title: Features preceding diagnosis of bipolar versus major depressive disorders.
abstract: BACKGROUND
  Better and earlier predictive differentiation of bipolar (BD) vs. unipolar major depressive disorder (UD) diagnoses should improve long-term clinical planning.
  
  
  METHODS
  We reviewed randomly selected clinical records of 334 adults diagnosed with DSM-IV-TR BD-I (n=109), BD-II (n=106), and UD (n=119) and compared features preceding major affective episodes or diagnoses, using bivariate, multivariate, and Bayesian methods.
  
  
  RESULTS
  We identified antecedents selectively associated with later BD vs. UD in 52.6% vs. 31.1% of subjects in childhood, starting at age 7.4 years, and 60.0% vs. 32.8% in adolescence, with far more features in BD than UD cases (10.3 vs. 4.64/100 person-years; p<0.001). In multivariate modeling, BD-selective factors were: younger at first clinical event > male sex > family BD-history > cyclothymic or hyperthymic temperament > antecedents/person-year. Nonaffective (anxiety, eating, or substance-use) disorders preceded BD vs. UD in 41.4% vs. 28.6% of subjects (p=0.02). By ROC analysis, differential prediction of BD vs. UD was optimal with any ≥ 3 factors/person.
  
  
  CONCLUSIONS
  The validity and timing of antecedent events and factors identified retrospectively from clinical records could not be verified independently, but information was recorded systematically and consistently by a single mood-disorder expert prior to diagnosis, and extracted by two independent observers.
  
  
  CONCLUSIONS
  Early clinical features distinguished later BD from UD, often by years. Such prediction should improve treatment-planning and limit risk of mood-switching.
authors.affiliation: NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Serra
authors.affiliation: International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Koukopoulos
authors.affiliation: NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: De Chiara
authors.affiliation: NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Napoletano
authors.affiliation: NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: Alexia E
authors.initials: AE
authors.lastname: Koukopoulos
authors.affiliation: NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: Curto
authors.affiliation: NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Manfredi
authors.affiliation: International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Lucio Bini Mood Disorders Center, New York, NY, USA; New York University Medical Center & Child Study Center, New York, NY, USA.
authors.forename: Gianni
authors.initials: G
authors.lastname: Faedda
authors.affiliation: NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA; International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA. Electronic address: rbaldessarini@mclean.harvard.edu.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000328:Adult; D000367:Age Factors; D001499:Bayes Theorem; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062706:Prodromal Symptoms; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Adolescent; Antecedent; Bipolar disorder; Child; Major depression; Prodome