title: Longitudinal research on bipolar disorders.
abstract: Longitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from first-hospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.
authors.forename: Paola
authors.initials: P
authors.lastname: Salvatore
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
authors.forename: Hari-Mandir Kaur
authors.initials: HM
authors.lastname: Khalsa
authors.forename: Christopher
authors.initials: C
authors.lastname: Baethge
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tondo
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D001714:Bipolar Disorder / Q000209:etiology* / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies