Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-13T09:01:09.901Z Has data issue: false hasContentIssue false
  • English
  • Français

Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

Published online by Cambridge University Press:  02 February 2011

J.-M. Azorin ,
A. Kaladjian ,
M. Adida ,
E. Fakra ,
E. Hantouche  and
S. Lancrenon
J.-M. Azorin*
Affiliation:
SHU psychiatrie adultes, hôpital Sainte-Marguerite, Assistance publique–Hôpitaux de Marseille, 13274Marseille cedex 9, France
A. Kaladjian
Affiliation:
SHU psychiatrie adultes, hôpital Sainte-Marguerite, Assistance publique–Hôpitaux de Marseille, 13274Marseille cedex 9, France
M. Adida
Affiliation:
SHU psychiatrie adultes, hôpital Sainte-Marguerite, Assistance publique–Hôpitaux de Marseille, 13274Marseille cedex 9, France
E. Fakra
Affiliation:
SHU psychiatrie adultes, hôpital Sainte-Marguerite, Assistance publique–Hôpitaux de Marseille, 13274Marseille cedex 9, France
E. Hantouche
Affiliation:
Mood Center, Pitié-Salpêtrière Hospital, Assistance publique–Hôpitaux de Paris, 75013Paris, France
S. Lancrenon
Affiliation:
Sylia-Stat, 92340Bourg-La-Reine, France
*
*Corresponding author. Tel.: +33 4 91 74 40 82; fax: +33 4 91 74 55 78. E-mail address:jazorin@ap-hm.fr (J.-M. Azorin).
Get access

Abstract

Objective:

To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.

Methods:

One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.

Results:

Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.

Conclusion:

In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

Keywords

ManiaBipolar I disorderFirst-episode maniaMultiple-episode maniaProdromes
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 8 , November 2012 , pp. 557 - 562
Copyright
Copyright © European Psychiatric Association 2012

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

Akiskal, H.S., Azorin, J.M., Hantouche, E.G.Proposed multidimensional structure of mania: beyond the euphoric-dysphoric dichotomy. J Affect Disord. 2003; 73: 7–18.CrossRefGoogle ScholarPubMed
Akiskal, H.S., Downs, J., Jordan, P., Watson, S., Daugherty, D., Pruitt, D.B.Affective disorders in referred children and younger siblings of manic-depressives. Mode of onset and prospective course. Arch Gen Psychiatry. 1985; 42: 996–1003.CrossRefGoogle ScholarPubMed
Akiskal, H.S., Hantouche, E.G., Bourgeois, M.L., Azorin, J.M., Sechter, D., Allilaire, J.F.et al.Gender, temperament and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN). J Affect Disord. 1998; 50: 175–186.CrossRefGoogle ScholarPubMed
Akiskal, H.S., Hirschfeld, R.M.A., Yerevanian, B.The relationship of personality to affective disorders. A critical review. Arch Gen Psychiatry. 1983; 40: 801–810.CrossRefGoogle Scholar
Akiskal, H.S.Delineating irritable and hyperthymic variants of the cyclothymic temperament. J Pers Disord. 1992; 6: 326–342.CrossRefGoogle Scholar
Alloy, L.B., Abramson, L.Y., Urosevic, S., Walshaw, P.D., Nusslock, R., Neeren, A.M.The psychosocial context of bipolar disorder: environmental, cognitive, and developmental risk factors. Clin Psychol Rev. 2005; 25: 1043–1075.CrossRefGoogle ScholarPubMed
American Psychiatric Association Diagnostic and statistical manual of mental disorders. Fourth Edition (DSM IV) 1994 American Psychiatric Association Washington, DC [translated into French by Guelfi JD et al, Masson, Paris; 1996].Google Scholar
Angst, J., Angst, F., Gerber-Werder, R., Gamma, A.Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years’ follow-up. Arch Suicide Res. 2005; 9: 279–300.CrossRefGoogle Scholar
Azorin, J.M., Akiskal, H., Akiskal, K., Hantouche, E., Châtenel-Duchêne, L., Gury, C.et al.Is psychosis in DSM-IV mania due to severity? The relevance of selected demographic and comorbid social-phobic features. Acta Psychiatr Scand. 2007; 115: 29–34.CrossRefGoogle ScholarPubMed
Azorin, J.M., Hantouche, E., Akiskal, H., Bourgeois, M., Allilaire, J., Sechter, D.et al.Structure factorielle du syndrome maniaque: revue de la littérature et résultats de l’étude Française EPIMAN. Ann Med Psychol. 2000; 158: 279–289.Google Scholar
Azorin, J.M., Kaladjian, A., Adida, M., Hantouche, E., Hameg, A., Lancrenon, S.et al.Risk factors associated with lifetime suicide attempts in bipolar I patients: findings from a French National Cohort. Comp Psychiatry. 2009; 50: 115–120.CrossRefGoogle ScholarPubMed
Azorin, J.M., Kaladjian, A., Adida, M., Hantouche, E.G., Hameg, A., Lancrenon, S.et al.Psychopathological correlates of lifetime anxious comorbidity in bipolar 1 patients: findings from a French National Cohort. Psychopathology. 2009; 42: 380–385.CrossRefGoogle ScholarPubMed
Azorin, J.M.The role of treatment setting in the pharmacotherapy of bipolar disorder.Akiskal, H., Tohen, M.Bipolar psychopharmacotherapy. Caring for the patients. 2006 Wiley Chichester347–352.CrossRefGoogle Scholar
Beigel, A., Murphy, D., Bunney, W.The manic state rating scale: scale construction, reliability and validity. Arch Gen Psychiatry. 1971; 25: 256–262.CrossRefGoogle Scholar
Bordeleau, L.Centre Hospitalier Universitaire du Quebec. Quebec, Canada: Ste Foy, p G2V4G2; 1997.Google Scholar
Brodie, H.K., Leff, M.J.Bipolar depression – A comparative study of patient characteristics. Am J Psychiatry. 1971; 127: 1086–1090.CrossRefGoogle ScholarPubMed
Camacho, A., Akiskal, H.S.Proposal for a bipolar-stimulant spectrum: temperament, diagnostic validation and therapeutic outcomes with mood stabilizers. J Affect Disord. 2005; 85: 217–230.CrossRefGoogle ScholarPubMed
Carlson, G.A., Bromet, E.J., Sievers, S.Phenomenology and outcome of subjects with early and adult onset psychotic mania. Am J Psychiatry. 2000; 157: 213–219.CrossRefGoogle ScholarPubMed
Conus, P., McGorry, P.D.First-episode mania: a neglected priority for early intervention. Aust N Z J Psychiatry. 2002; 36: 158–172.CrossRefGoogle ScholarPubMed
Conus, P., Ward, J., Hallacen, K.T., Lucas, N., Macneil, C., McGorry, P.D.et al.The proximal prodrome to first episode mania – a new target for early intervention. Bipolar Disord. 2008; 10: 555–565.CrossRefGoogle Scholar
Conus, P., Ward, J., Lucas, N., Cotton, S., Yung, A.R., Berk, M.et al.Characterisation of the prodrome to a first episode of psychotic mania: results of a retrospective study. J Affect Disord. 2010; 124: 341–345.CrossRefGoogle ScholarPubMed
Coryell, W., Fiedorowicz, J., Solomon, D., Endicott, J.Age transitions in the course of bipolar I disorder. Psychol Med. 2009; 39: 1247–1252.CrossRefGoogle ScholarPubMed
Daly, I., Webb, M., Kaliszer, M.First admission incidence study of mania, 1975–1981. Br J Psychiatry. 1995; 167: 463–468.CrossRefGoogle ScholarPubMed
Duffy, A., Alda, M., Crawford, L., Milin, R., Grof, P.The early manifestations of bipolar disorder: a longitudinal prospective study of the offspring of bipolar parents. Bipolar Disord. 2007; 9: 828–838.CrossRefGoogle ScholarPubMed
Duffy, A., Alda, M., Hajek, T., Sherry, S.B., Grof, P.Early stages in the development of bipolar disorder. J Affect Disord. 2010; 121: 127–135.CrossRefGoogle ScholarPubMed
First, M., Spitzer, R., Williams, J.Structured clinical interview for the diagnostic and statistical manual. 4th ed.Washington, DC: American Psychiatric Association (Patient version); 1997.Google Scholar
Goldberg, J.F., Ernst, C.L.Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder. J Clin Psychiatry. 2002; 63: 985–991.CrossRefGoogle ScholarPubMed
Gonzalez-Pinto, A., van Os, J., Perez de Heredia, J.L., Mosquera, F., Aldama, A., Lalaguna, B.et al.Age dependance of Scheiderian psychotic symptoms in bipolar patients. Schizophr Res. 2003; 61: 157–162.CrossRefGoogle Scholar
Gunthert, K.C., Conner, T.S., Armeli, S., Tennen, H., Covault, J., Krangler, H.R.Serotonin transporter gene polymorphism (5-HTTLPR) and anxiety reactivity in daily life: a daily process approach to gene-environment interaction. Psychosom Med. 2007; 69: 761–768.CrossRefGoogle ScholarPubMed
Hammen, C., Burge, D., Burney, E., Adrian, C.Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Arch Gen Psychiatry. 1990; 47: 1112–1117.CrossRefGoogle ScholarPubMed
Hantouche, E., Kochman, F., Akiskal, H.Evaluation des tempéraments affectifs : version complète des outils d’auto-évaluation. Encephale. 2001; 27: 24–30.Google Scholar
Henin, A., Biederman, J., Mick, E., Sachs, G.S., Hirshfeld-Becker, D.R., Siegel, R.S.et al.Psychopathology in the offspring of parents with bipolar disorder: a controlled study. Biol Psychiatry. 2005; 58: 554–561.CrossRefGoogle ScholarPubMed
Henry, C., Lacoste, J., Bellivier, F., Verdoux, H., Bourgeois, M.L., Leboyer, M.Temperament in bipolar illness: impact on prognosis. J Affect Disord. 1999; 56: 103–108.CrossRefGoogle ScholarPubMed
Hillegers, M.H.J., Burger, H., Wals, M., Reichart, C.G., Verhulst, F.C., Nolen, W.A.et al.Impact of stressful life events, familial loading and their interaction on the onset of mood disorders. Study in a high-risk cohort of adolescent offspring of parents with bipolar disorder. Br J Psychiatry. 2004; 185: 97–101.CrossRefGoogle Scholar
Hirschfeld, R.M.A., Lewis, L., Vornik, L.A.Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003; 64: 161–174.CrossRefGoogle ScholarPubMed
Janowsky, D.S., Leff, M., Epstein, R.S.Playing the manic game: Interpersonal maneuvers of the acutely manic patient. Arch Gen Psychiatry. 1970; 22: 252–261.CrossRefGoogle ScholarPubMed
Keck, P.E. Jr., McElroy, S.L., Strakowski, S.M., West, S.A., Hawkins, J.M., Huber, T.J.et al.Outcome and comorbidity in first-compared with multiple-episode mania. J Nerv Ment Dis. 1995; 183: 320–324.CrossRefGoogle ScholarPubMed
Kennedy, N., Boydell, J., Kalidindi, S., Fearon, P., Jones, P.B., van, O.et al.Gender differences in incidence and age at onset of mania and bipolar disorder over a 35–year period in Camberwell, England. Am J Psychiatry. 2005; 162: 257–262.CrossRefGoogle Scholar
Kennedy, N., Murray, R.M.The clinical epidemiology of bipolar disorder: a 35-year incidence in south-east London.McDonald, ., Schulze, K, Murray, RM., Tohen, M.Bipolar disorder: the upswing in research and treatment. 2005 Taylor and Francis Abingdon1–8.Google Scholar
Kessing, L.V., Agerbo, E., Mortensen, P.B.Major stressful life events and other risk factors for first admission with mania. Bipolar Disord. 2004; 6: 122–129.CrossRefGoogle ScholarPubMed
Kieseppä, T., Partonen, T., Haukka, J., Kaprio, J., Lönnqvist, J.High concordance of bipolar I disorder in a nationwide sample of twins. Am J Psychiatry. 2004; 161: 1814–1821.CrossRefGoogle Scholar
Kowatch, R.A., Youngstrom, E.A., Danielyan, A., Findling, R.L.Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disord. 2005; 7: 483–496.CrossRefGoogle ScholarPubMed
Leff, J.P., Fischer, M., Bertelsen, A.A cross-national epidemiological study of mania. Br J Psychiatry. 1976; 129: 428–442.CrossRefGoogle ScholarPubMed
Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A., Hirschfeld, R.M.The National Depressive and Manic-Depressive Association (DMDA) survey of bipolar members. J Affect Disord. 1994; 31: 281–294.CrossRefGoogle ScholarPubMed
Mackinnon, D.F., Potash, J.B., McMahon, F.J., Simpson, S.G., DePaulo, J.R. Jr., Zandi, P.P.The National Institutes of Mental Health Bipolar Disorder Genetics Initiative. Rapid mood switching and suicidality in familial bipolar disorder. Bipolar Disord. 2005; 7: 441–448.CrossRefGoogle ScholarPubMed
Montgomery, S.A., Åsberg, M.A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134: 382–389.CrossRefGoogle ScholarPubMed
Pellet, J., Bobon, D., Mormont, I., Lang, F., Massardier, A.Étude princeps de validation française de la MADRS, sous échelle de dépression de la CPRS. Compte rendu du Congrès de psychiatrie et de neurologie de langue française. Paris: Masson; 1981.Google Scholar
Perlis, R.H., Ostacher, M.J., Patel, J.K., Marangell, L.B., Zhang, H., Wisniewski, S.R.et al.Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2006; 163: 217–224.CrossRefGoogle ScholarPubMed
Perugi, G., Akiskal, H.S., Toni, C., Simonini, E., Gemignani, A.The temporal relationship between anxiety disorders and (hypo)mania: a retrospective examination of 63 panic, social phobic and obsessive-compulsive patients with comorbid bipolar disorder. J Affect Disord. 2001; 67: 199–206.CrossRefGoogle ScholarPubMed
Post, R.M.Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry. 1992; 149: 999–1010.Google ScholarPubMed
Robb, J.C., Young, L.T., Cooke, R.G., Joffe, R.T.Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores. J Affect Disord. 1998; 69: 189–193.CrossRefGoogle Scholar
Roy-Byrne, P., Post, R.M., Uhde, T.W., Porcu, T., Davis, T.The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatr Scand. Suppl. 317 1985 1–34.CrossRefGoogle ScholarPubMed
Strakowski, S.M., Keck, P.E. Jr., McElroy, S.L., West, S.A., Sax, K.W., Hawkins, J.M.et al.Twelve-month outcome after a first hospitalization for affective psychosis. Arch Gen Psychiatry. 1998; 55: 49–55.CrossRefGoogle ScholarPubMed
Thompson, K.N., Conus, P.O., Ward, J.L., Philips, J., Kontsogiannis, J., Leicester, S.et al.The initial prodrome to bipolar affective disorder: prospective case studies. J Affect Disord. 2003; 77: 79–85.CrossRefGoogle ScholarPubMed
Tohen, M., Waternaux, C.M., Tsuang, M.T., Hunt, A.T.Four years following of twenty-four first episode manic patients. J Affect Disord. 1990; 19: 79–86.CrossRefGoogle Scholar
Tohen, M., Waternaux, C.M., Tsuang, M.T.Outcome in mania. A 4-year prospective follow-up of 75 patients utilizing survival analysis. Arch Gen Psychiatry. 1990; 47: 1106–1111.CrossRefGoogle Scholar
Tohen, B., Strakowski, S.M., Zarate, C.A. Jr., Hennen, J., Stoll, A.L., Suppes, T.et al.The McLean-Harvard first-episode project: 6-month systematic and functional outcome in affective and nonaffective psychosis. Biol Psychiatry. 2000; 48: 467–476.CrossRefGoogle Scholar
Tohen, M., Zarate, C.A. Jr., Hennen, J., Khalsa, S.M., Strakowski, S.M., Gebre-Medhin, P.et al.The McLean-Harvard first-episode mania study: prediction of recovery and first recurrence. Am J Psychiatry. 2003; 160: 2099–2107.CrossRefGoogle ScholarPubMed
Tohen, M., Vieta, E., Gonzalez-Pinto, A., Reed, C., Lin, D.European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) Advisory Board Baseline characteristics and outcomes in patients with first or multiple episode of acute mania. J Clin Psychiatry. 2010; 71: 255–261.CrossRefGoogle ScholarPubMed
Valtonen, H.Suicidal behaviour in bipolar disorder. Helsinki: National Public Health Institute; 2001.Google Scholar
Vieta, E., Colom, F., Corbella, B., Martinez-Aran, A., Reivares, M., Benabarre, A.et al.Clinical correlates of psychiatric comorbidity in bipolar 1 patients. Bipolar Disord. 2001; 3: 253–258.CrossRefGoogle Scholar
Winokur, G., Turvey, C., Akiskal, H., Coryell, W., Solomon, D., Leon, A.et al.Alcoholism and drug abuse in three groups-bipolar 1, unipolars and their acquaintances. J Affect Disord. 1998; 50: 81–89.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.