More pernicious course of bipolar disorder in the United States than in many European countries: implications for policy and treatment.
BACKGROUND
There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries.


METHODS
We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics.


RESULTS
Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment.


CONCLUSIONS
Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation.


CONCLUSIONS
The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.
Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States; Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., United States. Electronic address: Robert.post@speakeasy.net.
R M
RM
Post
UCLA Mood Disorders Research Program, VA Medical Center, Los Angeles, CA, United States.
L
L
Altshuler
Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands.
R
R
Kupka
Lindner Center of HOPE Mason, OH, United States; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States.
S
S
McElroy
Psychiatry, Mayo Clinic, Rochester, MI, United States.
M A
MA
Frye
Biostatistician, Bipolar Collaborative Network, Bethesda, MD, United States.
M
M
Rowe
Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States.
G S
GS
Leverich
Institute of Neuroscience, University of Newcastle upon Tyne, Newcastle, United Kingdom.
H
H
Grunze
Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States.
T
T
Suppes
Psychiatry & Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Lindner Center of HOPE Mason, OH, United States.
P E
PE
Keck
University Medical Center, University of Groningen, Groningen, Netherlands.
W A
WA
Nolen
D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
Early onset; Epigenetics; Genetics; Rapid cycling; Stress; Substance abuse disorders