Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample

Medeiros, Gustavo C.; Senço, Sofia B.; Lafer, Beny; Almeida, Karla Mathias de

doi:10.1590/1516-4446-2015-1680

Cited by 26 publications

(22 citation statements)

References 22 publications

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“…The mean DUB in this study was shorter than figures of 6.7–20 years reported from Western countries345717, but similar to the finding of 3.9 years reported from China18. The different definitions of DUB may partly account for the inconsistency of the results.…”

Section: Discussionsupporting

confidence: 85%

“…Commonly reported demographic and clinical correlates of DUI included BD-II, female gender, early onset, depressive onset, long duration of illness, suicide attempts, family history of BD and co-morbid anxiety disorders3479. Recently the concept of duration of untreated bipolar disorder (DUB) has been recommended to replace DUI47 to ensure a more accurate definition.…”

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confidence: 99%

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Duration of untreated bipolar disorder: a multicenter study

Zhang

Fang

et al. 2017

Sci Rep

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Little is known about the demographic and clinical differences between short and long duration of untreated bipolar disorder (DUB) in Chinese patients. This study examined the demographic and clinical features of short (≤2 years) and long DUB (>2 years) in China. A consecutively recruited sample of 555 patients with bipolar disorder (BD) was examined in 7 psychiatric hospitals and general hospital psychiatric units across China. Patients’ demographic and clinical characteristics were collected using a standardized protocol and data collection procedure. The mean DUB was 3.2 ± 6.0 years; long DUB accounted for 31.0% of the sample. Multivariate analyses revealed that longer duration of illness, diagnosis of BD type II, and earlier misdiagnosis of BD for major depressive disorder or schizophrenia were independently associated with long DUB. The mean DUB in Chinese BD patients was shorter than the reported figures from Western countries. The long-term impact of DUB on the outcome of BD is warranted.

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Section: Discussionsupporting

confidence: 85%

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confidence: 99%

Duration of untreated bipolar disorder: a multicenter study

Zhang

Fang

et al. 2017

Sci Rep

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“…Several antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity disorder (ADHD) medications and mood stabilizers indicated in adults have received regulatory approval for use in children and/or adolescents 5 , and many are used off‐label 6‐10 . However, despite evidence for the efficacy of a number of psychotropic medications in youth, the duration of untreated illness in depressive disorder 11 , bipolar disorder 12,13 , schizophrenia 14 , obsessive‐compulsive disorder 15 , anxiety disorders 16 , and other mental disorders 17 is often long 18,19 , which adversely affects long‐term outcomes 14,20‐24 . Such delay can be related to several factors.…”

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confidence: 99%

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

et al. 2020

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Mental disorders frequently begin in childhood or adolescence. Psychotropic medications have various indications for the treatment of mental disorders in this age group and are used not infrequently off‐label. However, the adverse effects of these medications require special attention during developmentally sensitive periods of life. For this meta‐review, we systematically searched network meta‐analyses and meta‐analyses of randomized controlled trials (RCTs), individual RCTs, and cohort studies reporting on 78 a priori selected adverse events across 19 categories of 80 psychotropic medications – including antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity disorder (ADHD) medications and mood stabilizers – in children and adolescents with mental disorders. We included data from nine network meta‐analyses, 39 meta‐analyses, 90 individual RCTs, and eight cohort studies, including 337,686 children and adolescents. Data on ≥20% of the 78 adverse events were available for six antidepressants (sertraline, escitalopram, paroxetine, fluoxetine, venlafaxine and vilazodone), eight antipsychotics (risperidone, quetiapine, aripiprazole, lurasidone, paliperidone, ziprasidone, olanzapine and asenapine), three anti‐ADHD medications (methylphenidate, atomoxetine and guanfacine), and two mood stabilizers (valproate and lithium). Among these medications with data on ≥20% of the 78 adverse events, a safer profile emerged for escitalopram and fluoxetine among antidepressants, lurasidone for antipsychotics, methylphenidate among anti‐ADHD medications, and lithium among mood stabilizers. The available literature raised most concerns about the safety of venlafaxine, olanzapine, atomoxetine, guanfacine and valproate. Nausea/vomiting and discontinuation due to adverse event were most frequently associated with antidepressants; sedation, extrapyramidal side effects, and weight gain with antipsychotics; anorexia and insomnia with anti‐ADHD medications; sedation and weight gain with mood stabilizers. The results of this comprehensive and updated quantitative systematic meta‐review of top‐tier evidence regarding the safety of antidepressants, antipsychotics, anti‐ADHD medications and mood stabilizers in children and adolescents can inform clinical practice, research and treatment guidelines.

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“…Also, factors such as lack of adherence to treatment, side effects of medications, and stigma, which are relevant to all mental health problems and especially to psychosis, could also contribute to the poorer outcome. 37,41,42 Given that our study included youths with BD who developed first lifetime onset of psychosis during follow-up, we were able, for the first time in the BD literature, to evaluate the risk factors that predate the onset of psychosis. Increased risk of developing psychosis was associated with low SES, living with only one biological parent, BD-I/II subtypes, comorbid anxiety, and family history of suicidality and mania.…”

Section: Schizoaffective Disorder and Schizophreniamentioning

confidence: 99%

Longitudinal course and risk factors associated with psychosis in bipolar youths

et al. 2019

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Objectives To compare the longitudinal clinical course of youths with bipolar disorder (BD) spectrum with lifetime (past, intake, and/or follow‐up) psychosis (BDP+) to youths with BD without lifetime psychosis (BDP−). Also, to identify risk factors associated with increased risk of first onset of psychosis during prospective follow‐up. Method Bipolar disorder youths (BDP+ = 137, BDP− = 233), aged 7‐17 years old, were followed on average every 7 months for 11.7 years and were evaluated using standardized instruments. Data were analyzed using linear and generalized linear models for the full sample, as well as for youths who developed first period of psychosis (n = 55). Results After adjusting for confounders, BDP+ youths with one, and in particular ≥2 lifetime psychotic episodes, had higher rates and more severe mood and anxiety symptoms, higher rates of suicidality, psychiatric hospitalizations, and sexual/physical abuse, and poorer psychosocial functioning than BDP− youths. Even before the first onset of psychosis during follow‐up, BDP+ youths showed more psychopathology and had more family history of psychiatric illness than those who never developed psychosis. First‐onset psychosis was associated with low socioeconomic status (SES), living with one parent, bipolar disorder type one and type two, comorbid anxiety, history of hospitalizations, and family history of mania and suicidality. Conclusion BDP+ is associated with poor prognosis and worse clinical picture, even before the onset of psychosis, indicating the need for prompt identification and treatment of these youths. Studies aimed to treat acute symptoms of psychosis, as well as prevent the onset of psychosis, including risk factors amenable to change, are warranted.

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Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample

Abstract: As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.

Cited by 26 publications

References 22 publications

Duration of untreated bipolar disorder: a multicenter study

Duration of untreated bipolar disorder: a multicenter study

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

Longitudinal course and risk factors associated with psychosis in bipolar youths

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