Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment

  1. N. Drancourt1,
  2. B. Etain1,2,3,
  3. M. Lajnef2,
  4. C. Henry1,2,3,4,
  5. A. Raust1,
  6. B. Cochet1,
  7. F. Mathieu2,
  8. S. Gard3,5,
  9. K. MBailara3,5,6,
  10. L. Zanouy3,5,
  11. J. P. Kahn3,7,
  12. R. F. Cohen7,
  13. O. Wajsbrot-Elgrabli7,
  14. M. Leboyer1,2,3,4,
  15. J. Scott3,4,8,
  16. F. Bellivier1,2,3,4

Article first published online: 20 AUG 2012

DOI: 10.1111/j.1600-0447.2012.01917.x

Issue

Acta Psychiatrica Scandinavica

Acta Psychiatrica Scandinavica

Volume 127, Issue 2, pages 136–144, February 2013

Additional Information

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

Author Information

  1. 1

    AP-HP, Hôpital H. Mondor – A. Chenevier, Pôle de Psychiatry, Créteil

  2. 2

    Inserm, U955, Créteil

  3. 3

    Fondation Fondamental, Créteil

  4. 4

    Université Paris Est, Faculté de médecine, Créteil

  5. 5

    Hôpital Charles Perrens, Service de psychiatrie adulte, Bordeaux

  6. 6

    Laboratoire de psychologie, Université Victor Segalen, Bordeaux

  7. 7

    Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France

  8. 8

    Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK

*Bruno Etain, Pôle de Psychiatrie, Hôpital Albert Chenevier, 40, rue de Mesly, 94010 Créteil Cedex, France. E-mail: bruno.etain@inserm.fr

Publication History

  1. Issue published online: 9 JAN 2013
  2. Article first published online: 20 AUG 2012
  3. Accepted for publication July 2, 2012

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Keywords:

  • bipolar disorder;
  • duration of untreated illness;
  • onset;
  • course;
  • suicide

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.

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