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. 2009 Jun;6(2):96-101.
doi: 10.4306/pi.2009.6.2.96. Epub 2009 Jun 30.

Polarity of the first episode and time to diagnosis of bipolar I disorder

Boseok Cha  1 , Jeong Hyun Kim, Tae Hyon Ha, Jae Seung Chang, Kyooseob Ha
Affiliations

Polarity of the first episode and time to diagnosis of bipolar I disorder

Boseok Cha et al. Psychiatry Investig. 2009 Jun.

Abstract

Objective: The current study explored the relationship between the polarity of the first episode and the timing of eventual diagnosis of bipolar I disorder, and associated clinical implications.

Methods: Twelve years of clinical data from the medical records of 258 inpatients meeting DSM-III-R or DSM-IV criteria for bipolar I disorder were analyzed. Subjects were divided into two groups according to the polarity of the first episode: those with depressive polarity (FE-D), and those with manic polarity (FE-M). Comparisons were made between the two groups on variables associated with the timing of diagnosis and related outcomes.

Results: In population with bipolar I disorder, a significant longer time lapse from the first major mood episode to the confirmed diagnosis was associated with the FE-D group compared to the FE-M group [5.6 (+/-6.1) vs. 2.5 (+/-5.5) years, p<0.001]. FE-D subjects tended to have prior diagnoses of schizophrenia and major depressive disorder while FE-M subjects tended to have prior diagnoses of bipolar disorder and schizophrenia. A significantly higher rate of suicide attempts was associated with the FE-D group compared to the FE-M group (12.7 vs. 1.7%, p<0.001).

Conclusion: The results of this study indicate that first-episode depressive polarity is likely to be followed by a considerable delay until an eventual confirmed diagnosis of bipolar I disorder. Given that first-episode depressive patients are particularly vulnerable to unfavorable clinical outcomes such as suicide attempts, a more systematic approach is needed to differentiate bipolar disorder among depressed patients in their early stages.

Keywords: Bipolar disorder; Diagnosis; First episode; Polarity; Suicide.

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