Staging models applied in a sample of patients with bipolar disorder: Results from a retrospective cohort study.
Bipolar disorder
Clinical staging
Disease progression
Retrospective study
Staging models
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
15 02 2023
15 02 2023
Historique:
received:
13
05
2022
revised:
18
11
2022
accepted:
23
11
2022
pubmed:
2
12
2022
medline:
13
1
2023
entrez:
1
12
2022
Statut:
ppublish
Résumé
Bipolar Disorder (BD) is a life-long illness with compelling evidence of progression. Although different staging models have been proposed to evaluate its course, clinical data remain limited. The aim of the present study was to retrospectively assess applicability of available staging approaches and their pattern of progression in a sample of bipolar patients. In a naturalistic sample of 100 BD patients, retrospective assessment of clinical stages was performed at four time points over 10 years, according to four staging models. Staging progression with potential associations between stages and unfavourable illness characteristics were analyzed. A pattern of stage worsening emerged for each model, with a significant increase at every time point. Greater stage increases emerged in patients with lower educational level, age at first elevated episode ≤35 years, duration of illness ≤25 years, and duration of untreated illness ≤5 years. Lower stage values were associated with BD II, no psychiatric hospitalization, depressive onset and predominant polarity, ≤three lifetime episodes, age at first mood stabilizer >40 years, duration of illness ≤25 years, and engaged/employed status. Higher stage values were associated with lower age at first elevated episode and mood stabilizing treatment instead. Naturalistic and retrospective design, recruitment at a 2nd level specialistic clinic. Reported findings support the progressive nature of BD and the application of staging models for early intervention, suggesting a conceptualization of a standardized approach to better characterize patients, predict their clinical course, and deliver tailored treatment options.
Sections du résumé
BACKGROUND
Bipolar Disorder (BD) is a life-long illness with compelling evidence of progression. Although different staging models have been proposed to evaluate its course, clinical data remain limited. The aim of the present study was to retrospectively assess applicability of available staging approaches and their pattern of progression in a sample of bipolar patients.
METHODS
In a naturalistic sample of 100 BD patients, retrospective assessment of clinical stages was performed at four time points over 10 years, according to four staging models. Staging progression with potential associations between stages and unfavourable illness characteristics were analyzed.
RESULTS
A pattern of stage worsening emerged for each model, with a significant increase at every time point. Greater stage increases emerged in patients with lower educational level, age at first elevated episode ≤35 years, duration of illness ≤25 years, and duration of untreated illness ≤5 years. Lower stage values were associated with BD II, no psychiatric hospitalization, depressive onset and predominant polarity, ≤three lifetime episodes, age at first mood stabilizer >40 years, duration of illness ≤25 years, and engaged/employed status. Higher stage values were associated with lower age at first elevated episode and mood stabilizing treatment instead.
LIMITATIONS
Naturalistic and retrospective design, recruitment at a 2nd level specialistic clinic.
CONCLUSIONS
Reported findings support the progressive nature of BD and the application of staging models for early intervention, suggesting a conceptualization of a standardized approach to better characterize patients, predict their clinical course, and deliver tailored treatment options.
Identifiants
pubmed: 36455717
pii: S0165-0327(22)01341-6
doi: 10.1016/j.jad.2022.11.081
pii:
doi:
Substances chimiques
Antipsychotic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
452-460Informations de copyright
Copyright © 2022 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest In the last three years, Prof. Dell'Osso has received lecture honoraria and grants from Angelini, Lundbeck, Janssen, Pfizer, Otzuka, Neuraxpharm, and Livanova. Prof. Ketter has received grants from Agency for Healthcare Research and Quality, personal fees from Acadia Pharmaceuticals, Allergan Pharmaceuticals, Janssen Pharmaceuticals, Myriad Genetic Laboratories, Inc., Navigen, Otsuka Pharmaceuticals, Sunovion Pharmaceuticals, Supernus Pharmaceuticals, Teva Pharmaceuticals, GlaxoSmithKline, grants from Merck & Co., Inc., personal fees from American Psychiatric Publishing, Inc., outside the submitted work. The other authors have no conflicts to declare.