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

Abstract

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.

Increased parental history of bipolar disorder in the United States: association with early age of onset

“…There is a higher burden of parental loading for a mood disorder in the United States than in Europe, and this is associated with an early age of onset of bipolar disorder. Not only has an earlier age of onset been repeatedly associated with a more adverse course of illness compared with adult onset illness, but early onset is associated with greater duration of delay to first treatment, and this treatment delay is independently related to a poor prospective outcome in adults average age 41 when they entered our network (1).Drancourt et al (24) have similarly related the duration of delay to first treatment to a more adverse course of bipolar disorder.…”

Screening the risk of bipolar spectrum disorders: Validity evidence of the Mood Disorder Questionnaire in adolescents and young adults

“…9---11 Untreated bipolar disorder normally lasts an average of some 6 years. 12 This delay in identifying the clinical picture is associated with, among other aspects, greater depressive symptomatology and suicide attempts, as well as worse long-term progression. 12 Likewise, early intervention in patients with bipolar disorder is linked to better functional results, 13---15 as well as better response to psychiatric mood stabilising drugs.…”

“…12 This delay in identifying the clinical picture is associated with, among other aspects, greater depressive symptomatology and suicide attempts, as well as worse long-term progression. 12 Likewise, early intervention in patients with bipolar disorder is linked to better functional results, 13---15 as well as better response to psychiatric mood stabilising drugs. 16 These results demonstrate that identification and early intervention for (hypo)manic symptoms and experiences in the general population or in high-risk groups, as well as in health care and clinical settings, would be a relevant task.…”

Detección del riesgo para los trastornos del espectro bipolar: evidencias de validez del Mood Disorder Questionnaire en adolescentes y adultos jóvenes

“…Por otro lado, la duración media del trastorno bipolar sin tratar se sitúa en los 6 años 12 . Esta demora en la identificación del cuadro clínico se asocia, entre otros aspectos, con una mayor sintomatología depresiva e intentos de suicido, así como una peor evolución a largo plazo 12 . Del mismo modo, una intervención temprana en pacientes con trastorno bipolar está asociada con mejores resultados funcionales 13---15 , así como una mejor respuesta a los psicofármacos estabilizadores del estado de ánimo 16 .…”