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Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment.

Abstract : OBJECTIVE: Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples. METHOD: In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined. RESULTS: The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB (P < 0.0001). An extended DUB was associated with more mood episodes (P < 0.0001), more suicidal behaviour (P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania). CONCLUSION: Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines.
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Submitted on : Thursday, August 23, 2012 - 3:05:37 PM
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Noëmie Drancourt, Bruno Etain, Mohamed Lajnef, Chantal Henry, Aurélie Raust, et al.. Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment.. Acta Psychiatrica Scandinavica, Wiley, 2013, 127 (2), pp.136-44. ⟨10.1111/j.1600-0447.2012.01917.x⟩. ⟨inserm-00724982⟩



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