Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent findings in samples from France and the United States. - Archive ouverte HAL Access content directly
Journal Articles Journal of Clinical Psychiatry Year : 2012

Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent findings in samples from France and the United States.

(1, 2, 3) , (1) , (1, 2, 3) , (1) , (2) , (2) , (4) , (4) , (5) , (5) , (5) , (1, 3) , (3, 6) , (1, 2, 3) , (1, 2, 3)
1
2
3
4
5
6
Katia M'Bailara
  • Function : Author
  • PersonId : 856155

Abstract

BACKGROUND: The clinical presentation, course, and comorbidities of bipolar disorder type I are highly heterogeneous, and this variability remains poorly predictable. Certain onset characteristics (eg, age and polarity at onset) may delineate subgroups differing in clinical expression and outcome. METHOD: We retrospectively investigated the association between both age and polarity at onset and the clinical characteristics of bipolar I disorder (DSM-IV) in 2 independent adult samples: 480 French patients assessed in 1992-2006 (patients had been recruited from 3 university-affiliated psychiatry departments) and 714 US patients assessed in 1991-2003 (data were extracted from the Bipolar Disorder Phenome Database). RESULTS: Polarity at onset correlated with subsequent predominance (P < .001). Most patients experienced a depressive onset (57.9% in France vs 71.0% in the United States; P < .001) associated with a higher density of depressive episodes, suicidal behavior, and alcohol misuse. A manic onset was associated with a higher density of manic episodes. Early onset was frequent in both countries (42% in France vs 68% in the United States; P < .001) and was associated with suicidal behavior and cannabis and cocaine/opiate misuse. Sensitivity for the prediction of clinical characteristics was 1%-35% for age at onset and 26%-47% for polarity at onset. CONCLUSIONS: Onset characteristics are associated with subsequent predominant polarity, suicidal behavior, and substance misuse in bipolar I disorder. These findings may facilitate personalized treatment strategies based on type of onset and may also facilitate early focused strategies for preventing comorbidity. Given the relatively low sensitivity and specificity of these onset characteristics for predicting clinical variables, the relevance of age and polarity at onset as specifiers in nosographical classifications will require further studies. However, polarity at onset may be the more relevant specifier, with further investigation required for age at onset.
Fichier principal
Vignette du fichier
Etain_J10_M06504_Revised_Revised_manuscript_FINAL.pdf (139.41 Ko) Télécharger le fichier
Origin : Files produced by the author(s)
Loading...

Dates and versions

inserm-00700452 , version 1 (01-10-2012)

Identifiers

Cite

Bruno Etain, Mohamed Lajnef, Frank Bellivier, Flavie Mathieu, Aurélie Raust, et al.. Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent findings in samples from France and the United States.. Journal of Clinical Psychiatry, 2012, 73 (4), pp.e561-6. ⟨10.4088/JCP.10m06504⟩. ⟨inserm-00700452⟩

Collections

INSERM IMRB UPEC
632 View
984 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More