RJB has recently been a consultant or investigator-initiated research collaborator with AstraZeneca, Auritec, Biotrofix, Janssen, JDS-Noven, Eli Lilly & Co., Luitpold, NeuroHealing, Novartis, Pfizer, and SK-BioPharmaceutical Corporation; he is not a member of pharmaceutical speakers bureaus, nor does he or any family member hold equity positions in biomedical or pharmaceutical corporations. MT was an employee of Eli Lilly & Co. (to 2008), and has consulted to, or received speakers honoraria from AstraZeneca, Bristol Myers-Squibb, Eli Lilly & Co., GlaxoSmithKline, Johnson & Johnson, and Wyeth Corporations; his spouse is an Eli Lilly employee and stockholder. PS, H-MKK, PG-M, HI, AG-P, JP, NC, and CM have no relevant disclosures or potential conflicts of interest to report.
Morbidity in 303 first-episode bipolar I disorder patients
Article first published online: 10 MAY 2010
© 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S
Volume 12, Issue 3, pages 264–270, May 2010
How to Cite
Baldessarini, R. J., Salvatore, P., Khalsa, H.-M. K., Gebre-Medhin, P., Imaz, H., González-Pinto, A., Perez, J., Cruz, N., Maggini, C. and Tohen, M. (2010), Morbidity in 303 first-episode bipolar I disorder patients. Bipolar Disorders, 12: 264–270. doi: 10.1111/j.1399-5618.2010.00812.x
- Issue published online: 10 MAY 2010
- Article first published online: 10 MAY 2010
- Received 30 July 2009, revised and accepted for publication 29 December 2009
- bipolar disorder;
- first episode;
Baldessarini RJ, Salvatore P, Khalsa H-MK, Gebre-Medhin P, Imaz H, González-Pinto A, Perez J, Cruz N, Maggini C, Tohen M. Morbidity in 303 first-episode bipolar I disorder patients. Bipolar Disord 2010: 12: 264–270. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S.
Objectives: To test the hypotheses that: (i) depressive-dysthymic-dysphoric (D-type) morbidity is more prevalent than manic-hypomanic-psychotic (M-type) morbidity even from first episodes of bipolar I disorder (BPD-I) and despite treatment; (ii) initial presentations predict later morbidity; (iii) morbidity varies internationally; and (iv) early and later morbidity are similar.
Methods: We followed SCID-based, DSM-IV BPD-I patients (n = 303) systematically and prospectively for two years to estimate the percent of weeks in specific morbid states from first lifetime major episodes.
Results: Total morbidity accounted for 44% of the first two years, and D-type exceeded M-type illnesses by 2.1-fold (30%/14%) among morbidities ranking: mixed states (major + minor) ≥ dysthymia ≥ mania ≥ major depression > hypomania > psychosis. In 164 cases, morbidities at 0.5–2.5 and 2.5–4.5 years were very similar. Depressive or mixed initial episodes predicted a 3.6-fold excess of D-type morbidity, and initial M-type episodes predicted a 7.1-fold excess of M-type morbidity over two years. Morbidity in European (EU) sites was nearly half that in the U.S., and 22% greater overall among men than women. In five comparable studies, illness accounted for 54% of follow-up time, and the ratio of D/M morbidity averaged 3.0.
Conclusions: In accord with four midcourse studies, morbidity from BPD-I onset, despite treatment by community standards, averaged 44%, was 68% D-type morbidity, and was strongly predicted by first-episode polarity. Lower morbidity in EU than U.S. sites may reflect differences in healthcare or social systems.