Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients
Version of Record online: 10 JUL 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Acta Psychiatrica Scandinavica
Volume 129, Issue 4, pages 275–285, April 2014
How to Cite
Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients., , , , , , , , .
- Issue online: 13 MAR 2014
- Version of Record online: 10 JUL 2013
- Manuscript Accepted: 28 MAY 2013
- NIH. Grant Numbers: MH-47370, MH-73049
- NIH . Grant Numbers: MH-04844, MH-10948
- bipolar disorder;
- first psychotic episodes;
As initial episode type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode types.
We studied 263 first-episode, adult, DSM-IV-TR type I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first lifetime manic vs. other (mixed, depressive, or non-affective) major psychotic episodes.
We identified 32 antecedents arising at early, intermediate or later times, starting 12.3 ± 10.7 years prior to first lifetime major psychotic episodes. Based on multivariate modeling, antecedents associated significantly and independently with other (n = 113) more than manic (n = 150) first lifetime major psychotic episodes ranked by odds ratio: more early attentional disturbances, more late depression, more early perplexity, more detoxification, more early unstable mixed affects, more antidepressants, more early dysphoria, more intermediate depression, more early impulsivity, more late anhedonia, longer early-to-intermediate intervals, more intermediate substance abuse, more family history of major depression, and younger at earliest antecedents. Antecedents selectively preceding manic more than other first psychotic episodes included more late behavioral problems and more risk of familial BD-I.
Clinical antecedents in adult, BD-I patients, beginning a decade before first major episodes and progressing through sequential stages were dissimilar in manic vs. other first psychotic episodes.