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

Noëmie Drancourt; Bruno Etain; Mohamed Lajnef; Chantal Henry; Aurélie Raust; Barbara Cochet; Flavie Mathieu; Sébastien Gard; Katia M'Bailara; L. Zanouy; Jean-Pierre Kahn; Renaud Cohen; O. Wajsbrot-Elgrabli; Marion Leboyer; J. Scott; Frank Bellivier

doi:10.1111/j.1600-0447.2012.01917.x

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

Noëmie Drancourt ¹ Bruno Etain ^{1, 2, 3, *} Mohamed Lajnef ² Chantal Henry ^{1, 2, 3} Aurélie Raust ¹ Barbara Cochet ¹ Flavie Mathieu ² Sébastien Gard ^{3, 4} Katia M'Bailara ^{3, 4, 5} L. Zanouy ^{3, 4} Jean-Pierre Kahn ^{3, 6} Renaud Cohen ⁶ O. Wajsbrot-Elgrabli ⁶ Marion Leboyer ^{1, 2, 3} J. Scott ^{3, 7} Frank Bellivier ^{1, 2, 3}

* Auteur correspondant

1 Service de psychiatrie

2 IMRB - Institut Mondor de Recherche Biomédicale

3 Fondation FondaMental

4 Service de psychiatrie adulte

5 Laboratoire de psychologie

6 Service de Psychiatrie et Psychologie Clinique

7 Academic Psychiatry

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.

Keywords : bipolar disorder duration of untreated illness onset course suicide

Type de document :

Article dans une revue

Acta Psychiatrica Scandinavica, Wiley, 2013, 127 (2), pp.136-44. 〈10.1111/j.1600-0447.2012.01917.x〉

Domaine :

Sciences du Vivant [q-bio] / Médecine humaine et pathologie / Psychiatrie et santé mentale

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Soumis le : jeudi 23 août 2012 - 15:05:37
Dernière modification le : jeudi 8 février 2018 - 15:56:34
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Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment.

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

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