Implicaciones clínicas de la edad de inicio del trastorno bipolar I: dos subgrupos con diferente pronóstico

Age‐at‐onset subsets of bipolar I disorders: A critical insight into admixture analyses

“…González Pinto et al (2009) already pointed the fact that even if they found, using admixture analyses, three subgroups of patients regarding AAO, clinical analysis showed that the early and intermediate onset groups had no significant differences for any of the clinical variables studied, which according to them was in favor of the existence of two different AAO groups instead of three. Moreover, Consoli et al (2007) identified a GM of two AAO subgroups using admixture analysis which may be explained in part by the population sample which was different from other studies including patients with Cotard's syndrome with comorbid bipolar disorder but probably also by the very small sample of the study (n = 27), in fact too small to allow fitting any model with more than two subsets.…”

“…In psychiatric applications, used techniques are primarily based on the likelihood ratio test (LRT), which is assumed to be chi-square distributed. This widely used approach (Azorin et al, 2013;Bellivier et al, 2003Bellivier et al, , 2014González Pinto et al, 2009;Hamshere et al, 2009;Manchia et al, 2008) consistently identified three different subsets in terms of the AAO of type I disorders, with slight differences in terms of mean and prevalence of these subsets (Figure 1).…”

Bipolar disorder: Trimodal age‐at‐onset distribution

“…Thirteen studies (62%, n = 13) used DSM-IV criteria alone to determine a bipolar disorder diagnosis. 5,[7][8][9]14,[22][23][24][25][26][27][28][29] Two studies used DSM-IV or ICD-10 criteria, 30,31 one used DSM-IV or Research Diagnostic Criteria (RDC), 32 one used DSM-IV or DSM-III-R criteria, 15 one used both DSM-III-R and RDC, 33 two used RDC only 34,35 and one used case records only. 36 F I G U R E 1 PRISMA flowchart of included studies [Colour figure can be viewed at wileyonlinelibrary.com]…”

“…Heterogeneous definitions of AAO were used across studies including: age at which diagnostic criteria for an affective episode was first met according to medial case notes, interviews or selfreport 5,7,9,[23][24][25][26][27]29,30,[32][33][34][35] ; age at first impairment due to an affective episode according to self-report 8 ; age at first contact with psychiatric services for symptoms of mania 14,22 ; age at first treatment for an affective disorder 28 and age at first psychiatric hospitalisation. 36 Across all studies, AAO was determined retrospectively using information gathered from medical records and/or interviews with participants and their relatives.…”

“…Seven studies recruited patients from a clinic setting only, 9,15,23,27,29,34,35 two from community settings only 8,32 and two from inpatient hospital settings only. 25,36 Three studies recruited from both the clinic and the community, 24,30,31 three from both the clinic and hospital setting 5,28,33 and four studies recruited from the hospital, clinic and the community.…”