Karishma R Kulkarni1, Preethi V Reddy1, Abhishek Purty1, Shyam Sundar Arumugham1, Kesavan Muralidharan2, Yc Janardhan Reddy1, Lakshmi Yatham3, Sanjeev Jain1. 1. Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore 560029, Karnataka, India. 2. Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore 560029, Karnataka, India. Electronic address: drmuralidk@gmail.com. 3. Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada.
Abstract
BACKGROUND: An understanding of the early course of Bipolar Disorder (BD) can contribute towards developing timely interventions. First episode mania (FEM) determines a diagnosis of bipolarity, and therefore, onset of BD-I. We investigated the course of BD-I over a five-year period after FEM by retrospective chart review. METHODS: Charts of patients diagnosed with FEM in 2008 (n = 108) were reviewed. Data was extracted about FEM and subsequent course up to 5 years, for those who came for follow-up during this period. The factors influencing course were evaluated with statistical analyses including logistic regression and survival analysis. RESULTS: The mean age at onset of BD was 26 ± 9.2 years and mean age at FEM was 27.1 ± 9 years. 41 (38%) patients had previous depression. Patients who returned for at least one follow-up were 60/108 (55.6%), with 54 (90%) of them experiencing another mood episode following FEM. Most recurrences occurred between 6 months to 1 year after FEM, with manic episodes occurring two-three times as frequently as depressive episodes. Good adherence to treatment was a predictor of fewer hospitalizations [B = -0.61; t = -3.1; p = 0.004]. LIMITATIONS: The study was limited by its retrospective design and high number of dropouts. CONCLUSION: The five-year course after FEM showed twice the number of manic compared to depressive recurrences, irrespective of when the recurrence occurred. Consistent with earlier reports from India, BD-I appears to be mania-predominant, even early in the course. This has significant implications in planning maintenance treatments.
BACKGROUND: An understanding of the early course of Bipolar Disorder (BD) can contribute towards developing timely interventions. First episode mania (FEM) determines a diagnosis of bipolarity, and therefore, onset of BD-I. We investigated the course of BD-I over a five-year period after FEM by retrospective chart review. METHODS: Charts of patients diagnosed with FEM in 2008 (n = 108) were reviewed. Data was extracted about FEM and subsequent course up to 5 years, for those who came for follow-up during this period. The factors influencing course were evaluated with statistical analyses including logistic regression and survival analysis. RESULTS: The mean age at onset of BD was 26 ± 9.2 years and mean age at FEM was 27.1 ± 9 years. 41 (38%) patients had previous depression. Patients who returned for at least one follow-up were 60/108 (55.6%), with 54 (90%) of them experiencing another mood episode following FEM. Most recurrences occurred between 6 months to 1 year after FEM, with manic episodes occurring two-three times as frequently as depressive episodes. Good adherence to treatment was a predictor of fewer hospitalizations [B = -0.61; t = -3.1; p = 0.004]. LIMITATIONS: The study was limited by its retrospective design and high number of dropouts. CONCLUSION: The five-year course after FEM showed twice the number of manic compared to depressive recurrences, irrespective of when the recurrence occurred. Consistent with earlier reports from India, BD-I appears to be mania-predominant, even early in the course. This has significant implications in planning maintenance treatments.