Morbidity in 303 first‐episode bipolar I disorder patients

Baldessarini RJ, Salvatore P, Khalsa H‐MK, Gebre‐Medhin P, Imaz H, González‐Pinto A, Perez J, Cruz N, Maggini C, Tohen M. Morbidity in 303 first‐episode bipolar I disorder patients.
Bipolar Disord 2010: 12: 264–270. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S. Objectives: To test the hypotheses that: (i) depressive‐dysthymic‐dysphoric (D‐type) morbidity is more prevalent than manic‐hypomanic‐psychotic (M‐type) morbidity even from first episodes of bipolar I disorder (BPD‐I) and despite treatment; (ii) initial presentations predict later morbidity; (iii) morbidity varies internationally; and (iv) early and later morbidity are similar. Methods: We followed SCID‐based, DSM‐IV BPD‐I patients (n = 303) systematically and prospectively for two years to estimate the percent of weeks in specific morbid states from first lifetime major episodes. Results: Total morbidity accounted for 44% of the first two years, and D‐type exceeded M‐type illnesses by 2.1‐fold (30%/14%) among morbidities ranking: mixed states (major + minor) ≥ dysthymia ≥ mania ≥ major depression > hypomania > psychosis. In 164 cases, morbidities at 0.5–2.5 and 2.5–4.5 years were very similar. Depressive or mixed initial episodes predicted a 3.6‐fold excess of D‐type morbidity, and initial M‐type episodes predicted a 7.1‐fold excess of M‐type morbidity over two years. Morbidity in European (EU) sites was nearly half that in the U.S., and 22% greater overall among men than women. In five comparable studies, illness accounted for 54% of follow‐up time, and the ratio of D/M morbidity averaged 3.0. Conclusions: In accord with four midcourse studies, morbidity from BPD‐I onset, despite treatment by community standards, averaged 44%, was 68% D‐type morbidity, and was strongly predicted by first‐episode polarity. Lower morbidity in EU than U.S. sites may reflect differences in healthcare or social systems.