Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment.
OBJECTIVE
Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples.


METHODS
In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined.


RESULTS
The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB (P < 0.0001). An extended DUB was associated with more mood episodes (P < 0.0001), more suicidal behaviour (P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania).


CONCLUSIONS
Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines.
AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France.
N
N
Drancourt
B
B
Etain
M
M
Lajnef
C
C
Henry
A
A
Raust
B
B
Cochet
F
F
Mathieu
S
S
Gard
K
K
Mbailara
L
L
Zanouy
J P
JP
Kahn
R F
RF
Cohen
O
O
Wajsbrot-Elgrabli
M
M
Leboyer
J
J
Scott
F
F
Bellivier
D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D057210:Delayed Diagnosis / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D013997:Time Factors