Longitudinal research on bipolar disorders

Abstract

Abstract. Longitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from firsthospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.

Efficacy of psychoeducation in bipolar patients: Systematic review of randomized trials.

“…It is still an underdiagnosed disease among clinicians and health professionals, with a high prevalence of misdiagnosis and diagnostic shifts from other psychiatric disorders to bipolar disorder. For this reason, a large percentage of this population remains untreated (Salvatore, Tohen, Khalsa, Baethge, Tondo & Baldessarini, 2007). High rates of misdiagnosis and lack of recognition often lead patients with bipolar disorder to have a chronic illness course with high disability, unemployment rates, and mortality (Leboyer & Kupfer, 2010).…”

What are the perspectives of human brain mapping in the field of bipolar disorder?

“…In the last two decades brain imaging studies, specifically with magnetic resonance imaging (MRI), have tried to elucidate the underlying neurobiology of bipolar disorder, which is a severe and heritable illness (Salvatore et al, 2007). There is evidence that an extensive fronto-limbic circuitry in brain areas, including prefrontal cortex (i.e.…”

Achieving a better knowledge on the causes and early course of psychoses: a profitable investment for the future?

“…In the second Editorial, Paola Salvatore and Colleagues from the research group leaded by Ross Baldessarini (Salvatore et al, 2007) at the Harvard Medical School in Boston, using data from the McLean-Harvard First Episode Project, explore the specificity of the early course of bipolar disorder and confute some stereotypes about it having a more benign course than other psychoses. The findings they present highlight that, if 98% of subjects having experienced a first episode of mania or mixed state no longer fulfil the DSM-IV diagnostic criteria for this disorder after 24 months, only 72% are symptomatically well, and only 43% had returned to baseline functioning.…”

“…Nel secondo Editoriale, Paola Salvatore e Colleghi del gruppo di ricerca diretto da Ross Baldessarini alia Harvard Medical School di Boston (Salvatore et al, 2007), utilizzando dati tratti dal McLean-Harvard First Episode Project, esplorano la specificita delle prime fasi del decorso del disturbo bipolare e mettono in discussione alcuni stereotipi secondo cui i disturbi bipolari avrebbero un decorso piu benigno delle altre psicosi. I dati che essi presentano mettono in luce che, se il 98% dei soggetti che hanno sperimentato un primo episodio di mania o di stato misto 24 mesi dopo e destinato a non soddisfare piu i criteri DSM-IV per tale disturbo, soltanto il 72% non presenta sintomi e soltanto il 43% e ritornato al funzionamento premorboso.…”

“…This complexity has attracted the attention of several scientists in the last decade and constitutes a very promising position from which to test gene environment interactions (Caspi & Moffitt, 2006). Studies of the early stages of bipolar disorders, as the one presented in the Editorial by Salvatore et al (2007), will allow us to disentangle the intrinsic clinical and psychological characteristics, from the effects of the environment and biological susceptibility.…”