Clinical and evolutionary characteristics of bipolar disorder according to the polarity of the first episode

##plugins.themes.academic_pro.article.main##

Bram Nessrine
Elloumi Hend
Zalila Haifa
Cheour Majda
Boussetta Afif

Abstract

Background: The polarity of the inaugural episode seems to determine the clinical and evolutionary profile of bipolar disorder.
Aim: To study the clinical and evolutionary characteristics bipolar disorder according to the polarity of the first episode.
Methods: We undertook a retrospective, descriptive and comparative study including all the patients reached of bipolar disorder I and II (DSM IV TR) who were hospitalized between January 1 2000 and December 31 2006. The minimal duration of follow-up was 4 years. Patients were divided into two groups according to the polarity of the first episode: maniac or hypomaniaque and depressive. The characteristics sociodemographic, clinical, evolutionary and therapeutic were raised and compared between the two groups.
Results: The sample was composed of 38 patients (23 men and 15 women). The first episode was of polarity maniac in 57.89% of cases. This mode of beginning was related to a later polarity preferentially maniac, more often punctuated of characteristics psychotics with a sur representation of the addictives conduits and bipolar disorder of type I an episode index of depressive polarity was associated to more chronic evolution, marked by a stronger recurrence of episodes particularly depressive episodes, with a raised suicidal risk and a high representation of the bipolar disorder II.
Conclusion: The clinical and evolutionary profile of the bipolar disorder seems strongly related to the polarity of the first episode. The strategies of prevention must take account of the inaugural polarity.

Keywords:

Bipolar disorders, mania, depression, first episode, manic polarity, depressive polarity

##plugins.themes.academic_pro.article.details##

References

  1. Kaladjian A, Fakra E, Adida M et al. Polarité maniaque du premier épisode d'un trouble bipolaire: aspects cliniques et pronostiques. L'Encéphale 2010;36:13-17.
  2. Forty L, Jones L, Smith DJ et al. Polarity at illness onset in bipolar I disorder and clinical course of illness. Bipolar Disorder 2009;11:82-88.
  3. Berk M, Hallem K, Lucas N et al. Early intervention in bipolar disorders: opportunities and pitfalls. Med J Aust 2007;187:11-4.
  4. American psychiatric association_DSM-IV-TR. Manuel diagnostique et statistique des troubles mentaux, 4ème edition,Texte Révisé (Washington DC, 2000). Traduction française par J.D. Guelfi et al, Masson, Paris, 2003,1120 pages.
  5. Cha B, Kim JH, Ha TH et al. Polarity of the first episode and time to diagnosis of bipolar disorder. Psychiatry Invest 2009;6:96-101.
  6. Daban C, Colom F, Sanchez-Moreno J et al. Clinical correlates of first episode polarity in bipolar disorder. Compr Psychiatry 2006;47:433-37.
  7. Azorin JM, Kaladjian A, Adida A et al. Correlates of first episode polarity in a French cohort of 1089 bipolar I disorder patients: role of temperaments and triggering events. J Affect Disord 2011;129:39-46.
  8. Besnier N, Fakra E, Kaladjian A, et al. Premier épisode dépressif d'un trouble bipolaire : aspects cliniques et pronostiques. L'Encéphale 2010;36:18-22.
  9. Perugi G, Micheli C, Akiskal HS et al. Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients. Compr Psychiatry2000;41:13-8.
  10. Chaudhury SR, Grunebaum MF, Galfavlvy HC et al. Does first episode polarity predict risk for suicide attempt in bipolar disorder? J Affect Disord 2007;104:245-50.
  11. Rosa AR, Andreazza AC, Kunz M et al. Predominant polarity in bipolar disorder: diagnostic implications. J Affect Disord 2008;107:45-51.
  12. Kennedy N, Boydell J, Kalidindi S et al. Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. Am J Psychiatry 2005;162: 257-62.
  13. Kassem L, Lopez V, Hedeker D et al. Familiality of polarity at illness onset in bipolar affective disorder. Am J Psychiatry 2006;163:1754-9.
  14. Douki S, Taktak MJ, Ben Zineb et al. Cultural aspects of bipolar disorder. Symposium régional de la WPA, Beyrouth, Avril 1998.
  15. Chemingui H. Les manies délirantes. Thèse de doctorat en médecine. Faculté de médecine de Tunis 2000.
  16. Dammak MA. Trouble bipolaire chez la femme (à propos de 100 cas). Thèse de doctorat en médecine. Faculté de médecine de Tunis 2005.
  17. Colom F, Vieta E, Daban C et al. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord 2006; 93:13-7.
  18. Perlis R H, Delbello MP, Miyahara S et al. Revisiting depressive-prone bipolar disorder: polarity of initial mood episode and disease course among bipolar I systematic treatment enhancement program for bipolar disorder participants. Biol Psychiatry 2005; 58: 549-53.
  19. Nehdi HZ. L'évolution du trouble bipolaire : une étude comparative entre deux populations de patients hospitalisés en Tunisie et en France. Thèse de doctorat en médecine. Faculté de médecine de Tunis 2001.
  20. Kawa I, Carter JD, Joyce PR et al. Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation. Bipolar Disord 2005;7:119-25.
  21. Kukopulos A, Caliari B, Tundo A et al. Rapid cyclers, temperament, and antidepressants. Compr Psychiatry 1983;24:249-58.
  22. Bauer MS, Calabrese J, Dunner DL, et al. Multisite data reanalysis of the validity of rapid cycling as a course modifier for bipolar disorder in DSM-IV. Am J Psychiatry 1994;151:506-15.
  23. Kukopulos A, Reginaldi D, Laddomada P, et al. Course of the manic-depressive cycle and changes caused by treatment. Pharmakopsychiatr Neuropsychopharmakol 1980;13:156-67.
  24. Altshuler LL, Post RM, Leverich GS et al. Antidepressantinduced mania and cycle acceleration: a controversy revisited. Am J Psychiatry 1995;152:1130-8.
  25. Goodwin FK, Fireman B, Simon GE, et al. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA 2003;290:1467-73.
  26. Ghaemi SN, Boiman EE, Goodwin FK. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry 2000;61:804-8.
  27. Calabrese JR, Vieta E, El-Mallakh R, et al. Mood state at study entry as predictor of the polarity of relapse in bipolar disorder. Biol Psychiatry 2004;56:957-63.
  28. Strakowski SM, Williams JR, Sax KW, et al. Is impaired outcome following a first manic episode due to mood-incongruent psychosis? J Affect Disord 2000;61:87-94.
  29. Goldberg JF, Harrow M. Consistency of remission and outcome in bipolar and unipolar mood disorders: a 10-year prospective follow-up. J Affect Disord 2004;81:123-31.
  30. Martinez-Aran A, Vieta E, Colom F, et al. Cognitive dysfunctions in bipolar disorder: evidence of neuropsychological disturbances. Psychother Psychosom 2000;69:2-18.
  31. Quitkin FM, Rabkin JG, Prien RF. Bipolar disorder: are there manic-prone and depressive-prone forms? J Clin Psychopharmacol 1986;6:167-72.
  32. Judd LL, Akiskal HS, Schetter PJ, et al.The comparative clinical phenotype and long term longitudinal episode course of bipolar I and II: a clinical spectrum or distinct disorders? J Affect Disord 2003;73:19-32.
  33. Vieta E, Gast C, Otero A, et al. Differential features between bipolar I and bipolar II disorder. Compr Psychiatry 1997;38:98-101.