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Early clinical predictors and correlates of long-term morbidity in bipolar disorder

Published online by Cambridge University Press:  23 March 2020

G. Serra ,
A Koukopoulos ,
L. De Chiara ,
A.E. Koukopoulos ,
G. Sani ,
L. Tondo ,
P. Girardi ,
D. Reginaldi  and
R.J. Baldessarini
G. Serra*
Affiliation:
Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Rome, Italy
A Koukopoulos
Affiliation:
International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Rome, Italy
L. De Chiara
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
A.E. Koukopoulos
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy Lucio Bini Mood Disorder Center, Rome, Italy
G. Sani
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy Lucio Bini Mood Disorder Center, Rome, Italy
L. Tondo
Affiliation:
Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
P. Girardi
Affiliation:
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy Lucio Bini Mood Disorder Center, Rome, Italy
D. Reginaldi
Affiliation:
International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA Lucio Bini Mood Disorder Center, Rome, Italy
R.J. Baldessarini
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
*
*Corresponding author. Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome (Italy). E-mail address:[email protected] (G. Serra).
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Abstract

Objectives:

Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).

Methods:

We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.

Results:

Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P = 0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P < 0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.

Conclusions:

Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.

Keywords

Bipolar disorderD/M ratioLong-term morbidityOutcomePredictionProdrome
Type
Original article
Information
European Psychiatry , Volume 43 , June 2017 , pp. 35 - 43
Copyright
Copyright © European Psychiatric Association 2017

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