First‐episode types in bipolar disorder: predictive associations with later illness

Abstract

Objective Characteristics of initial illness in bipolar disorder (BD) may predict later morbidity. Method We reviewed computerized clinical records and life charts of DSM-IV-TR BD-I or BD-II patients at affiliated mood-disorder centers to ascertain relationships of initial major illnesses to later morbidity and other clinical characteristics. Results Adult BD patient–subjects (N = 1081; 59.8% BD-I; 58.1% women; 43% ever hospitalized) were followed 15.7 ± 12.8 years after onsets ranking: depression (59%) > mania (13%) > psychosis (8.0%) ≥ anxiety (7.6%) ≥ hypomania (6.7%) > mixed states (5.5%). Onset types differed in clinical characteristics and strongly predicted later morbidity. By initial episode types, total time-ill ranked: mania ≥ hypomania ≥ mixed-states ≥ psychosis > depression > anxiety. Depression was most prevalent long-term, overall; its ratio to mania-like illness (D/M, by per cent-time-ill) ranked by onset type: anxiety (4.75) > depression (3.27) > mixed states (1.39) > others (all <1.00). The MDI (mania or hypomania–depression–euthymia interval) course-pattern was most common (34.4%) and associated with psychotic or manic onset; the depression before mania (DMI) pattern (25.0%) most often followed anxiety (38.8%), depression (30.8%), or mixed onsets (13.3%); both were predicted by initial mania depression sequences. Conclusion First-lifetime illnesses and cycles predicted later morbidity patterns among BD patients, indicating value of early morbidity for prognosis and long-term planning.