Predominant recurrence polarity among 928 adult international bipolar I disorder patients

Authors

  • R. J. Baldessarini,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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  • J. Undurraga,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
    3. Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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  • G. H. Vázquez,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Clinical Neuroscience, Palermo University, Buenos Aires, Argentina
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  • L. Tondo,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
    3. Lucio Bini Mood Disorder Center, Cagliari, Sardinia
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  • P. Salvatore,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
    3. Section of Psychiatry, Department of Neuroscience, University of Parma, Parma, Italy
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  • K. Ha,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
    3. Department of Psychiatry, Seoul National University Bundang Hospital, Bundang, Gyeonggi, Korea
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  • H.-M. K. Khalsa,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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  • B. Lepri,

    1. Lucio Bini Mood Disorder Center, Cagliari, Sardinia
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  • T. H. Ha,

    1. Department of Psychiatry, Seoul National University Bundang Hospital, Bundang, Gyeonggi, Korea
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  • J. S. Chang,

    1. Department of Psychiatry, Seoul National University Bundang Hospital, Bundang, Gyeonggi, Korea
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  • M. Tohen,

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
    3. Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
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  • E. Vieta

    1. International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA
    2. Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Ross J. Baldessarini, Mailman Research Center 312, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106 USA.
E-mail: rbaldessarini@mclean.harvard.edu

Abstract

Baldessarini RJ, Undurraga J, Vázquez GH, Tondo L, Salvatore P, Ha K, Khalsa H-MK, Lepri B, Ha TH, Chang JS, Tohen M, Vieta E. Predominant recurrence polarity among 928 adult international bipolar I disorder patients.

Objective:  To test the hypothesis that patients with bipolar disorder (BPD) differ demographically and clinically within subgroups based on the predominant-polarity of major recurrences.

Method:  We tested factors for association with predominantly (≥2 : 1) depressive vs. mania-like episodes with 928 DSM-IV type-I BPD subjects from five international sites.

Results:  Factors preliminarily associated with predominant-depression included: electroconvulsive treatment, longer latency-to-BPD diagnosis, first episode depressive or mixed, more suicide attempts, more Axis-II comorbidity, ever having mixed-states, ever married, and female sex. Predominant-mania was associated with: initial manic or psychotic episodes, more drug abuse, more education, and more family psychiatric history. Of the 47.3% of subjects without polarity-predominance, risks for all factors considered were intermediate. Expanding the definition of polarity-predominance to ≥51% added little, but shifting mixed-states to ‘predominant-depression’ increased risk of suicidal acts from 2.4- to 4.5-fold excess over predominant-mania–hypomania, and suicidal risk was associated continuously with increasing proportions of depressive or mixed episodes.

Conclusion:  Subtyping by predominant-polarity yielded predictive associations, including the polarity of first episodes and risk of suicide attempts. Such subtyping may contribute to improve planning of clinical care and to biological studies of BPD.

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