The course of bipolar disorder in rural India

Abstract

Aim:To examine the naturalistic course of bipolar disorder in a rural, community-based, partially treated cohort.Methods:All patients diagnosed with bipolar disorder during an epidemiological survey (n=34) in a rural area in India were followed longitudinally using standardized instruments, and the life-chart method used to examine their course.Results:Seven (26%) of the 27 patients evaluated directly had not received any treatment whatsoever. Four patients (15%) had experienced rapid-cycling at some time; patients without rapid-cycling had experienced a mean 0.22 episodes/year. Episodes of mania accounted for 72% of all episodes. None of the variables examined appeared to predict the total number of episodes experienced by individual patients, although rapid-cycling occurred significantly more often if the patients had not received any psychopharmacological treatment.Conclusions:A mania-predominant course was observed in this small cohort, similar to reports from other developing countries.

Bipolar disorder in Asia: Illness course and contributing factors

“…The Asian studies have noted lower prevalence rates of SUD when compared to the Western literature (Chopra et al, 2006;Karthick et al, 2015a;Munoli et al, 2014). Male gender (Ahmadi et al, 2001;Hapangama et al, 2013) and low socio-economic status (Sedain, 2013) were independently associated with increased rates of substance use.…”

“…Few studies have conducted prospective follow-up to ascertain the illness course (Chopra et al, 2006;Khess et al, 1997). On studying the typology of mood recurrences, manic episodes predominated the illness course of bipolar illness observed in the Asian (Avashthi et al, 1996;Chopra et al, 2006;Karthick et al, 2015a;Khanna et al, 1992;Ramdurg and Kumar, 2013;Rangappa et al, n.d.;Yazıcı and Cakır, 2012) and the Middle East regions (Osher et al, 2000). One study found that the patients spent more percent time in the manic phases when the total duration of illness is considered (Karthick et al, 2015a).…”

“…Apart from a younger age of onset in UPM, studies were not able to clearly differentiate UPM and BPM regarding the phenomenology, frequency of recurrences, duration of illness, gender distribution among many other factors (Aghanwa, 2001;Srinivasan et al, 1985). However, when the stricter definition of "only manic recurrences" is relaxed, a majority of Asian studies report that though patients had both manic and depressive recurrences, the former had a greater prevalence over the course of illness (Aghanwa, 2001;Baldessarini et al, 2012b;Bopp et al, 2010;Chopra et al, 2006;Judd et al, 2002;Khanna et al, 1992;Osher et al, 2000;Ramdurg and Kumar, 2013). The relevant studies from Asia are summarized in Table 1.…”

“…Male gender (Ahmadi et al, 2001;Hapangama et al, 2013) and low socio-economic status (Sedain, 2013) were independently associated with increased rates of substance use. Alcohol is the most commonly used substance in patients with BD (Chopra et al, 2006;Hapangama et al, 2013;Munoli et al, 2014;Tamam and Ozpoyraz, 2002;Tsai et al, 1997). Table 3 emphasizes the high negative influence exerted by SUD over the course and outcome of BD.…”

“…Low socio-economic strata and increased transport costs additionally contribute to medication non-adherence due to difficulties in the accessibility and affordability of mental health care (Oflaz et al, 2015). Additionally, various illness-related factors (Chopra et al, 2006;Hapangama et al, 2013;Moon et al, 2012;Oflaz et al, 2015;Yen et al, 2005), and patient-related factors such as ignorance about side effects (Bener et al, 2013) and…”