Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-24T09:37:37.569Z Has data issue: false hasContentIssue false
  • English
  • Français

Early clinical predictors and correlates of long-term morbidity in bipolar disorder

Published online by Cambridge University Press:  23 March 2020

G. Serra ,
A Koukopoulos ,
L. De Chiara ,
A.E. Koukopoulos ,
G. Sani ,
L. Tondo ,
P. Girardi ,
D. Reginaldi  and
R.J. Baldessarini
G. Serra*
Affiliation:
Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Rome, Italy
A Koukopoulos
Affiliation:
International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Rome, Italy
L. De Chiara
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
A.E. Koukopoulos
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy Lucio Bini Mood Disorder Center, Rome, Italy
G. Sani
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy Lucio Bini Mood Disorder Center, Rome, Italy
L. Tondo
Affiliation:
Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
P. Girardi
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy Lucio Bini Mood Disorder Center, Rome, Italy
D. Reginaldi
Affiliation:
International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Rome, Italy
R.J. Baldessarini
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
*
*Corresponding author. Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome (Italy). E-mail address:giuliaserra@gmail.com (G. Serra).
Get access

Abstract

Objectives:

Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).

Methods:

We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.

Results:

Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P = 0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P < 0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.

Conclusions:

Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.

Keywords

Bipolar disorderD/M ratioLong-term morbidityOutcomePredictionProdrome
Type
Original article
Information
European Psychiatry , Volume 43 , June 2017 , pp. 35 - 43
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Forte, ABaldessarini, RJTondo, LVázquez, GHPompili, MGirardi, PLong-term morbidity in bipolar-I, bipolar-II, and unipolar major depressive disorders. J Affect Disord 2015;178: 71–78 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/25797049, cited 2015 Dec 17 ].CrossRefGoogle ScholarPubMed
Melartin, TKRytsälä, HJLeskelä, USLestelä-Mielonen, PSSokero, TPIsometsä, ETSeverity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. J Clin Psychiatry 2004;65(6):810–819 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/15291658, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Melchior, MChastang, J-FLeclerc, ARibet, CRouillon, FLow socioeconomic position and depression persistence: longitudinal results from the GAZEL cohort study. Psychiatry Res 1771–22010 92–96 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/20381167, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Montagnier, DBarberger-Gateau, PJacqmin-Gadda, HDartigues, J-FRainfray, MPérès, Ket al.Evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large sample of older French people: results from the personnes agées quid study. J Am Geriatr Soc 2006;54(12):1839–1845 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/17198488, cited 2016 May 24 ].CrossRefGoogle Scholar
Seemüller, FMeier, SObermeier, MMusil, RBauer, MAdli, Met al.Three-year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: severe relapse rates and risk factors. Eur Arch Psychiatry Clin Neurosci 2014;264(7):567–575 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/24590257, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Baldessarini, RJUndurraga, JVázquez, GHTondo, LSalvatore, PHa, Ket al.Predominant recurrence polarity among 928 adult international bipolar I disorder patients. Acta Psychiatr Scand 2012;125(4):293–302 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/22188017, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Baldessarini, RJTondo, LVisioli, CFirst-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatr Scand 2014;129(5):383–392 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/24152091, cited 2016 May 17 ].CrossRefGoogle ScholarPubMed
Koukopoulos, AReginaldi, DTondo, LVisioli, CBaldessarini, RJCourse sequences in bipolar disorder: depressions preceding or following manias or hypomanias. J Affect Disord 2013;151(1):105–110 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/23827534, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Faedda, GLBaldessarini, RJSuppes, TTondo, LBecker, ILipschitz, DSPediatric-onset bipolar disorder: a neglected clinical and public health problem. Harv Rev Psychiatry 1995;3(4):171–195 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/9384947, cited 2015 Nov 10 ].CrossRefGoogle ScholarPubMed
Leverich, GSPost, RMKeck, PEAltshuler, LLFrye, MAKupka, RWet al.The poor prognosis of childhood-onset bipolar disorder. J Pediatr 2007;150(5):485–490 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/17452221, cited 2015 Nov 10 ].CrossRefGoogle ScholarPubMed
Perlis, RHDennehy, EBMiklowitz, DJDelbello, MPOstacher, MCalabrese, JRet al.Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study. Bipolar Disord 2009;11(4):391–400 [Internet, Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3992980&tool=pmcentrez&rendertype=Abstract, cited 2015 Nov 10 ].CrossRefGoogle ScholarPubMed
van Noorden, MSMinkenberg, SEGiltay, EJden Hollander-Gijsman, MEvan Rood, YRvan der Wee, NJet al.Pre-adult versus adult onset major depressive disorder in a naturalistic patient sample: the Leiden Routine Outcome Monitoring Study. Psychol Med 2011;41(7):1407–1417 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/21078226, cited 2015 Nov 10 ].CrossRefGoogle Scholar
Zisook, SRush, AJAlbala, AAlpert, JBalasubramani, GKFava, Met al.Factors that differentiate early vs. later onset of major depression disorder. Psychiatry Res 2004;129(2):127–140 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/15590040, cited 2015 Nov 10 ].CrossRefGoogle ScholarPubMed
Perlis, RHMiyahara, SMarangell, LBWisniewski, SROstacher, MDelBello, MPet al.Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry 2004;55(9):875–881 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/15110730, cited 2016 Jan 18 ].CrossRefGoogle Scholar
McCraw, SParker, GGraham, RSynnott, HMitchell, PBThe duration of undiagnosed bipolar disorder: effect on outcomes and treatment response. J Affect Disord 2014;168: 422–429 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/25108774, cited 2016 May 12 ].CrossRefGoogle ScholarPubMed
Baethge, CSmolka, MNGruschka, PBerghöfer, ASchlattmann, PBauer, Met al.Does prophylaxis-delay in bipolar disorder influence outcome? Results from a long-term study of 147 patients. Acta Psychiatr Scand 2003;107(4):260–267 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/12662248, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Baethge, CTondo, LBratti, IMBschor, TBauer, MViguera, ACet al.Prophylaxis latency and outcome in bipolar disorders. Can J Psychiatry 2003;48(7):449–457 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/12971014, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Baldessarini, RJTondo, LBaethge, CJLepri, BBratti, IMEffects of treatment latency on response to maintenance treatment in manic-depressive disorders. Bipolar Disord 2007;9(4):386–393 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/17547585, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Baldessarini, RJTondo, LHennen, JTreatment-latency and previous episodes: relationships to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord 2003;5(3):169–179 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/12780871, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Bratti, IMBaldessarini, RJBaethge, CTondo, LPretreatment episode count and response to lithium treatment in manic-depressive illness. Harv Rev Psychiatry 2003;11(5):245–256. [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/14555425, cited 2016 May 24 ]CrossRefGoogle ScholarPubMed
Baldessarini, RJTondo, LVisioli, CVázquez, GHIllness history: not associated with remission during treatment of major depression in 515 mood disorder patients. J Affect Disord 2016;191: 118–122 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/26655121, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Akiskal, HSMallya, GCriteria for the “soft” bipolar spectrum: treatment implications. Psychopharmacol Bull 1987;23(1):68–73 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/3602332, cited 2015 Nov 10 ].Google ScholarPubMed
Hamilton, MA rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23: 56–62 [Internet, Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=495331&tool=pmcentrez&rendertype=Abstract, cited 2014 Dec 21 ].CrossRefGoogle ScholarPubMed
Young, RCBiggs, JTZiegler, VEMeyer, DAA rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133: 429–435 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/728692, cited 2015 Apr 16 ].CrossRefGoogle ScholarPubMed
Denicoff, KDAli, SOSollinger, ABSmith-Jackson, EELeverich, GSPost, RMUtility of the daily prospective National Institute of Mental Health Life-Chart Method (NIMH-LCM-p) ratings in clinical trials of bipolar disorder. Depress Anxiety 2002;15(1):1–9 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/11816046, cited 2016 May 17 ].CrossRefGoogle ScholarPubMed
Sani, GVöhringer, PANapoletano, FHoltzman, NSDalley, SGirardi, Pet al.Koukopoulos’ diagnostic criteria for mixed depression: a validation study. J Affect Disord 2014;164: 14–18 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/24856547, cited 2016 May 17 ].CrossRefGoogle Scholar
Serra, GKoukopoulos, ADe Chiara, LNapoletano, FKoukopoulos, AECurto, Met al.Features preceding diagnosis of bipolar versus major depressive disorders. J Affect Disord 2015;173: 134–142 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/25462407, cited 2015 Nov 10 ].CrossRefGoogle ScholarPubMed
Tondo, LLepri, BCruz, NBaldessarini, RJAge at onset in 3014 Sardinian bipolar and major depressive disorder patients. Acta Psychiatr Scand 2010;121(6):446–452 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/20040069, cited 2016 Apr 14 ].CrossRefGoogle ScholarPubMed
Oepen, GBaldessarini, RJSalvatore, PSlater, EOn the periodicity of manic-depressive insanity, by Eliot Slater (1938): translated excerpts and commentary. J Affect Disord 2004;78(1):1–9 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/14672791, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Goodwin, FKJaminson, KRManic-depressive illness: bipolar disorders and recurrent depression, 2nd Ed., New York: Oxford University Press, editor; 2007.Google Scholar
Gaudiano, BAMiller, IWAnxiety disorder comobidity in Bipolar I Disorder: relationship to depression severity and treatment outcome. Depress Anxiety 2005;21(2):71–77 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/15786484, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Mazza, MMandelli, LDi Nicola, MHarnic, DCatalano, VTedeschi, Det al.Clinical features, response to treatment and functional outcome of bipolar disorder patients with and without co-occurring substance use disorder: 1-year follow-up. J Affect Disord 2009;115(1–2):27–35 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/18845344, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Frank, ECyranowski, JMRucci, PShear, MKFagiolini, AThase, MEet al.Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Arch Gen Psychiatry 2002;59(10):905–911 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/12365877, cited 2016 May 24 ].CrossRefGoogle ScholarPubMed
Simon, NMOtto, MWWisniewski, SRFossey, MSagduyu, KFrank, Eet al.Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2004;161(12):2222–2229 [Internet, Available from: http://www.ncbi.nlm.nih.gov/pubmed/15569893, cited 2016 May 24 ].CrossRefGoogle Scholar
Pacchiarotti, IBond, DJBaldessarini, RJNolen, WAGrunze, HLicht, RWet al.The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013;170(11):1249–1262 [Internet, Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4091043&tool=pmcentrez&rendertype=Abstract, cited 2016 May 13 ].CrossRefGoogle ScholarPubMed
Serra, GKoukopoulos, ADe Chiara, LNapolitano, FKoukopoulos, AESani, Get al.Child and adolescent clinical features preceding adult suicide attempts. Arch Suicide Res 2016; 1–17.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.