An analysis of data from the naturalistic Health Outcomes and Patient Evaluations in Bipolar Disorder (HOPE-BD) study reinforces the importance of early diagnosis and interventions in patients with bipolar disorder (BD). The study results, published in the Journal of Affective Disorders, emphasized the need to treat depression and other comorbidities including anxiety and substance use disorders.

Jairo Vinicius Pinto, MD, from the department of psychiatry, University of British Columbia, Vancouver, Canada, and colleagues used the HOPE-BD database to prospectively examine the course of BD, describe how demographic and psychosocial factors are associated with symptomatic and functional outcomes, and assess how treatments are administered across Canada. Patients were followed for up to 4 years, with visits occurring at least once every 3 months. Mental health outcomes were measured with validated, widely used scales.

Overall, the study included 354 patients (57.3% BD type I; median age at onset, 25.4±11.4 years). The prevalence of current and lifetime alcohol use disorder was 4.8% and 28.5%, respectively, and current or lifetime misuse of other psychoactive substances was 5.6% and 18.9%, respectively. Of the 222 symptomatic patients at baseline, 75% were depressed, while 22% were manic or hypomanic. The median time to remission from baseline was 10.9 months, and the estimated mean time to recurrence was 14.5 months in euthymic patients.

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Factors predicting longer delays to a correct diagnosis included depression as the first episode (P =.0072), younger age at onset (P =.00001), and older age at the time of the first professional help (P =.00001). Longer time to remission was associated with lifetime alcohol use disorder (hazard ratio [HR], 0.53; P =.0011) and depression severity at baseline (HR, 0.97; P =.0211). A history of anxiety disorder decreased time to recurrence with an HR of 2.47 (P =.0001), while older age at onset of mood symptoms was associated with longer time to recurrence (HR: 0.96; P =.0001)


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The study findings may not apply to all bipolar patients as the study did not include patients from primary care or hospital settings.

The researchers concluded that “our study reinforces the importance and necessity of early diagnosis and interventions, as well as the importance of treating depressive symptoms and comorbidities, such as anxiety and substance use disorders.”

Disclosure: Multiple study authors reported ties to the pharmaceutical industry. Please see the original paper for a full list.

Reference

Pinto JV, Saraf G, Kozicky J, et al. Remission and recurrence in bipolar disorder: the data from health outcomes and patient evaluations in bipolar disorder (HOPE-BD) study. J Affect Disord. 2020;268:150-157.