Longitudinal course of bipolar I disorder: duration of mood episodes

David A Solomon; Andrew C Leon; William H Coryell; Jean Endicott; Chunshan Li; Jess G Fiedorowicz; Lara Boyken; Martin B Keller

doi:10.1001/archgenpsychiatry.2010.15

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Longitudinal course of bipolar I disorder: duration of mood episodes

Journal article

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Peer reviewed

Longitudinal course of bipolar I disorder: duration of mood episodes

David A Solomon, Andrew C Leon, William H Coryell, Jean Endicott, Chunshan Li, Jess G Fiedorowicz, Lara Boyken and Martin B Keller

Archives of general psychiatry, Vol.67(4), pp.339-347

04/2010

DOI: 10.1001/archgenpsychiatry.2010.15

PMCID: PMC3677763

PMID: 20368510

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Abstract

The phenomenology of bipolar I disorder affects treatment and prognosis. To describe the duration of bipolar I mood episodes and factors associated with recovery from these episodes. Subjects with Research Diagnostic Criteria bipolar I disorder were prospectively followed up for as long as 25 years. The probability of recovery over time from multiple successive mood episodes was examined with survival analytic techniques, including a mixed-effects grouped-time survival model. Five US academic medical centers. Two hundred nineteen subjects with bipolar I disorder. Level of psychopathology was assessed with the Longitudinal Interval Follow-up Evaluation every 6 months for the first 5 years of follow-up and annually thereafter. The median duration of bipolar I mood episodes was 13 weeks. More than 75% of the subjects recovered from their mood episodes within 1 year of onset. The probability of recovery was significantly less for an episode with severe onset (psychosis or severe psychosocial impairment in week 1 of the episode) (hazard ratio [HR] = 0.746; 95% confidence interval [CI], 0.578-0.963; P = .02) and for subjects with greater cumulative morbidity (total number of years spent ill with any mood episode) (HR = 0.917; 95% CI, 0.886-0.948; P < .001). Compared with the probability of recovery from a major depressive episode, there was a significantly greater probability of recovery from an episode of mania (HR = 1.713; 95% CI, 1.373-2.137; P < .001), hypomania (HR = 4.502; 95% CI, 3.466-5.849; P < .001), or minor depression (HR = 2.027; 95% CI, 1.622-2.534; P < .001) and, conversely, a significantly reduced probability of recovery from a cycling episode (switching from one pole to the other without an intervening period of recovery) (HR = 0.438; 95% CI, 0.351-0.548; P < .001). The median duration of bipolar I mood episodes was 13 weeks, and the probability of recovery was significantly decreased for cycling episodes, mood episodes with severe onset, and subjects with greater cumulative morbidity.

United States

Recurrence

Prospective Studies

Humans

Kaplan-Meier Estimate

Male

Affect

Disease Progression

Bipolar Disorder - psychology

Psychiatric Status Rating Scales

Time Factors

Depression - psychology

Adult

Female

Remission, Spontaneous

Details

Title: Subtitle: Longitudinal course of bipolar I disorder: duration of mood episodes
Creators: David A Solomon - UpToDate, Inc, Waltham, Massachusetts, USA. dasolomon@lifespan.org
Andrew C Leon
William H Coryell
Jean Endicott
Chunshan Li
Jess G Fiedorowicz
Lara Boyken
Martin B Keller
Resource Type: Journal article
Publication Details: Archives of general psychiatry, Vol.67(4), pp.339-347
DOI: 10.1001/archgenpsychiatry.2010.15
PMID: 20368510
PMCID: PMC3677763
NLM abbreviation: Arch Gen Psychiatry
ISSN: 0003-990X
eISSN: 1538-3636
Publisher: American Medical Association; United States
Grant note: R01 MH025478 / NIMH NIH HHS MH25478-29A2 / NIMH NIH HHS U01 MH025478 / NIMH NIH HHS
Language: English
Date published: 04/2010
Academic Unit: Psychiatry; Epidemiology; Internal Medicine
Record Identifier: 9984003921402771

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