title: First-episode types in bipolar disorder: predictive associations with later illness.
abstract: OBJECTIVE
  Characteristics of initial illness in bipolar disorder (BD) may predict later morbidity.
  
  
  METHODS
  We reviewed computerized clinical records and life charts of DSM-IV-TR BD-I or BD-II patients at affiliated mood-disorder centers to ascertain relationships of initial major illnesses to later morbidity and other clinical characteristics.
  
  
  RESULTS
  Adult BD patient-subjects (N=1081; 59.8% BD-I; 58.1% women; 43% ever hospitalized) were followed 15.7±12.8 years after onsets ranking: depression (59%)>mania (13%)>psychosis (8.0%)≥anxiety (7.6%)≥hypomania (6.7%)>mixed states (5.5%). Onset types differed in clinical characteristics and strongly predicted later morbidity. By initial episode types, total time-ill ranked: mania≥hypomania≥mixed-states≥psychosis>depression>anxiety. Depression was most prevalent long-term, overall; its ratio to mania-like illness (D/M, by per cent-time-ill) ranked by onset type: anxiety (4.75)>depression (3.27)>mixed states (1.39)>others (all<1.00). The MDI (mania or hypomania-depression-euthymia interval) course-pattern was most common (34.4%) and associated with psychotic or manic onset; the depression before mania (DMI) pattern (25.0%) most often followed anxiety (38.8%), depression (30.8%), or mixed onsets (13.3%); both were predicted by initial mania depression sequences.
  
  
  CONCLUSIONS
  First-lifetime illnesses and cycles predicted later morbidity patterns among BD patients, indicating value of early morbidity for prognosis and long-term planning.
authors.affiliation: International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Baldessarini
authors.forename: L
authors.initials: L
authors.lastname: Tondo
authors.forename: C
authors.initials: C
authors.lastname: Visioli
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis*; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D017050:Episode of Care; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008875:Middle Aged; D010347:Patient Care Planning; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis*; D018570:Risk Assessment; D013997:Time Factors
keywords: bipolar disorder; cycling; first-episodes; long-term morbidity; outcome; prediction; prognosis