Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-26T21:58:43.351Z Has data issue: false hasContentIssue false
  • English
  • Français

Age transitions in the course of bipolar I disorder

Published online by Cambridge University Press:  01 April 2009

W. Coryell ,
J. Fiedorowicz ,
D. Solomon  and
J. Endicott
W. Coryell*
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
J. Fiedorowicz
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
D. Solomon
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
J. Endicott
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
*
*Address for correspondence: W. Coryell, M.D., Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA52242, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This analysis aimed to show whether symptoms of either pole change in their persistence as individuals move through two decades, whether such changes differ by age grouping, and whether age of onset plays an independent role in symptom persistence.

Method

Participants in the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) who completed at least 20 years of follow-up and who met study criteria for bipolar I or schizo-affective manic disorder, before intake or during follow-up, were divided by age at intake into youngest (18–29 years, n=56), middle (30–44 years, n=68) and oldest (>44 years, n=24) groups.

Results

The persistence of depressive symptoms increased significantly in the two younger groups. Earlier ages of onset were associated with higher depressive morbidity throughout the 20 years of follow-up but did not predict changes in symptom persistence. The proportions of weeks spent in episodes of either pole correlated across follow-up periods in all age groupings, although correlations were stronger for depressive symptoms and for shorter intervals.

Conclusions

Regardless of age at onset, the passage of decades in bipolar illness seems to bring an increase in the predominance of depressive symptoms in individuals in their third, fourth and fifth decades and an earlier age of onset portends a persistently greater depressive symptom burden. The degree to which either depression or manic/hypomanic symptoms persist has significant stability over lengthy periods and seems to reflect traits that manifest early in an individual's illness.

Keywords

Age of onsetage periodsmajor depressionsymptom persistence
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 8 , August 2009 , pp. 1247 - 1252
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Angst, J, Baastrup, P, Grof, P, Hippius, H, Poldinger, W, Weis, P (1973). The course of monopolar depression and bipolar psychoses. Psychiatria, Neurologia, Neurochirurgia 76, 489–500.Google ScholarPubMed
Angst, J, Gamma, A, Sellaro, R, Lavori, PW, Zhang, H (2003). Recurrence of bipolar disorders and major depression. A life-long perspective. European Archives of Psychiatry and Clinical Neuroscience 253, 236–240.CrossRefGoogle ScholarPubMed
Carlson, GA, Bromet, EJ, Driessens, C, Mojtabai, R, Schwartz, JE (2002). Age at onset, childhood psychopathology, and 2-year outcome in psychotic bipolar disorder. American Journal of Psychiatry 159, 307–309.CrossRefGoogle ScholarPubMed
Carlson, GA, Bromet, EJ, Sievers, S (2000). Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. American Journal of Psychiatry 157, 213–219.CrossRefGoogle ScholarPubMed
Carter, TD, Mundo, E, Parikh, SV, Kennedy, JL (2003). Early age at onset as a risk factor for poor outcome of bipolar disorder. Journal of Psychiatry Research 37, 297–303.CrossRefGoogle ScholarPubMed
Coryell, W, Solomon, D, Leon, A, Fiedorowicz, JG, Schettler, P, Judd, L, Keller, M (in press). Does major depressive disorder change with age? Psychological Medicine.Google Scholar
Endicott, J, Spitzer, RL (1978). A diagnostic interview: the schedule for affective disorders and schizophrenia. Archives of General Psychiatry 35, 837–844.CrossRefGoogle ScholarPubMed
Ernst, CL, Goldberg, JF (2004). Clinical features related to age at onset in bipolar disorder. Journal of Affective Disorders 82, 21–27.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreasen, NC (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Kukopulos, A, Reginaldi, D, Laddomada, P, Floris, G, Serra, G, Tondo, L (1980). Course of the manic-depressive cycle and changes caused by treatment. Pharmakopsychiatrie, Neuro-Psychopharmakologie 13, 156–167.CrossRefGoogle ScholarPubMed
McElroy, SL, Altshuler, LL, Suppes, T, Keck, PE Jr., Frye, MA, Denicoff, KD, Nolen, WA, Kupka, RW, Leverich, GS, Rochussen, JR, Rush, AJ, Post, RM (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. American Journal of Psychiatry 158, 420–426.CrossRefGoogle ScholarPubMed
Roy-Byrne, P, Post, RM, Uhde, TW, Porcu, T, Davis, D (1985). The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatrica Scandinavica (Suppl.) 317, 1–34.CrossRefGoogle ScholarPubMed
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Tohen, M, Hennen, J, Zarate, CM Jr., Baldessarini, RJ, Strakowski, SM, Stoll, AL, Faedda, GL, Suppes, T, Gebre-Medhin, P, Cohen, BM (2000). Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. American Journal of Psychiatry 157, 220–228.CrossRefGoogle ScholarPubMed
Turvey, CL, Coryell, WH, Arndt, S, Solomon, DA, Leon, AC, Endicott, J, Mueller, T, Keller, M, Akiskal, H (1999). Polarity sequence, depression, and chronicity in bipolar I disorder. Journal of Nervous and Mental Disorders 187, 181–187.CrossRefGoogle ScholarPubMed
Zis, AP, Grof, P, Webster, M, Goodwin, FK (1980). Prediction of relapse in recurrent affective disorder. Psychopharmacology Bulletin 16, 47–49.Google ScholarPubMed