recently, the concept of predominant polarity (two-thirds of episodes belonging to a single pole of the illness) has been introduced to further characterise subtypes of bipolar disorders. This concept has been proven to have diagnostic and therapeutic implications, but little is known on the underlying psychopathology and temperaments. With this study, we aimed to further validate the concept and explore its relationships with temperament. METHODS This study enrolled 143 patients with bipolar or unipolar disorder. We analysed predominant polarity in the sample of bipolar I patients (N=124), focussing on those who showed a clear predominance for one or the other polarity, and distinguishing manic/hypomanic (MP) from depressive polarity (DP), and a unipolar major depression (UP) group (N=19),. We also assessed temperament by means of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). RESULTS Over 55% of the bipolar I sample fulfilled predominant polarity criteria, with two-thirds of those meeting criteria for MP and one third for DP. MP and DP were similar in scoring higher than UP on the hyperthymic/cyclothymic scales of the TEMPS-A; the UP group scored higher on the anxious/depressive scales. DISCUSSION Our results show that both bipolar I MP and DP subgroups are temperamentally similar and different from UP. Depression in DP bipolar I patients should be viewed as the overlap of depression on a hyperthymic/cyclothymic temperament. These findings confirm the value of the predominant polarity concept as well as the importance of temperaments to separate bipolar from unipolar disorders.
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Affiliation(s)
- Lorenzo Mazzarini
- Bipolar Disorders Programme, Institute of Clinical Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Vieta E, Berk M, Wang W, Colom F, Tohen M, Baldessarini RJ. Predominant previous polarity as an outcome predictor in a controlled treatment trial for depression in bipolar I disorder patients. J Affect Disord 2009; 119:22-7. [PMID: 19324419 DOI: 10.1016/j.jad.2009.02.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 02/25/2009] [Accepted: 02/26/2009] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We hypothesized that predominant episode-polarity would predict response to treatment of depressive episodes in bipolar I disorder (BPD) patients with treatment in a placebo-controlled trial, in the sense that patients with manic predominant polarity (PM) would respond better than patients with depressive predominant polarity (PD). METHOD This post-hoc analysis of a published trial examined outcomes of 788 depressed (MADRS score >or=20) adult BPD patients with baseline and follow-up assessments, according to their predominant polarity based on previous recurrences of mania-hypomania vs. depression in >or=2:1 excess. Patients (total=833) were randomized to an 8-week trial of treatment with placebo (n=377), olanzapine (5-20 mg/day; n=370), or olanzapine/fluoxetine combination (OFC; 6/25, 6/50, or 12/50 mg/day; n=86). Treatment response was based on improvement in Clinical Global Impression of depression severity (CGI-D). We analyzed for associations of this outcome with predominant lifetime illness-polarity, based on retrospective SCID-based assessment of individual clinical history. RESULTS Predominant polarity could be demonstrated in 367/788 patients (46.6%), showing a 2.7-fold excess of predominant depressive over manic past-illnesses (34.1%/12.4%), with similar distribution by sex and among treatment-arms. Moreover, based on least-square change in CGI-D severity (based on a mixed model of repeated measures [MMRM]), predominant polarity has different impact in the treatment outcome for each gender. Men with predominantly manic polarity had statistically significant better improvement than men with predominantly depressive polarity. Such difference was not observed in the female population. Other outcome measures yielded similar conclusions. CONCLUSIONS Predominant previous depressive>manic episodes selectively yielded poorer responses of BPD to treatment for acute BP depression, particularly in men.
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Affiliation(s)
- E Vieta
- Bipolar Disorders Program, University of Barcelona Hospital Clinic, Institut d'Investigacions Biomédiques Agustí Pi Sunyer, CIBER-SAM, Barcelona, Spain.
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Tohen M, Frank E, Bowden CL, Colom F, Ghaemi SN, Yatham LN, Malhi GS, Calabrese JR, Nolen WA, Vieta E, Kapczinski F, Goodwin GM, Suppes T, Sachs GS, Chengappa KR, Grunze H, Mitchell PB, Kanba S, Berk M. The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2009; 11:453-73. [PMID: 19624385 DOI: 10.1111/j.1399-5618.2009.00726.x] [Citation(s) in RCA: 328] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Via an international panel of experts, this paper attempts to document, review, interpret, and propose operational definitions used to describe the course of bipolar disorders for worldwide use, and to disseminate consensus opinion, supported by the existing literature, in order to better predict course and treatment outcomes. METHODS Under the auspices of the International Society for Bipolar Disorders, a task force was convened to examine, report, discuss, and integrate findings from the scientific literature related to observational and clinical trial studies in order to reach consensus and propose terminology describing course and outcome in bipolar disorders. RESULTS Consensus opinion was reached regarding the definition of nine terms (response, remission, recovery, relapse, recurrence, subsyndromal states, predominant polarity, switch, and functional outcome) commonly used to describe course and outcomes in bipolar disorders. Further studies are needed to validate the proposed definitions. CONCLUSION Determination and dissemination of a consensus nomenclature serve as the first step toward producing a validated and standardized system to define course and outcome in bipolar disorders in order to identify predictors of outcome and effects of treatment. The task force acknowledges that there is limited validity to the proposed terms, as for the most part they represent a consensus opinion. These definitions need to be validated in existing databases and in future studies, and the primary goals of the task force are to stimulate research on the validity of proposed concepts and further standardize the technical nomenclature.
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Affiliation(s)
- Mauricio Tohen
- Department of Psychiatry, Division of Mood and Anxiety Disorders, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA.
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Cha B, Kim JH, Ha TH, Chang JS, Ha K. Polarity of the first episode and time to diagnosis of bipolar I disorder. Psychiatry Investig 2009; 6:96-101. [PMID: 20046381 PMCID: PMC2796048 DOI: 10.4306/pi.2009.6.2.96] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 04/29/2009] [Accepted: 05/11/2009] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The current study explored the relationship between the polarity of the first episode and the timing of eventual diagnosis of bipolar I disorder, and associated clinical implications. METHODS Twelve years of clinical data from the medical records of 258 inpatients meeting DSM-III-R or DSM-IV criteria for bipolar I disorder were analyzed. Subjects were divided into two groups according to the polarity of the first episode: those with depressive polarity (FE-D), and those with manic polarity (FE-M). Comparisons were made between the two groups on variables associated with the timing of diagnosis and related outcomes. RESULTS In population with bipolar I disorder, a significant longer time lapse from the first major mood episode to the confirmed diagnosis was associated with the FE-D group compared to the FE-M group [5.6 (+/-6.1) vs. 2.5 (+/-5.5) years, p<0.001]. FE-D subjects tended to have prior diagnoses of schizophrenia and major depressive disorder while FE-M subjects tended to have prior diagnoses of bipolar disorder and schizophrenia. A significantly higher rate of suicide attempts was associated with the FE-D group compared to the FE-M group (12.7 vs. 1.7%, p<0.001). CONCLUSION The results of this study indicate that first-episode depressive polarity is likely to be followed by a considerable delay until an eventual confirmed diagnosis of bipolar I disorder. Given that first-episode depressive patients are particularly vulnerable to unfavorable clinical outcomes such as suicide attempts, a more systematic approach is needed to differentiate bipolar disorder among depressed patients in their early stages.
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Affiliation(s)
- Boseok Cha
- Mood Disorders Clinic and Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Hyun Kim
- Mood Disorders Clinic and Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Hyon Ha
- Mood Disorders Clinic and Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Seung Chang
- Mood Disorders Clinic and Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyooseob Ha
- Mood Disorders Clinic and Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
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Cognitive impairment in bipolar disorder: neurodevelopment or neurodegeneration? An ECNP expert meeting report. Eur Neuropsychopharmacol 2008; 18:787-93. [PMID: 18725178 DOI: 10.1016/j.euroneuro.2008.07.005] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 06/28/2008] [Accepted: 07/08/2008] [Indexed: 12/31/2022]
Abstract
This is a report arising from an ECNP expert meeting. Recent studies have focussed on cognitive problems in manic-depressive illness and a few have addressed premorbid neuropsychological functioning. The results are not fully consistent but seem to point to a neurodegenerative model, rather than a neurodevelopmental one, for some cognitive domains. There is agreement that cognitive dysfunction is highly correlated with psychosocial functioning. The neurobiological and clinical implications of recent findings will be discussed. Treatments to reduce subsyndromal symptoms and relapses may indirectly improve neurocognitive deficits and this should be better documented. Moreover, neurocognitive impairment in bipolar disorder should be considered a potential therapeutic target, so that research should focus on new drugs and psychological interventions, including neurocognitive rehabilitation, addressed to improve not only the cognition but also the functional outcome of this population.
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