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

Published online by Cambridge University Press:  18 July 2012

R. Uher ,
O. Mantere ,
K. Suominen  and
E. Isometsä
R. Uher*
Affiliation:
Department of Psychiatry, Dalhousie University, Halifax, NS, Canada Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland
O. Mantere
Affiliation:
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland Department of Adolescent Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
K. Suominen
Affiliation:
Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland
E. Isometsä
Affiliation:
Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland Department of Psychiatry, University of Helsinki, Finland
*
*Address for correspondence: Dr R. Uher, Mood Disorders Program, Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 3rd floor, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2Canada. (Email: rudolf.uher@kcl.ac.uk)
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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.

Keywords

Bipolar disorderclassificationclinical courselatent class analysislongitudinal studies
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 4 , April 2013 , pp. 789 - 799
Copyright
Copyright © Cambridge University Press 2012

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