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

Autor: N, Drancourt, B, Etain, M, Lajnef, C, Henry, A, Raust, B, Cochet, F, Mathieu, S, Gard, K, Mbailara, L, Zanouy, J P, Kahn, R F, Cohen, O, Wajsbrot-Elgrabli, M, Leboyer, J, Scott, F, Bellivier
Přispěvatelé: Service de psychiatrie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Hôpital Albert Chenevier, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Fondation FondaMental [Créteil], Service de psychiatrie adulte, Université Bordeaux Segalen - Bordeaux 2-Hôpital Charles Perrens, Laboratoire de psychologie, Université Bordeaux Segalen - Bordeaux 2, Service de Psychiatrie et Psychologie Clinique, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Hôpital Jeanne-d'Arc, Academic Psychiatry, Newcastle University [Newcastle], Research funding relating to this study was obtained from INSERM, Paris, France, Assistance Publique-Hôpitaux de Paris, Paris, France, RTRS Santé Mentale (Fondation FondaMental), Créteil, France, Agence Nationale pour la Recherche(ANR), Paris, France, Fondation pour la Recherche sur le Cerveau (FRC), Paris, France, and National Alliance for Research on Schizophrenia and Depression (NARSAD), Great Neck, New York., Etain, Bruno, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Bordeaux Segalen - Bordeaux 2-Centre hospitalier Charles Perrens [Bordeaux], Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL)
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: Acta Psychiatrica Scandinavica
Acta Psychiatrica Scandinavica, Wiley, 2013, 127 (2), pp.136-44. ⟨10.1111/j.1600-0447.2012.01917.x⟩
Acta Psychiatrica Scandinavica, 2013, 127 (2), pp.136-44. ⟨10.1111/j.1600-0447.2012.01917.x⟩
Acta Psychiatrica Scandinavica, Wiley, 2013, 127 (2), pp.136-144. ⟨10.1111/j.1600-0447.2012.01917.x⟩
ISSN: 0001-690X
1600-0447
Popis: International audience; 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.
Databáze: OpenAIRE
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