Onset-age of bipolar disorders at six international sites

Department of Psychiatry & Neuroscience Program, Harvard Medical School, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 07/2009; 121(1-2):143-6. DOI: 10.1016/j.jad.2009.05.030
Source: PubMed


Onset-age is a stable characteristic of bipolar disorder (BPD) patients of clinical and probable psychobiological importance, but large pooled clinical samples from multiple sites employing modern diagnostic criteria to quantify onset-age remain rare.
We pooled diagnostic, demographic, and clinical data from 1566 BPD patients from six international sites (5 European, 1 US) to compare onset-ages in subgroups.
Median+/-IQR onset in 1090 BP-I patients was 5.8 years younger than 476 BP-II cases (24.3+/-18.3 vs. 30.1+/-13.8 years; p<0.0001). Onset-age ranked: [a] BP-I men (23.0+/-12.8); [b] BP-I women (26.0+/-14.2); [c] BP-II men (29.7+/-19.1); and [d] BP-II women (30.1+/-17.5 years. Juvenile-onset (<or=age 20) was more common in Europe than the US (27% vs. 16%), as was childhood-onset (<13 years: 3.3% vs. 0%; both p<0.001). Proportion of all cases, and median onset for first episodes ranked: [a] BP-I psychotic (6.3%; 22.7+/-9.2); [b] BP-I manic (29.3%; 24.0+/-12.1); [c] BP-I depressed (25.1%; 24.5+/-14.9); [d] BP-I mixed (9.7%; 27.9+/-16.0); [e] BP-II depressed (26.9%; 30.0+/-19.5); and [f] BP-II hypomanic (2.8%; 33.6+/-15.1 years; p<0.0001). Among BP-I patients, onset was similar for various forms of mania and major depression; in BP-II patients initial depression was 9.6-times more frequent and diagnosed earlier than hypomania.
There was some variance among sites and only 34.1% of patients were evaluated at onset.
Type I BPD began much earlier than type II; its mainly psychotic presentations occurred earliest, but BP-I men were younger than women, especially at psychotic or mixed onsets.

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    • "However, the overall rate of bipolar disorders and the transition rate to bipolar spectrum disorders are striking, given that the majority of participants in this sample have not yet reached the peak age of onset for clinical bipolar disorders. Using a large clinical sample of adults with bipolar I and II disorders across six international sites, Baldessarini et al. (2010) reported the median age of onset across disorders to be 25.2 years. As noted, the mean age of participants in the present research was 22.5 years. "
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    ABSTRACT: Current clinical and epidemiological research provides support for a continuum of bipolar psychopathology: a bipolar spectrum that ranges from subthreshold characteristics to clinical disorders. The present research examined risk for bipolar spectrum psychopathology at a 3-year follow-up assessment in a nonclinically ascertained sample of 112 young adults identified by the Hypomanic Personality Scale (HPS). Participants completed diagnostic interviews assessing bipolar psychopathology, borderline personality traits, substance use disorders, impulsivity, and psychosocial functioning. At the original assessment, 18 of the 112 participants met criteria for a bipolar spectrum disorder. At the follow-up, an additional 13 had developed bipolar spectrum disorders. A total of 58% of participants scoring in the upper quartile of the HPS qualified for bipolar spectrum disorders at the follow-up, including 27% with DSM-IV-TR disorders. The HPS predicted new cases and total number of cases of bipolar spectrum disorders, as well as total number of DSM-IV-TR bipolar disorders. The HPS also predicted hyperthymic temperament or history of hypomania, grandiose traits, impulsivity, substance use disorders, psychosocial impairment, and borderline traits. The majority of these effects were significant after removing participants with DSM-IV-TR bipolar disorders from the analyses, suggesting that the results were not driven by a subset of participants with clinical disorders. Overall, these results offer further support for the bipolar spectrum construct and the predictive validity of the HPS as a measure of bipolar spectrum psychopathology. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · May 2015 · Journal of Abnormal Psychology
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    • "Therefore they are inherently also a risk factor for SZ [23,24,31]. Although psychoses and SUD have been documented as frequently occurring disorders in patients developing BD or SZ [21,22,26,27,29] in the present study the association was stronger for SZ and thus, may serve as evidence for differentiating preceding psychiatric histories of patients with BD or SZ. "
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    ABSTRACT: The aim of this comparative study was to investigate the type and frequency of diagnoses preceding adult bipolar disorder (BD) and schizophrenia (SZ). A follow-back study of all preceding diagnoses in all patients aged 21-34 years with a primary, first time diagnosis of BD (N = 784) or SZ (N = 1667) in 2008 to 2010. Data were taken from the Danish Psychiatric Central Register (DPCR) including ICD-10 and ICD-8 diagnoses. The numbers of patients with any preceding diagnoses amounted to 69.3% in BD and 76.6% in SZ with affective disorders (excluding BD) being the most frequent preceding diagnosis (46.6 vs. 28.0%), followed by psychoses (PSY) other than SZ (14.2 vs. 41.5%, p < .001), and substance use disorders (SUD) (16.1 vs. 26.9%, p < .001). Reactions to severe stress were equally frequent in both samples (26.3 vs. 26.6%) as were personality disorders (21.8 vs. 22.4%) and ADHD (4.2 vs. 3.5%), whereas rates of conduct disorders (1.7 vs. 3.1%) were rather low in both samples. Very few of the preceding diagnoses had their onset in childhood and adolescence. Overall patients with SZ had a minor but statistically significant earlier onset of any psychiatric disorder compared to BD (mean age: 23.3 vs. 22.5, p < .001). Regression analyses indicated that BD was associated with an increased risk of having experienced preceding affective disorders, ADHD, and conduct disorders while SZ was associated with an increased risk of preceding substance use disorders, psychosis, anxiety disorders, and personality disorders. Specific developmental trajectories of preceding disorders were delineated for BD and SZ with affective disorders being more specific for BD and both substance use disorders and psychosis more specific to SZ. There are different patterns of vulnerability in terms of preceding diagnosis in young adults with BD and SZ.
    Full-text · Article · Dec 2013 · BMC Psychiatry
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    • "Such risk may be particularly high among juvenile depressed patients, who are more likely to be treated with antidepressants (ADs) and stimulants before a diagnosis of BPD is made (Martin et al., 2004; Baldessarini et al., 2005; Lim et al., 2005; Biederman et al., 2009; Offidani et al., 2012). Moreover, patients who begin BPD with depressive or mixed episodes appear to be at increased risk for long-term morbidity, disability, and suicide (Baldessarini et al., 2010a, 2010b, 2012b). These considerations indicate the importance of quantifying the risk of excessive elevation of mood and behavioral activation during Contents lists available at SciVerse ScienceDirect journal homepage: "
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    ABSTRACT: OBJECTIVES: Compare reported rates of mood-shifts from major depression to mania/hypomania/mixed-states during antidepressant (AD)-treatment and rates of diagnostic change from major depressive disorder (MDD) to bipolar disorder (BPD). METHODS: Searching computerized literature databases, followed by summary analyses. RESULTS: In 51 reports of patients diagnosed with MDD and treated with an AD, the overall risk of mood-switching was 8.18% (7837/95,786) within 2.39±2.99 years of treatment, or 3.42 (95% CI: 3.34-3.50) %/year. Risk was 2.6 (CI: 2.5-2.8) times greater with/without AD-treatment by meta-analysis of 10 controlled trials. Risk increased with time up to 24 months of treatment, with no secular change (1968-2012). Incidence rates were 4.5 (CI: 4.1-4.8)-times greater among juveniles than adults (5.62/1.26 %/year; p<0.0001). In 12 studies the overall rate of new BPD-diagnoses was 3.29% (1928/56,754) within 5.38 years (0.61 [0.58-0.64] %/year), or 5.6-times lower (3.42/0.61) than annualized rates of mood-switching. CONCLUSIONS: AD-treatment was associated with new mania-like responses in 8.18% of patients diagnosed with unipolar MDD. Contributions to mood-switching due to unrecognized BPD versus mood-elevating pharmacological effects, as well as quantitative associations between switching and later diagnosis of BPD not associated with AD-treatment remain uncertain. LIMITATIONS: Rates and definitions of mood-switching with ADs varied greatly, exposure-times rarely were precisely defined, and there was little information on predictive associations between mood-switches and BPD-diagnosis.
    Full-text · Article · Dec 2012 · Journal of Affective Disorders
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