Giulia Serra1, Athanasios Koukopoulos2, Lavinia De Chiara3, Flavia Napoletano3, Alexia E Koukopoulos4, Martina Curto5, Giovanni Manfredi4, Gianni Faedda6, Paolo Girardi4, Ross J Baldessarini7. 1. NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Lucio Bini Mood Disorder Center, Rome, Italy. 2. International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Lucio Bini Mood Disorder Center, Rome, Italy. 3. NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy. 4. NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy. 5. NESMOS Department, Sant׳Andrea Hospital, "Sapienza" University of Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA. 6. International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA; Lucio Bini Mood Disorders Center, New York, NY, USA; New York University Medical Center & Child Study Center, New York, NY, USA. 7. Department of Psychiatry, Harvard Medical School, Boston, MA, USA; International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, USA. Electronic address: rbaldessarini@mclean.harvard.edu.
Abstract
BACKGROUND: Better and earlier predictive differentiation of bipolar (BD) vs. unipolar major depressive disorder (UD) diagnoses should improve long-term clinical planning. METHODS: We reviewed randomly selected clinical records of 334 adults diagnosed with DSM-IV-TR BD-I (n=109), BD-II (n=106), and UD (n=119) and compared features preceding major affective episodes or diagnoses, using bivariate, multivariate, and Bayesian methods. RESULTS: We identified antecedents selectively associated with later BD vs. UD in 52.6% vs. 31.1% of subjects in childhood, starting at age 7.4 years, and 60.0% vs. 32.8% in adolescence, with far more features in BD than UD cases (10.3 vs. 4.64/100 person-years; p<0.001). In multivariate modeling, BD-selective factors were: younger at first clinical event > male sex > family BD-history > cyclothymic or hyperthymic temperament > antecedents/person-year. Nonaffective (anxiety, eating, or substance-use) disorders preceded BD vs. UD in 41.4% vs. 28.6% of subjects (p=0.02). By ROC analysis, differential prediction of BD vs. UD was optimal with any ≥ 3 factors/person. LIMITATIONS: The validity and timing of antecedent events and factors identified retrospectively from clinical records could not be verified independently, but information was recorded systematically and consistently by a single mood-disorder expert prior to diagnosis, and extracted by two independent observers. COMMENT: Early clinical features distinguished later BD from UD, often by years. Such prediction should improve treatment-planning and limit risk of mood-switching.
BACKGROUND: Better and earlier predictive differentiation of bipolar (BD) vs. unipolar major depressive disorder (UD) diagnoses should improve long-term clinical planning. METHODS: We reviewed randomly selected clinical records of 334 adults diagnosed with DSM-IV-TR BD-I (n=109), BD-II (n=106), and UD (n=119) and compared features preceding major affective episodes or diagnoses, using bivariate, multivariate, and Bayesian methods. RESULTS: We identified antecedents selectively associated with later BD vs. UD in 52.6% vs. 31.1% of subjects in childhood, starting at age 7.4 years, and 60.0% vs. 32.8% in adolescence, with far more features in BD than UD cases (10.3 vs. 4.64/100 person-years; p<0.001). In multivariate modeling, BD-selective factors were: younger at first clinical event > male sex > family BD-history > cyclothymic or hyperthymic temperament > antecedents/person-year. Nonaffective (anxiety, eating, or substance-use) disorders preceded BD vs. UD in 41.4% vs. 28.6% of subjects (p=0.02). By ROC analysis, differential prediction of BD vs. UD was optimal with any ≥ 3 factors/person. LIMITATIONS: The validity and timing of antecedent events and factors identified retrospectively from clinical records could not be verified independently, but information was recorded systematically and consistently by a single mood-disorder expert prior to diagnosis, and extracted by two independent observers. COMMENT: Early clinical features distinguished later BD from UD, often by years. Such prediction should improve treatment-planning and limit risk of mood-switching.
Authors: Roger S McIntyre; Martin Alda; Ross J Baldessarini; Michael Bauer; Michael Berk; Christoph U Correll; Andrea Fagiolini; Kostas Fountoulakis; Mark A Frye; Heinz Grunze; Lars V Kessing; David J Miklowitz; Gordon Parker; Robert M Post; Alan C Swann; Trisha Suppes; Eduard Vieta; Allan Young; Mario Maj Journal: World Psychiatry Date: 2022-10 Impact factor: 79.683
Authors: Giulia Serra; Maria Elena Iannoni; Monia Trasolini; Gino Maglio; Camilla Frattini; Maria Pia Casini; Ross J Baldessarini; Stefano Vicari Journal: Brain Sci Date: 2021-03-29