R J Baldessarini1, P Salvatore2, H-M K Khalsa3, H Imaz-Etxeberria4, A Gonzalez-Pinto4, M Tohen5. 1. Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Boston, MA, United States. Electronic address: rbaldessarini@mclean.harvard.edu. 2. Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Boston, MA, United States; Section of Psychiatry, Department of Neuroscience, University of Parma, Italy. 3. Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Boston, MA, United States. 4. Department of Psychiatry, Vittoria Medical Center, Vittoria, Spain. 5. Department of Psychiatry, University of Texas Health Sciences Center, San Antonio, TX, United States.
Abstract
BACKGROUND: Preliminary review of a century of studies of the course of manic-depressive syndromes produced 40 reports, of which approximately one-third report evidence of shortening wellness intervals or cycle-lengths with more recurrences, and two-thirds did not. METHODS: We evaluated inter-episode intervals (cycle-length) in 128 clinically-treated, DSM-IV bipolar-I disorder patients followed prospectively and systematically over 5.7 years, with 6.5 episodes/person. RESULTS: As expected, cycle-length varied inversely with total cycle-count/person; however, multivariate linear regression found only longer initial hospitalization and fewer total cycles to be associated with cycle-length, whereas cycle-number (1, 2, 3, etc.), sex, intake-age, and first-episode polarity were not. Regression of within-subject cycle-length versus cycle-number yielded individual slope-functions with pseudo-random distribution (28% fell within ±1 month/cycle of the null [zero-slope]). Mean duration of early and late euthymic intervals (cycles 2 vs. 5) in patients with matched recurrence-counts was nearly identical. CONCLUSIONS: The course of bipolar-I disorder from onset was largely random or chaotic over nearly 6 years from onset. Only a minority of patients showed either cycle-acceleration or slowing, without changes in wellness intervals. The findings may be influenced by treatment-effects, but seem to indicate that most current bipolar-I disorder patients are unlikely to show progressive shortening of recurrence-cycles.
BACKGROUND: Preliminary review of a century of studies of the course of manic-depressive syndromes produced 40 reports, of which approximately one-third report evidence of shortening wellness intervals or cycle-lengths with more recurrences, and two-thirds did not. METHODS: We evaluated inter-episode intervals (cycle-length) in 128 clinically-treated, DSM-IV bipolar-I disorderpatients followed prospectively and systematically over 5.7 years, with 6.5 episodes/person. RESULTS: As expected, cycle-length varied inversely with total cycle-count/person; however, multivariate linear regression found only longer initial hospitalization and fewer total cycles to be associated with cycle-length, whereas cycle-number (1, 2, 3, etc.), sex, intake-age, and first-episode polarity were not. Regression of within-subject cycle-length versus cycle-number yielded individual slope-functions with pseudo-random distribution (28% fell within ±1 month/cycle of the null [zero-slope]). Mean duration of early and late euthymic intervals (cycles 2 vs. 5) in patients with matched recurrence-counts was nearly identical. CONCLUSIONS: The course of bipolar-I disorder from onset was largely random or chaotic over nearly 6 years from onset. Only a minority of patients showed either cycle-acceleration or slowing, without changes in wellness intervals. The findings may be influenced by treatment-effects, but seem to indicate that most current bipolar-I disorderpatients are unlikely to show progressive shortening of recurrence-cycles.
Authors: Ayal Schaffer; Erkki T Isometsä; Jean-Michel Azorin; Frederick Cassidy; Tina Goldstein; Zoltán Rihmer; Mark Sinyor; Leonardo Tondo; Doris H Moreno; Gustavo Turecki; Catherine Reis; Lars Vedel Kessing; Kyooseob Ha; Abraham Weizman; Annette Beautrais; Yuan-Hwa Chou; Nancy Diazgranados; Anthony J Levitt; Carlos A Zarate; Lakshmi Yatham Journal: Aust N Z J Psychiatry Date: 2015-07-14 Impact factor: 5.744
Authors: Afra van der Markt; Ursula Mh Klumpers; Stasja Draisma; Annemiek Dols; Willem A Nolen; Robert M Post; Lori L Altshuler; Mark A Frye; Heinz Grunze; Paul E Keck; Susan L McElroy; Trisha Suppes; Aartjan Tf Beekman; Ralph W Kupka Journal: Bipolar Disord Date: 2018-12-12 Impact factor: 6.744