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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).
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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

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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
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