Typology of clinical course in bipolar disorder based on 18-month naturalistic follow-up.

Abstract:

BACKGROUND:Individual variation in the clinical course of bipolar disorder may have prognostic and therapeutic implications but is poorly reflected in current classifications. We aimed to establish a typology of the individual clinical trajectories based on detailed prospective medium-term follow-up. Method Latent class analysis (LCA) of nine characteristics of clinical course (time depressed, severity of depression, stability of depression, time manic, severity of mania, stability of mania, mixed symptoms, mania-to-depression and depression-to-mania phase switching) derived from life charts prospectively tracking the onsets and offsets of (hypo)manic, depressive, mixed and subsyndromal episodes in a representative sample of 176 patients with bipolar disorder. RESULTS:The best-fitting model separated patients with bipolar disorder into large classes of episodic bipolar (47%) and depressive type (32%), moderately sized classes characterized by prolonged hypomanias (10%) and mixed episodes (5%) and five small classes with unusual course characteristics including mania-to-depression and depression-to-mania transitions and chronic mixed affective symptoms. This empirical typology is relatively independent of the distinction between bipolar disorder type I and type II. Lifetime co-morbidity of alcohol use disorders is characteristic of the episodic bipolar course type. CONCLUSIONS:There is potential for a new typology of clinical course based on medium-term naturalistic follow-up of a representative clinical sample of patients with bipolar disorder. Predictive validity and stability over longer follow-up periods remain to be established.

journal_name

Psychol Med

journal_title

Psychological medicine

authors

Uher R,Mantere O,Suominen K,Isometsä E

doi

10.1017/S0033291712001523

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

789-99

issue

4

eissn

0033-2917

issn

1469-8978

pii

S0033291712001523

journal_volume

43

pub_type

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