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Morbidity in 303 first-episode bipolar I disorder patients

Authors

  • Ross J Baldessarini,

    1. Department of Psychiatry, Harvard Medical School, Boston
    2. International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
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  • Paola Salvatore,

    1. Department of Psychiatry, Harvard Medical School, Boston
    2. Department of Neuroscience, Section on Psychiatry, University of Parma, Parma, Italy
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  • Hari-Mandir Kaur Khalsa,

    1. International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
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  • Priscilla Gebre-Medhin,

    1. International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
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  • Harkaitz Imaz,

    1. Bipolar Disorder Program, Department of Psychiatry, Santiago Apóstol Hospital, Vitoria, Spain
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  • Ana González-Pinto,

    1. International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
    2. Bipolar Disorder Program, Department of Psychiatry, Santiago Apóstol Hospital, Vitoria, Spain
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  • Jesus Perez,

    1. International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
    2. Department of Psychiatry, Cambridge University, Cambridge, UK
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  • Núria Cruz,

    1. International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
    2. Bipolar Disorder Program, Department of Psychiatry, Institute of Clinical Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
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  • Carlo Maggini,

    1. Department of Psychiatry, Harvard Medical School, Boston
    2. Department of Neuroscience, Section on Psychiatry, University of Parma, Parma, Italy
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  • Mauricio Tohen

    1. International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA
    2. Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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  • 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.

Corresponding author:
Ross J. Baldessarini, M.D.
Department of Psychiatry
Mailman Research Center 306
McLean Hospital
115 Mill Street
Belmont, MA 02478, USA
Fax: 1-617-855-3479
E-mail: rjb@mclean.org

Abstract

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.

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