Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment
Version of Record online: 20 AUG 2012
© 2012 John Wiley & Sons A/S
Acta Psychiatrica Scandinavica
Volume 127, Issue 2, pages 136–144, February 2013
How to Cite
Drancourt, N., Etain, B., Lajnef, M., Henry, C., Raust, A., Cochet, B., Mathieu, F., Gard, S., MBailara, K., Zanouy, L., Kahn, J. P., Cohen, R. F., Wajsbrot-Elgrabli, O., Leboyer, M., Scott, J. and Bellivier, F. (2013), Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment. Acta Psychiatrica Scandinavica, 127: 136–144. doi: 10.1111/j.1600-0447.2012.01917.x
- Issue online: 9 JAN 2013
- Version of Record online: 20 AUG 2012
- Accepted for publication July 2, 2012
- bipolar disorder;
- duration of untreated illness;
Objective: Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples.
Method: In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined.
Results: The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB (P < 0.0001). An extended DUB was associated with more mood episodes (P < 0.0001), more suicidal behaviour (P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania).
Conclusion: Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines.