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Duration of untreated illness and bipolar disorder: time for a new definition? Results from a cross-sectional study

2021; Elsevier BV; Volume: 294; Linguagem: Inglês

10.1016/j.jad.2021.07.062

1573-2517

Giovanna Fico, Gerard Anmella, Marta Gómez-Ramiro, Carlota de Miquel, Diego Hidalgo‐Mazzei, Mirko Manchia, Martin Alda, Ana González‐Pinto, André F. Carvalho, Eduard Vieta, Andréa Murru,

Family Caregiving in Mental Illness

We primarily aimed to explore the associations between duration of untreated illness (DUI), treatment response, and functioning in a cohort of patients with bipolar disorder (BD).261 participants with BD were recruited. DUI was defined as months from the first affective episode to the start of a mood-stabilizer. The functioning assessment short test (FAST) scores and treatment response scores for lithium, valproate, or lamotrigine according to the Alda Scale Total Score (TS) were compared between patients with short (<24 months) or long DUI. Differences in FAST scores among good (GR; TS≥7), poor (PR; TS=2-6), or non-responders (NR; TS<2) to each mood-stabilizer were analyzed. Linear regression was computed using the FAST global score as the dependent variable.DUI and FAST scores showed no statistically significant correlation. Patients with a longer DUI showed poorer response to lithium (Z=-3.196; p<0.001), but not to valproate or lamotrigine. Response to lithium (β=-1.814; p<0.001), number of hospitalizations (β=0.237; p<0.001), and illness duration (β=0.160; p=0.028) were associated with FAST total scores. GR to lithium was associated with better global functioning compared to PR or NR [H=27.631; p<0.001].The retrospective design could expose our data to a recall bias. Also, only few patients were on valproate or lamotrigine treatment.Poor functioning in BD could be the result of multiple affective relapses, rather than a direct effect of DUI. A timely diagnosis with subsequent effective prophylactic treatment, such as lithium, may prevent poor functional outcomes in real-world patients with BD.