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11-11-2010 | Mental health | Article

Diagnostic delays, poor treatment adherence linked to frequent BD episodes

Abstract

Free abstract

MedWire News: Delays in diagnosis and poor treatment adherence are associated with a high frequency of mood episodes in patients with bipolar disorder (BD), research shows.

Among patients with BD, "the frequency of affective disorder (episode frequency) can range from once in lifetime to many per year," explain Luis Gutiérrez-Rojas and colleagues from the University of Granada in Spain.

They add that previous studies have shown that an increased frequency of mood episodes predicts poor outcomes in patients with BD.

To investigate factors associated with an increased frequency of mood episodes among such patients, the team studied 108 outpatients (69% women) with BD who were aged an average of 42 years.

Clinical interviews with the patients were used to gather data on variables such as age at onset of BD, age at diagnosis, duration of illness, polarity of first episode, lifetime number of mood episodes, number of hospital admissions, and history of suicide attempts.

The participants' treating physicians and family members were also consulted to confirm these data, and to assess treatment compliance.

Median split criteria were used to divide the patients into two groups based on a high (nine or more) or low (less than nine) frequency of mood episodes. A high frequency of manic episodes was defined as four or more, and a high frequency of depressive episodes as five or more.

The researchers found that the mean delay in diagnosis was 8.84 years, with each year of delayed diagnosis associated with a 1.1-fold increased risk for having a high frequency of mood episodes.

Other factors associated with an increased frequency of mood episodes included poor adherence to medication (odds ratio [OR]=3.6), being age 36-55 years (OR=3.5) and over 55 years (OR=2.7), versus less than 36 years, and current use of antipsychotic medication (OR=2.7).

Factors significantly associated with a high frequency of manic episodes included female gender (OR=2.5), age 36-55 years (OR=7.5) and age over 55 years (OR=10.1), versus less than 36 years, and a manic onset of the illness (OR=3.0).

Factors significantly associated with a high frequency of depressive episodes included a delay in diagnosis (OR=1.1 per year) and poor adherence to medication (OR=4.2).

Gutiérrez-Rojas and team conclude in the Journal of Affective Disorders: "Avoiding delay in diagnosis and enhancing treatment adherence might be important targets for reducing recurrences in BD."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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