Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study

Altamura, Alfredo Carlo; Buoli, Massimiliano; Caldiroli, Alice; Caron, Lea; Melter, Claudia Cumerlato; Dobrea, Cristina; Cigliobianco, Michela; Quarantini, Francesco Zanelli

doi:10.1016/j.jad.2015.04.024

Cited by 138 publications

(114 citation statements)

References 32 publications

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“…neuropsychiatry), thus patients have a shorter DUI that has been associated with a better outcome in the long-term (Altamura et al, 2015). On the other hand, obstetrical complications could have an "anticipatory effect" (possibly determining early presentation of psychiatric disorders in subjects with a predisposition to mental illness), as demonstrated by the earlier age at onset in this group.…”

Section: Discussionmentioning

confidence: 91%

Are obstetrical complications really involved in the etiology and course of schizophrenia and mood disorders?

Buoli

Bertino

Caldiroli

et al. 2016

Psychiatry Research

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The impact of stressful experiences during gestation or early life, leading to increased psychiatric disorders susceptibility, is currently well described in literature, however, few data are available on the association between obstetrical complications and later development of specific diagnoses or clinical features (e.g. psychotic symptoms). Aim of the present paper was to evaluate obstetrical complications frequency in different psychiatric diagnoses and their association with clinical features. Three hundred and eighty-eight patients with a diagnosis of schizophrenia, bipolar disorder or major depressive disorder were compared in terms of clinical presentation according to the presence, type and severity of obstetrical complications. Seventeen percent of the total sample (N=65) had history of at least one obstetrical complication. Patients with a history of at least one obstetrical complication result in an earlier age of onset (F=3.93, p=0.04) and a current higher GAF score (F=6.46, p=0.01). Lewis-Murray scale score was directly correlated with GAF scores (t=2.9, p=0.004) and inversely correlated with age at onset (t=-2.77, p=0.006). Obstetrical complications are frequently registered in patients with schizophrenia or mood disorders. In our sample, they appear to have an anticipatory effect on illness onset, but they seem not to be associated with a specific psychiatric diagnosis.

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Section: Discussionmentioning

confidence: 91%

Are obstetrical complications really involved in the etiology and course of schizophrenia and mood disorders?

Buoli

Bertino

Caldiroli

et al. 2016

Psychiatry Research

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“…Indeed, many individuals are not accurately diagnosed until up to 10 years after the onset of symptoms, with one to four alternate diagnoses typically being given prior to correct recognition and treatment34, 35 This delay has important consequences, including inadequate initial treatment and worse prognosis in terms of episode recurrence and functional outcome 36, 37…”

Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…This complex condition is often exacerbated by the presence of one or more comorbid conditions, in addition to a number of clinical factors such long duration of illness (Altamura et al, 2015;Altamura et al, 2010). While BD, schizophrenia spectrum disorders (SSD) and autism spectrum disorders (ASD) are considered distinct conditions, there is evidence for an overlap between BD and SSD (Altamura, Buoli, & Pozzoli, 2014;Carroll & Owen, 2009;Moller, 2003), as well as between ASD and BD (Carroll & Owen, 2009;Stahlberg, Soderstrom, Rastam, & Gillberg, 2004).…”

Section: Introductionmentioning

confidence: 99%

Autistic and schizotypal traits and global functioning in bipolar I disorder

Abu‐Akel

Clark

Perry

et al. 2017

Journal of Affective Disorders

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Objective: To determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar I disorder (BD-I), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD-I. Method: Autistic and positive schizotypal traits were self-assessed in 797 individuals with BD-I recruited by the Bipolar Disorder Research Network. Differences in global functioning (rated using the Global Assessment Scale) during lifetime worst depressive and manic episodes (GASD and GASM respectively) were calculated in groups with high/low autistic and positive schizotypal traits.Regression analyses assessed the interactive effect of autistic and positive schizotypal traits on global functioning. Results: 47.2% (CI=43.7-50.7%) showed clinically significant levels of autistic traits, and 23.22% (95% CI=20.29-26.14) showed clinically significant levels of positive schizotypal traits. In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning compared to the other groups. Individual differences analyses showed that high levels of co-occurring traits were associated with better global functioning in both mood states. Limitations: Autistic and schizotypal traits were assessed using self-rated questionnaires. Conclusions: Expression of autistic and schizotypal traits in adults with BD-I is prevalent, and may be important to predict illness aetiology, prognosis, and diagnostic practices in this population. Future work should focus on replicating these findings in independent samples, and on the biological and/or psychosocial mechanisms underlying better global functioning in those who have high levels of both autistic and positive schizotypal traits.

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Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study

Cited by 138 publications

References 32 publications

Are obstetrical complications really involved in the etiology and course of schizophrenia and mood disorders?

Are obstetrical complications really involved in the etiology and course of schizophrenia and mood disorders?

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Autistic and schizotypal traits and global functioning in bipolar I disorder

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