title: The role of comorbidities in duration of untreated illness for bipolar spectrum disorders.
abstract: BACKGROUND
  Growing interest has been given to the construct of Duration of untreated illness (DUI) on the outcome of bipolar disorder (BD), due to its potentially modifiable nature. The aim of this study was to identify possible clinical correlates of DUI in a sample of BD patients.
  
  
  METHODS
  119 BD spectrum patients included. DUI rate was calculated and dichotomized into short DUI and long DUI subgroups, cut-off 24 months. These subgroups were compared for socio-demographic and clinical variables. Significant results were included into direct logistic regressions to assess their impact on the likelihood of presenting with long DUI.
  
  
  RESULTS
  Mean DUI±SD was 75.6±98.3 months. Short DUI subgroup comprised 56 (47.1%), long DUI 60 (52.9%) patients. Age at onset of BD was lower in the long DUI subgroup (p=0.021), illness duration longer (p=0.011). Long DUI subgroup showed significantly more comorbidity with Axis I (p=0.002) and personality disorders (p=0.017), less interepisodic recovery (p<0.001) and less Manic Predominant Polarity (p=0.009). Direct logistic regression as a full model was significant, correctly classifying 76.7% of cases. A unique statistically significant contribution was made by: Manic Predominant Polarity, Personality Disorder Comorbidity, and Total Changes in Medications.
  
  
  CONCLUSIONS
  Partial retrospective data, cross sectional study.
  
  
  CONCLUSIONS
  DUI was longer than 24 months in half of the sample. Psychotic /Manic onset contributed to a quick diagnostic classification. Personality disorders in depressed patients could delay a correct diagnosis of BD, factors associated with an increased likelihood of BD must be considered. More research on personality disorder comorbidities is needed.
authors.affiliation: Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, c/Villaroel 170, esc. 12 pl. 0, 08036 Barcelona (ES), Catalonia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Murru
authors.affiliation: Department of Public Health, Section of Psychiatry and Psychiatric Clinic, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Primavera
authors.affiliation: Department of Public Health, Section of Psychiatry and Psychiatric Clinic, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Oliva
authors.affiliation: Department of Public Health, Section of Psychiatry and Psychiatric Clinic, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Meloni
authors.affiliation: Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, c/Villaroel 170, esc. 12 pl. 0, 08036 Barcelona (ES), Catalonia, Spain. Electronic address: EVIETA@CLINIC.UB.ES.
authors.forename: E
authors.initials: E
authors.lastname: Vieta
authors.affiliation: Department of Public Health, Section of Psychiatry and Psychiatric Clinic, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Carpiniello
mesh_terms: D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Bipolar Disorder; DUI; Duration of Untreated Illness; Personality Disorders; Predominant Polarity