title: Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample.
abstract: OBJECTIVE
  Bipolar disorder (BD) is often left untreated for long periods, and this delay in treatment correlates with unfavorable prognosis. The present study sought to assess the magnitude of duration of untreated bipolar disorder (DUB) in Brazil. We hypothesized that DUB would be longer in Brazil than in developed countries, and would be associated with poor clinical outcomes.
  
  
  METHODS
  One hundred and fifty-two psychiatric outpatients were evaluated for BD diagnosis, demographics, DUB, and clinical outcomes.
  
  
  RESULTS
  The mean age and mean DUB were, respectively, 38.9±10.8 and 10.4±9.8 years. An extended DUB was associated with early onset of BD (p < 0.001), depression as first mood episode (p = 0.04), and presence of BD in a first-degree relative (p = 0.012). Additionally, a longer DUB was associated with poorer clinical outcomes, such as elevated rates of rapid cycling (p = 0.004) and anxiety disorders (p = 0.016), as well as lower levels of current full remission (p = 0.021).
  
  
  CONCLUSIONS
  As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.
authors.affiliation: Departamento de Psiquiatria, Instituto de Psiquiatria, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Gustavo C
authors.initials: GC
authors.lastname: Medeiros
authors.affiliation: Departamento de Psiquiatria, Instituto de Psiquiatria, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Sofia B
authors.initials: SB
authors.lastname: Senço
authors.affiliation: Departamento de Psiquiatria, Instituto de Psiquiatria, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
authors.affiliation: Departamento de Psiquiatria, Instituto de Psiquiatria, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Karla M
authors.initials: KM
authors.lastname: Almeida
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D001938:Brazil; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000523:psychology*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061665:Time-to-Treatment