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First‐episode types in bipolar disorder: predictive associations with later illness
Author(s) -
Baldessarini R. J.,
Tondo L.,
Visioli C.
Publication year - 2014
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12204
Subject(s) - hypomania , mania , bipolar disorder , psychiatry , depression (economics) , anxiety , mood , psychology , psychosis , medicine , economics , macroeconomics
Objective Characteristics of initial illness in bipolar disorder ( BD ) may predict later morbidity. Method We reviewed computerized clinical records and life charts of DSM ‐ IV ‐ TR BD ‐I or BD ‐ II patients at affiliated mood‐disorder centers to ascertain relationships of initial major illnesses to later morbidity and other clinical characteristics. Results Adult BD patient–subjects ( N = 1081; 59.8% BD ‐I; 58.1% women; 43% ever hospitalized) were followed 15.7 ± 12.8 years after onsets ranking: depression (59%) > mania (13%) > psychosis (8.0%) ≥ anxiety (7.6%) ≥ hypomania (6.7%) > mixed states (5.5%). Onset types differed in clinical characteristics and strongly predicted later morbidity. By initial episode types, total time‐ill ranked: mania ≥ hypomania ≥ mixed‐states ≥ psychosis > depression > anxiety. Depression was most prevalent long‐term, overall; its ratio to mania‐like illness (D/M, by per cent‐time‐ill) ranked by onset type: anxiety (4.75) > depression (3.27) > mixed states (1.39) > others (all <1.00). The MDI (mania or hypomania–depression–euthymia interval) course‐pattern was most common (34.4%) and associated with psychotic or manic onset; the depression before mania ( DMI ) pattern (25.0%) most often followed anxiety (38.8%), depression (30.8%), or mixed onsets (13.3%); both were predicted by initial mania depression sequences. Conclusion First‐lifetime illnesses and cycles predicted later morbidity patterns among BD patients, indicating value of early morbidity for prognosis and long‐term planning.