A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder

Lewis L Judd; Hagop S Akiskal; Pamela J Schettler; William Coryell; Jean Endicott; Jack D Maser; David A Solomon; Andrew C Leon; Martin B Keller

doi:10.1001/archpsyc.60.3.261

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A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder

Journal article

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A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder

Lewis L Judd, Hagop S Akiskal, Pamela J Schettler, William Coryell, Jean Endicott, Jack D Maser, David A Solomon, Andrew C Leon and Martin B Keller

Archives of general psychiatry, Vol.60(3), pp.261-269

03/2003

DOI: 10.1001/archpsyc.60.3.261

PMID: 12622659

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Abstract

This is the first prospective longitudinal study, to our knowledge, of the natural history of the weekly symptomatic status of bipolar II disorder (BP-II). Weekly affective symptom status ratings for 86 patients with BP-II were based on interviews conducted at 6- or 12-month intervals during a mean of 13.4 years of prospective follow-up. Percentage of weeks at each symptom severity level and the number of shifts in symptom status and polarity were examined. Predictors of chronicity for BP-II were evaluated using new chronicity measures. Chronicity was also analyzed in relation to the percentage of follow-up weeks with different types of somatic treatment. Patients with BP-II were symptomatic 53.9% of all follow-up weeks: depressive symptoms (50.3% of weeks) dominated the course over hypomanic (1.3% of weeks) and cycling/mixed (2.3% of weeks) symptoms. Subsyndromal, minor depressive, and hypomanic symptoms combined were 3 times more common than major depressive symptoms. Longer intake episodes, a family history of affective disorders, and poor previous social functioning predicted greater chronicity. Prescribed somatic treatment did not correlate significantly with symptom chronicity. Patients with BP-II of brief (2-6 days) vs longer (> or =7 days) hypomanias were not significantly different on any measure. The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms. Symptom severity fluctuates frequently within the same patient over time, involving primarily symptoms of minor and subsyndromal severity. Longitudinally, BP-II is expressed as a dimensional illness involving the full severity range of depressive and hypomanic symptoms. Hypomania of long or short duration in BP-II seems to be part of the same disease process.

Severity of Illness Index

Psychiatric Status Rating Scales - statistics & numerical data

Prospective Studies

Follow-Up Studies

Humans

Middle Aged

Male

Bipolar Disorder - diagnosis

Bipolar Disorder - psychology

Antidepressive Agents - therapeutic use

Antipsychotic Agents - therapeutic use

Adolescent

Age of Onset

Adult

Female

Aged

Bipolar Disorder - therapy

Electroconvulsive Therapy

Chronic Disease

Longitudinal Studies

Details

Title: Subtitle: A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder
Creators: Lewis L Judd - Department of Psychiatry, University of California, San Diego, La Jolla 92093-0603, USA
Hagop S Akiskal
Pamela J Schettler
William Coryell
Jean Endicott
Jack D Maser
David A Solomon
Andrew C Leon
Martin B Keller
Resource Type: Journal article
Publication Details: Archives of general psychiatry, Vol.60(3), pp.261-269
DOI: 10.1001/archpsyc.60.3.261
PMID: 12622659
NLM abbreviation: Arch Gen Psychiatry
ISSN: 0003-990X
eISSN: 1538-3636
Publisher: American Medical Association; United States
Grant note: R01 MH025478 / NIMH NIH HHS
Language: English
Date published: 03/2003
Academic Unit: Psychiatry
Record Identifier: 9984003422502771

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