Four-year follow-up of twenty-four first-episode manic patients

Tohen, Mauricio; Waternaux, Christine; Tsuang, Ming T.; Hunt, Anne T.

doi:10.1016/0165-0327(90)90012-w

Cited by 120 publications

(100 citation statements)

References 10 publications

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“…Clinically, individuals with both AUDs and BD have higher rates of experienced physical or verbal abuse and suicide attempts , poorer treatment compliance (Strakowski et al, 1998), and higher relapse rates (Tohen et al, 1990) compared with BD patients alone. However, the etiology of AUDs in BD has not been previously explored experimentally (Le Strat and Gorwood, 2008).…”

Section: Introductionmentioning

confidence: 99%

Reduced Subjective Response to Acute Ethanol Administration Among Young Men with a Broad Bipolar Phenotype

Yip

Doherty

Wakeley

et al. 2012

Neuropsychopharmacol

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Elevated lifetime prevalence rates of alcohol use disorders (AUDs) are a feature of bipolar disorder (BD). Individuals at-risk for AUDs exhibit blunted subjective responses to alcohol (low levels of response), which may represent a biomarker for AUDs. Thus, individuals atrisk for BD may exhibit low responses to alcohol. Participants were 20 unmedicated adult males who reported high rates of hypomanic experiences (bipolar phenotype participants; BPPs), aged 18 to 21 years, and 20 healthy controls matched on age, gender, IQ, BMI, and weekly alcohol intake. Subjective and pharmacokinetic responses to acute alcohol (0.8 g/kg) vs placebo administration were collected in a randomized, double-blind, cross-over, placebo-controlled, within-subjects design. BPP participants reported significantly lower subjective intoxication effects ('feel high': F ¼ 14.2, p ¼ 0.001; 'feel effects': F ¼ 8.1, p ¼ 0.008) across time, but did not differ in their pharmacokinetic, stimulant, or sedative responses. Paradoxically, however, the BPP participants reported significantly higher expectations of the positive effects of alcohol than controls. Our results suggest that unmedicated young males with previous hypomanic experiences exhibit diminished subjective responses to alcohol. These blunted alcohol responses are not attributable to differences in weekly alcohol intake, pharmacokinetic effects (eg, absorption rates), or familial risk of AUDs. These observations suggest that the dampened intoxication may contribute to the increased rates of alcohol misuse in young people at-risk for BD, and suggest possible shared etiological factors in the development of AUDs and BD.

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Section: Introductionmentioning

confidence: 99%

Reduced Subjective Response to Acute Ethanol Administration Among Young Men with a Broad Bipolar Phenotype

Yip

Doherty

Wakeley

et al. 2012

Neuropsychopharmacol

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“…Recent longitudinal studies of bipolar disorder patients have challenged some traditional views of manic-depressive illnesses as disorders of favorable prognosis, in contrast to schizophrenia and other chronic, nonaffective psychotic disorders (Tohen et al, 1990a;Harrow et al, 1990;Coryell et al, 1990;Gitlin et al, 1995;Goldberg et al, 1995;Keck et al, 1998). Even with access to modern mood-stabilizing and other treatments, most bipolar disorder patients experience high levels of morbidity, accounting for more than 40% of weeks of long-term follow-up, most of which is accounted for by depressive-dysthimic illness (Judd et al, 2002;Post et al, 2003;Baldessarini et al, 2004b;Joffe et al, 2004).…”

Section: Longitudinal Studies In Bipolar Disordermentioning

confidence: 99%

“…Most have involved patients considered to have schizophrenia, usually in mid-course, and very few have compared mood and nonaffective psychotic disorders, or followed patients prospectively from illness-onset (Beiser et ai, 1988;Erickson et ai, 1989;Leff et ai, 1992;Tohen et al, 1990a;Bromet et ai, 1996;Craig et al, 1997). Such studies have yielded inconsistent findings, owing in part to mixing subjects who differ diagnostically, by illness-duration, and in effects of uncontrolled treatments (Zis & Goodwin, 1979;Tohen, 1991).…”

Section: Longitudinal Studies Of Psychotic Disordersmentioning

confidence: 99%

Longitudinal research on bipolar disorders

Salvatore¹,

Tohen²,

Khalsa³

et al. 2007

Epidemiol Psichiatr Soc

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Abstract. Longitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from firsthospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.

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“…27 Tohen et al 28 analyzed outcomes of a first manic episode, including recovery and relapse. The study involved 24 individuals in a naturalistic 4-year follow-up.…”

Section: First Episode Of Mania (Stage Ii)mentioning

confidence: 99%

“…It can last several weeks up to many years before full development of the disorder. 18,27,28 Mood symptoms commonly exhibited by children, adolescents, and young adults in the prodromal period include syndromal and subsyndromal major depressive disorder (MDD), anxiety and episodic subsyndromal manic symptoms, such as sleep disturbances, anger or irritability, increased energy, and rapid mood fluctuations 22 (also termed cyclotaxia). 29,30 Over time, there is a propensity to progression of psychopathology, and symptoms usually become more specific and more similar to those of full BD.…”

Section: Prodromal Period Of First Manic Episode (Stage I)mentioning

confidence: 99%

Early stages of bipolar disorder: characterization and strategies for early intervention

Rios

Noto

Rizzo

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To characterize the early stages of bipolar disorder (BD), defined as the clinical prodrome/ subsyndromal stage and first-episode phase, and strategies for their respective treatment. Methods: A selective literature search of the PubMed, Embase, PsycINFO, and ISI databases from inception until March 2014 was performed. Included in this review were articles that a) characterized prodromal and first-episode stages of BD or b) detailed efficacy and safety/tolerability of interventions in patients considered prodromal for BD or those with only one episode of mania/hypomania. Results: As research has only recently focused on characterization of the early phase of BD, there is little evidence for the effectiveness of any treatment option in the early phase of BD. Case management; individual, group, and family therapy; supportive therapy; and group psychoeducation programs have been proposed. Most evidence-based treatment guidelines for BD do not address treatment specifically in the context of the early stages of illness. Evidence for pharmacotherapy is usually presented in relation to illness polarity (i.e., manic/mixed or depressed) or treatment phase. Conclusions: Although early recognition and treatment are critical to preventing unfavorable outcomes, there is currently little evidence for interventions in these stages of BD.

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Four-year follow-up of twenty-four first-episode manic patients

Cited by 120 publications

References 10 publications

Reduced Subjective Response to Acute Ethanol Administration Among Young Men with a Broad Bipolar Phenotype

Reduced Subjective Response to Acute Ethanol Administration Among Young Men with a Broad Bipolar Phenotype

Longitudinal research on bipolar disorders

Early stages of bipolar disorder: characterization and strategies for early intervention

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