Sanna Pallaskorpi1,2, Kirsi Suominen1,2, Mikko Ketokivi3, Outi Mantere1,4,5, Petri Arvilommi1,2, Hanna Valtonen1,2, Sami Leppämäki4,6, Erkki Isometsä1,4,5. 1. Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland. 2. Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland. 3. Operations and Technology Department, IE Business School-IE University, Madrid, Spain. 4. Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland. 5. Department of Psychiatry, University of Helsinki, Helsinki, Finland. 6. Finnish Institute of Occupational Health, Helsinki, Finland.
Abstract
OBJECTIVES: The long-term outcome of bipolar disorder (BD) has been extensively investigated. However, previous studies may be biased towards hospitalized patients with bipolar I disorder (BD-I), and generalizability to the current treatment era remains uncertain. In this naturalistic study, we followed a secondary-care cohort of patients with BD. METHODS: In the Jorvi Bipolar Study, 191 patients with BD-I and bipolar II disorder (BD-II) were followed using a life-chart method. Interviews were conducted at six months, 18 months, and five years. Time to full remission, time to first recurrence, total time ill, their predictors, and BD-I versus BD-II differences were investigated among the 151 patients remaining in follow-up. RESULTS: Nearly all subjects recovered from the index episode, but almost all (90%) had a recurrence, and most had multiple recurrences. The patients spent about one-third of their time in illness episodes and 15% of their time with subthreshold symptoms; half of the time they were euthymic. After controlling for confounders, no difference in time spent in depressive states between patients with BD-I and BD-II persisted. Among patients with a depressive index phase, cluster C personality disorders [hazard ratio (HR) = 0.452, p = 0.040] and higher 17-item Hamilton Depression Scale score (HR = 0.951, p = 0.022) predicted longer time to remission, whereas lifetime psychotic symptoms (HR = 2.162, p = 0.016) predicted shorter time to first recurrence. CONCLUSIONS: Among patients with BD, chronicity as uninterrupted persistence of illness was rare, but multiple recurrences were the norm. Patients with BD spent only half of their time euthymic. Patients with BD-I and BD-II may differ little in proneness to depressive states. Severity of depression, cluster C personality disorders, and psychotic symptoms predicted outcome.
OBJECTIVES: The long-term outcome of bipolar disorder (BD) has been extensively investigated. However, previous studies may be biased towards hospitalized patients with bipolar I disorder (BD-I), and generalizability to the current treatment era remains uncertain. In this naturalistic study, we followed a secondary-care cohort of patients with BD. METHODS: In the Jorvi Bipolar Study, 191 patients with BD-I and bipolar II disorder (BD-II) were followed using a life-chart method. Interviews were conducted at six months, 18 months, and five years. Time to full remission, time to first recurrence, total time ill, their predictors, and BD-I versus BD-II differences were investigated among the 151 patients remaining in follow-up. RESULTS: Nearly all subjects recovered from the index episode, but almost all (90%) had a recurrence, and most had multiple recurrences. The patients spent about one-third of their time in illness episodes and 15% of their time with subthreshold symptoms; half of the time they were euthymic. After controlling for confounders, no difference in time spent in depressive states between patients with BD-I and BD-II persisted. Among patients with a depressive index phase, cluster C personality disorders [hazard ratio (HR) = 0.452, p = 0.040] and higher 17-item Hamilton Depression Scale score (HR = 0.951, p = 0.022) predicted longer time to remission, whereas lifetime psychotic symptoms (HR = 2.162, p = 0.016) predicted shorter time to first recurrence. CONCLUSIONS: Among patients with BD, chronicity as uninterrupted persistence of illness was rare, but multiple recurrences were the norm. Patients with BD spent only half of their time euthymic. Patients with BD-I and BD-II may differ little in proneness to depressive states. Severity of depression, cluster C personality disorders, and psychotic symptoms predicted outcome.
Authors: Diana Khoubaeva; Mikaela Dimick; Vanessa H Timmins; Lisa M Fiksenbaum; Rachel H B Mitchell; Ayal Schaffer; Mark Sinyor; Benjamin I Goldstein Journal: Eur Child Adolesc Psychiatry Date: 2021-05-24 Impact factor: 4.785
Authors: Petri Arvilommi; Sanna Pallaskorpi; Outi Linnaranta; Kirsi Suominen; Sami Leppämäki; Hanna Valtonen; Erkki Isometsä Journal: Int J Bipolar Disord Date: 2022-07-11
Authors: Jose Guzman-Parra; Fabian Streit; Andreas J Forstner; Jana Strohmaier; Maria José González; Susana Gil Flores; Francisco J Cabaleiro Fabeiro; Francisco Del Río Noriega; Fermin Perez Perez; Jesus Haro González; Guillermo Orozco Diaz; Yolanda de Diego-Otero; Berta Moreno-Kustner; Georg Auburger; Franziska Degenhardt; Stefanie Heilmann-Heimbach; Stefan Herms; Per Hoffmann; Josef Frank; Jerome C Foo; Lea Sirignano; Stephanie H Witt; Sven Cichon; Fabio Rivas; Fermín Mayoral; Markus M Nöthen; Till F M Andlauer; Marcella Rietschel Journal: Transl Psychiatry Date: 2021-01-11 Impact factor: 6.222
Authors: Kari I Aaltonen; Tom Rosenström; Pekka Jylhä; Irina Holma; Mikael Holma; Sanna Pallaskorpi; Kirsi Riihimäki; Kirsi Suominen; Maria Vuorilehto; Erkki T Isometsä Journal: Front Psychiatry Date: 2020-11-26 Impact factor: 4.157