title: Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 3: A comparison between Italian and English mental health services and a survey of bipolar disorder.
abstract: BACKGROUND
  Most of the prognostic factors of bipolar disorder, which determine disease course and outcome, could be detected from simple but often-unrecorded questions asked during the psychiatric clinic assessments. In previous parts of this research, we analysed various prognostic factors and focused on mixed states and rapid cycling subsets. We now compare our sample in England with a small sample from Italy to demonstrate the utility of focused prognostic questioning and of international comparison.
  
  
  METHODS
  We collected data from the clinical notes of 70 English bipolar and 8 Italian bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or outcome.
  
  
  RESULTS
  The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) English outpatients and 7 bipolar I (87.5%) and 1 bipolar II (12.5%) Italian outpatients. Differences between the groups are seen mainly in terms of age of onset, duration of both depressive and hypomanic episodes, presence of psychiatric family history, incidence of mixed state features and rapid cycling, presence of elated mood in response to past antidepressant treatment, and misuse of illicit drugs and alcohol.
  
  
  CONCLUSIONS
  In order to promote improved mental health primary care, mental health systems in all countries should develop standardized epidemiological tools that are shared between countries. We recommend the use of a questionnaire that reminds clinicians of potentially prognostic information and suggest that this might identify important components of a potential standardized diagnostic and prognostic tool.
authors.affiliation: School of Specialization in Psychiatry, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy, norma.verdolini@libero.it.
authors.forename: Norma
authors.initials: N
authors.lastname: Verdolini
authors.forename: Jonathon
authors.initials: J
authors.lastname: Dean
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Massucci
authors.forename: Sandro
authors.initials: S
authors.lastname: Elisei
authors.forename: Roberto
authors.initials: R
authors.lastname: Quartesan
authors.forename: Rashid
authors.initials: R
authors.lastname: Zaman
authors.forename: Mark
authors.initials: M
authors.lastname: Agius