Morbidity in 303 first-episode bipolar I disorder patients.
OBJECTIVE
To test the hypotheses that: (i) depressive-dysthymic-dysphoric (D-type) morbidity is more prevalent than manic-hypomanic-psychotic (M-type) morbidity even from first episodes of bipolar I disorder (BPD-I) and despite treatment; (ii) initial presentations predict later morbidity; (iii) morbidity varies internationally; and (iv) early and later morbidity are similar.


METHODS
We followed SCID-based, DSM-IV BPD-I patients (n = 303) systematically and prospectively for two years to estimate the percent of weeks in specific morbid states from first lifetime major episodes.


RESULTS
Total morbidity accounted for 44% of the first two years, and D-type exceeded M-type illnesses by 2.1-fold (30%/14%) among morbidities ranking: mixed states (major + minor) >or= dysthymia >or= mania >or= major depression > hypomania > psychosis. In 164 cases, morbidities at 0.5-2.5 and 2.5-4.5 years were very similar. Depressive or mixed initial episodes predicted a 3.6-fold excess of D-type morbidity, and initial M-type episodes predicted a 7.1-fold excess of M-type morbidity over two years. Morbidity in European (EU) sites was nearly half that in the U.S., and 22% greater overall among men than women. In five comparable studies, illness accounted for 54% of follow-up time, and the ratio of D/M morbidity averaged 3.0.


CONCLUSIONS
In accord with four midcourse studies, morbidity from BPD-I onset, despite treatment by community standards, averaged 44%, was 68% D-type morbidity, and was strongly predicted by first-episode polarity. Lower morbidity in EU than U.S. sites may reflect differences in healthcare or social systems.
Baldessarini
Ross J
RJ
Department of Psychiatry, Harvard Medical School, Boston, MA, USA. rjb@mclean.org
Salvatore
Paola
P
Khalsa
Hari-Mandir Kaur
HM
Gebre-Medhin
Priscilla
P
Imaz
Harkaitz
H
González-Pinto
Ana
A
Perez
Jesus
J
Cruz
Núria
N
Maggini
Carlo
C
Tohen
Mauricio
M
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D003431:Cross-Cultural Comparison; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009017:Morbidity; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D055815:Young Adult