title: Long term course of bipolar I disorder in India: using retrospective life chart method.
abstract: BACKGROUND
  There are grounds to believe that the course of bipolar disorder may be different in tropical countries such as India when compared to temperate nations. There is a dearth of literature about the course of bipolar I disorder from India.
  
  
  METHODS
  This study was conducted in a multispecialty teaching hospital in southern India. Patients with a DSM-IV TR diagnosis of bipolar I disorder, confirmed using SCID-I, with a minimum duration of illness of 3 years were assessed. Information was gathered on demographic and clinical variables, and the life course of episodes was charted using the National Institute of Mental Health - Life Chart Methodology Clinician Retrospective Chart (NIMH-LCM-CRC).
  
  
  RESULTS
  A total of 150 patients with bipolar disorder were included. The mean age at onset of illness was 24.8 (± 8.2) years. Mania was the first episode in a majority (85%) of the cases, and was the most frequent episode in the course of the illness, followed by depression. Patients spent an average of 11.1% of the illness duration in a mood episode, most commonly a manic episode. The median duration of manic or depressive episode was 2 months. Median time to recurrence after the first episode was 21 months (inter-quartile range of 10-60 months), and was shorter for women than men.
  
  
  CONCLUSIONS
  The hospital based sample from a particular region limits generalizability. Recall bias may be present in this retrospective information based study. Medical illness, personality disorders, other Axis I psychiatric disorders (apart from substance use disorder) and influence of adherence to treatment on the course of the disorder were not assessed systematically.
  
  
  CONCLUSIONS
  Bipolar I disorder among Indian patients has a course characterized by predominantly manic episodes, which is in line with previous reports from tropical countries and substantially different from that of temperate regions.
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Karthick
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India. Electronic address: drshivanand@gmail.com.
authors.forename: Shivanand
authors.initials: S
authors.lastname: Kattimani
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
authors.forename: Ravi Philip
authors.initials: RP
authors.lastname: Rajkumar
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
authors.forename: Balaji
authors.initials: B
authors.lastname: Bharadwaj
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Sarkar
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Bipolar disorder; Follow-up studies; Gender; India; Prognosis; Psychiatric status rating scales