Hostname: page-component-77c89778f8-cnmwb Total loading time: 0 Render date: 2024-07-16T12:47:40.887Z Has data issue: false hasContentIssue false
  • English
  • Français

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)
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Angst, J (1978). The course of affective disorders. II. Typology of bipolar manic-depressive illness. Archiv fur Psychiatrie und Nervenkrankheiten 226, 65–73.CrossRefGoogle ScholarPubMed
Arvilommi, P, Suominen, K, Mantere, O, Leppamaki, S, Valtonen, HM, Isometsä, E (2010). Maintenance treatment received by patients with bipolar I and II disorders – a naturalistic prospective study. Journal of Affective Disorders 121, 116–126.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Salvatore, P, Khalsa, HM, Gebre-Medhin, P, Imaz, H, Gonzalez-Pinto, A, Perez, J, Cruz, N, Maggini, C, Tohen, M (2010). Morbidity in 303 first-episode bipolar I disorder patients. Bipolar Disorders 12, 264–270.CrossRefGoogle ScholarPubMed
Bauer, M, Beaulieu, S, Dunner, DL, Lafer, B, Kupka, R (2008). Rapid cycling bipolar disorder – diagnostic concepts. Bipolar Disorders 10, 153–162.CrossRefGoogle ScholarPubMed
Benazzi, F (2001). Depressive mixed state: testing different definitions. Psychiatry and Clinical Neurosciences 55, 647–652.CrossRefGoogle ScholarPubMed
Bonsall, MB, Wallace-Hadrill, SM, Geddes, JR, Goodwin, GM, Holmes, EA (2012). Nonlinear time-series approaches in characterizing mood stability and mood instability in bipolar disorder. Proceedings of the Royal Society of London. Series B: Biological Sciences 279, 916–924.Google ScholarPubMed
Coryell, W, Andreasen, NC, Endicott, J, Keller, M (1987). The significance of past mania or hypomania in the course and outcome of major depression. American Journal of Psychiatry 144, 309–315.Google ScholarPubMed
Dunner, DL (1998). Bipolar disorders in DSM-IV: impact of inclusion of rapid cycling as a course modifier. Neuropsychopharmacology 19, 189–193.CrossRefGoogle ScholarPubMed
Feinman, JA, Dunner, DL (1996). The effect of alcohol and substance abuse on the course of bipolar affective disorder. Journal of Affective Disorders 37, 43–49.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Holmes, EA, Deeprose, C, Fairburn, CG, Wallace-Hadrill, SM, Bonsall, MB, Geddes, JR, Goodwin, GM (2011). Mood stability versus mood instability in bipolar disorder: a possible role for emotional mental imagery. Behaviour Research and Therapy 49, 707–713.CrossRefGoogle ScholarPubMed
Isometsä, E, Suominen, K, Mantere, O, Valtonen, H, Leppamaki, S, Pippingskold, M, Arvilommi, P (2003). The mood disorder questionnaire improves recognition of bipolar disorder in psychiatric care. BMC Psychiatry 3, 8.CrossRefGoogle ScholarPubMed
Joffe, RT, MacQueen, GM, Marriott, M, Robb, J, Begin, H, Young, LT (2002). Induction of mania and cycle acceleration in bipolar disorder: effect of different classes of antidepressant. Acta Psychiatrica Scandinavica 105, 427–430.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, Coryell, W, Endicott, J, Maser, JD, Solomon, DA, Leon, AC, Keller, MB (2003 a). A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Archives of General Psychiatry 60, 261–269.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Leon, AC, Solomon, DA, Coryell, W, Maser, JD, Keller, MB (2005). Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Archives of General Psychiatry 62, 1322–1330.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Maser, J, Solomon, DA, Leon, AC, Rice, JA, Keller, MB (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry 59, 530–537.CrossRefGoogle ScholarPubMed
Judd, LL, Schettler, PJ, Akiskal, HS, Maser, J, Coryell, W, Solomon, D, Endicott, J, Keller, M (2003 b). Long-term symptomatic status of bipolar I vs. bipolar II disorders. International Journal of Neuropsychopharmacology 6, 127–137.CrossRefGoogle ScholarPubMed
Kraepelin, E (1921). Manic Depressive Insanity and Paranoia. E. & S. Livingstone: Edinburgh.CrossRefGoogle Scholar
Kupka, RW, Altshuler, LL, Nolen, WA, Suppes, T, Luckenbaugh, DA, Leverich, GS, Frye, MA, Keck, Jr. PE, McElroy, SL, Grunze, H, Post, RM (2007). Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder. Bipolar Disorders 9, 531–535.CrossRefGoogle ScholarPubMed
Maj, M, Pirozzi, R, Formicola, AM, Tortorella, A (1999). Reliability and validity of four alternative definitions of rapid-cycling bipolar disorder. American Journal of Psychiatry 156, 1421–1424.CrossRefGoogle ScholarPubMed
Maj, M, Pirozzi, R, Magliano, L, Bartoli, L (2002). The prognostic significance of ‘switching’ in patients with bipolar disorder: a 10-year prospective follow-up study. American Journal of Psychiatry 159, 1711–1717.CrossRefGoogle ScholarPubMed
Mantere, O, Isometsä, E, Ketokivi, M, Kiviruusu, O, Suominen, K, Valtonen, HM, Arvilommi, P, Leppamaki, S (2010). A prospective latent analyses study of psychiatric comorbidity of DSM-IV bipolar I and II disorders. Bipolar Disorders 12, 271–284.CrossRefGoogle ScholarPubMed
Mantere, O, Suominen, K, Leppamaki, S, Valtonen, H, Arvilommi, P, Isometsä, E (2004). The clinical characteristics of DSM-IV bipolar I and II disorders: baseline findings from the Jorvi Bipolar Study (JoBS). Bipolar Disorders 6, 395–405.CrossRefGoogle ScholarPubMed
Mantere, O, Suominen, K, Valtonen, HM, Arvilommi, P, Leppamaki, S, Melartin, T, Isometsä, E (2008). Differences in outcome of DSM-IV bipolar I and II disorders. Bipolar Disorders 10, 413–425.CrossRefGoogle ScholarPubMed
Merikangas, KR, Herrell, R, Swendsen, J, Rössler, W, Ajdacic-Gross, V, Angst, J (2008). Specificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders: results from the Zurich cohort study. Archives of General Psychiatry 65, 47–52.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (2011). Mplus User's Guide: Statistical Analysis with Latent Variables, 5th edn. Muthén & Muthén: Los Angeles, CA.Google Scholar
Nylund, KL, Asparouhov, T, Muthen, BO (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling 14, 535–569.CrossRefGoogle Scholar
Pavlova, B, Uher, R, Dennington, L, Wright, K, Donaldson, C (2011). Reactivity of affect and self-esteem during remission in bipolar affective disorder: an experimental investigation. Journal of Affective Disorders 134, 102–111.CrossRefGoogle ScholarPubMed
Paykel, ES, Abbott, R, Morriss, R, Hayhurst, H, Scott, J (2006). Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. British Journal of Psychiatry 189, 118–123.CrossRefGoogle ScholarPubMed
Post, RM, Denicoff, KD, Leverich, GS, Altshuler, LL, Frye, MA, Suppes, TM, Rush, AJ, Keck, Jr. PE, McElroy, SL, Luckenbaugh, DA, Pollio, C, Kupka, R, Nolen, WA (2003). Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. Journal of Clinical Psychiatry 64, 680–690.CrossRefGoogle ScholarPubMed
Raftery, AE (1995). Bayesian model selection in social research. Sociological Methodology 25, 111–163.CrossRefGoogle Scholar
Solomon, DA, Leon, AC, Coryell, WH, Endicott, J, Li, C, Fiedorowicz, JG, Boyken, L, Keller, MB (2010). Longitudinal course of bipolar I disorder: duration of mood episodes. Archives of General Psychiatry 67, 339–347.CrossRefGoogle ScholarPubMed
Solomon, DA, Leon, AC, Endicott, J, Coryell, WH, Li, C, Fiedorowicz, JG, Keller, MB (2009). Empirical typology of bipolar I mood episodes. British Journal of Psychiatry 195, 525–530.CrossRefGoogle ScholarPubMed
Tondo, L, Lepri, B, Baldessarini, RJ (2008). Suicidal status during antidepressant treatment in 789 Sardinian patients with major affective disorder. Acta Psychiatrica Scandinavica 118, 106–115.CrossRefGoogle ScholarPubMed
Turvey, CL, Coryell, WH, Arndt, S, Solomon, DA, Leon, AC, Endicott, J, Mueller, T, Keller, M, Akiskal, H (1999). Polarity sequence, depression, and chronicity in bipolar I disorder. Journal of Nervous and Mental Disease 187, 181–187.CrossRefGoogle ScholarPubMed
Valtonen, HM, Suominen, K, Haukka, J, Mantere, O, Leppamaki, S, Arvilommi, P, Isometsa, ET (2008). Differences in incidence of suicide attempts during phases of bipolar I and II disorders. Bipolar Disorders 10, 588–596.CrossRefGoogle ScholarPubMed
Winokur, G, Kadrmas, A (1989). A polyepisodic course in bipolar illness: possible clinical relationships. Comprehensive Psychiatry 30, 121–127.CrossRefGoogle ScholarPubMed