title: History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder.
abstract: BACKGROUND
  There are obstacles to early identification of bipolar disorder. Identifying and treating illness early in its time course may be associated with a better prognosis.
  
  
  METHODS
  A questionnaire was administered at interview, when the participant was euthymic, to participants (n=240) enrolled in the Bipolar Comprehensive Outcomes Study (BCOS). Information was collected about the sequential timeline of specific symptoms of mental illness up to when they first received a diagnosis of Bipolar Disorder or Schizoaffective Disorder.
  
  
  RESULTS
  Any symptoms of mental illness were first experienced at 17.5 years (median; Inter Quartile Range (IQR) 13.8-24.3; n=216) and mood swings at 18.0 years (IQR 14-25; n=197). Symptoms of depression were experienced at 18.0 years (IQR 14-25; n=197), a full episode of depression at 21.2 years (IQR 17-28.5; n=200), symptoms of mania at 21.0 years (IQR 16.8-29.5; n=212) and a full episode of mania at 24.1 years (IQR 19-30.5; n=205). Medical treatment was sought at 24.0 years (IQR 19-31.5; n=217). Participants received a diagnosis of Bipolar Disorder or Schizoaffective Disorder at 30.0 years (IQR 23-37.3; n=215). Having had a previous diagnosis other than Bipolar Disorder or Schizoaffective Disorder was reported by 120 of 216 participants who answered this question, most commonly unipolar depression (26.6%). Diagnostic delay was greater in individuals with early onset disorder.
  
  
  CONCLUSIONS
  Participants typically experience a long sequential course of symptoms, episodes, treatments and diagnosis. The polarity of onset is most commonly depressive, and subthreshold symptoms tend to precede threshold symptoms of both polarities.
  
  
  CONCLUSIONS
  Data were collected retrospectively.
authors.affiliation: Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, PO Box 281, Geelong, Victoria 3220, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Berk
authors.forename: S
authors.initials: S
authors.lastname: Dodd
authors.forename: P
authors.initials: P
authors.lastname: Callaly
authors.forename: L
authors.initials: L
authors.lastname: Berk
authors.forename: P
authors.initials: P
authors.lastname: Fitzgerald
authors.forename: A R
authors.initials: AR
authors.lastname: de Castella
authors.forename: S
authors.initials: S
authors.lastname: Filia
authors.forename: K
authors.initials: K
authors.lastname: Filia
authors.forename: S
authors.initials: S
authors.lastname: Tahtalian
authors.forename: F
authors.initials: F
authors.lastname: Biffin
authors.forename: K
authors.initials: K
authors.lastname: Kelin
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.forename: W
authors.initials: W
authors.lastname: Montgomery
authors.forename: J
authors.initials: J
authors.lastname: Kulkarni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D003937:Diagnosis, Differential; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008487:Medical History Taking; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D011619:Psychotropic Drugs / Q000627:therapeutic use; D014739:Victoria
chemical_list: D011619:Psychotropic Drugs