Comorbidities, Depression Severity, and Circadian Rhythms Disturbances as Clinical Correlates of Duration of Untreated Illness in Affective Disorders

Abstract

Background and Objectives: Affective disorders, namely bipolar (BDs) and depressive disorders (DDs) are characterized by high prevalence and functional impairment. From a dimensional point of view, BDs and DDs can be considered as psychopathological entities lying on a continuum. A delay in treatment initiation might increase the burden associated with affective disorders. The aim of this study is to analyze the correlates of a long duration of untreated illness (DUI) in these conditions. Materials and Methods: Subjects with BDs and DDs, both in- and outpatients, were recruited. Long DUI was defined according to previous research criteria as >2 years for BDs or >1 year for DDs. Socio-demographic, clinical and psychopathological characteristics of the recruited subjects were collected. Bivariate analyses were performed to compare subjects with a long and short DUI (p < 0.05). Results: In our sample (n = 61), 34.4% of subjects presented a long DUI. A long DUI was significantly associated with longer overall illness duration (p = 0.022) and a higher rate of psychiatric (p = 0.048) and physical comorbidities (p = 0.023). As for psychopathological features, depressive symptoms were more severe in the long DUI subgroup, as demonstrated by a higher score at the Clinical Global Impression-severity of depression (p = 0.012) item and at the anxiety/depression factor of the Positive and Negative Syndrome Scale (p = 0.041). Furthermore, subjects with a long DUI displayed more severe disruption of circadian rhythms, as evaluated by the Biological Rhythms Interview for Assessment in Neuropsychiatry total (p = 0.044) and social domain (p = 0.005) scores and by the Hamilton Depression Rating Scale diurnal variation items (18a: p = 0.029, 18b: p = 0.047). Conclusions: A long DUI may underpin higher clinical severity, as well as worse illness course and unfavorable prognosis in affective disorders. Intervention strategies targeting comorbidities, depressive symptoms and circadian rhythms may decrease disease burden in subjects with a long DUI.

Reliability and validity of the Chinese version of the biological rhythms interview of assessment in neuropsychiatry in patients with major depressive disorder

“…The BRIAN scale has been used to assess biological rhythms in patients with MDD [ 25 – 27 ]. Using this scale, researchers have observed that biological rhythm disruption is associated with the severity of depression [ 6 , 35 ]. However, to date, no research has examined the reliability and validity of the BRIAN scale in patients with MDD.…”

Sex Differences in Bipolar Disorders: Impact on Psychopathological Features and Treatment Response

“…In the present sample, both males and females revealed a mean long DUI, defined by previous reports as >2 years (82), and a significant positive association between DUI and female sex was revealed by the logistic regression. A longer DUI underpins worse BD outcomes, as demonstrated by a higher number of mood episodes, suicide attempts, and hospitalizations (83, 84) and a higher prevalence of psychiatric and medical comorbidities (85,86). Moreover, delayed treatment in affective disorders is associated with a worse response to pharmacological and psychological interventions (87)(88)(89).…”

Prevention of Depression in Children, Adolescents, and Young Adults: The Role of Teachers and Parents

“…A longer duration of untreated depressive illness increases the latency to response [18], meaning that much time is lost in sufferance for the patient. Furthermore, a longer untreated illness duration in depression is associated with a longer overall duration of depression, more comorbidity, more severe depressive symptoms [19], and even higher cognitive impairment [20]. Taken together, these data indicate that the best intervention is early detection [21]; in fact, in more recent years diagnosticians tend to reduce the untreated illness duration and this was followed by reduced time to first pharmacotherapy [22].…”