Background

We primarily aimed to explore the associations between duration of untreated illness (DUI), treatment response, and functioning in a cohort of patients with bipolar disorder (BD).

Methods

261 participants with BD were recruited. DUI was defined as months from the first affective episode to the start of a mood-stabilizer. The functioning assessment short test (FAST) scores and treatment response scores for lithium, valproate, or lamotrigine according to the Alda Scale Total Score (TS) were compared between patients with short (<24 months) or long DUI. Differences in FAST scores among good (GR; TS≥7), poor (PR; TS=2-6), or non-responders (NR; TS<2) to each mood-stabilizer were analyzed. Linear regression was computed using the FAST global score as the dependent variable.

Results

DUI and FAST scores showed no statistically significant correlation. Patients with a longer DUI showed poorer response to lithium (Z=-3.196; p<0.001), but not to valproate or lamotrigine. Response to lithium (β=-1.814; p<0.001), number of hospitalizations (β=0.237; p<0.001), and illness duration (β=0.160; p=0.028) were associated with FAST total scores. GR to lithium was associated with better global functioning compared to PR or NR [H=27.631; p<0.001].

Limitations

The retrospective design could expose our data to a recall bias. Also, only few patients were on valproate or lamotrigine treatment.

Conclusions

Poor functioning in BD could be the result of multiple affective relapses, rather than a direct effect of DUI. A timely diagnosis with subsequent effective prophylactic treatment, such as lithium, may prevent poor functional outcomes in real-world patients with BD.

中文翻译：

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未经治疗的疾病和双相情感障碍的持续时间：是时候制定新定义了？横断面研究结果

背景

我们的主要目的是在一组双相情感障碍 (BD) 患者中探索未治疗疾病 (DUI) 持续时间、治疗反应和功能之间的关联。

方法

招募了 261 名患有 BD 的参与者。DUI 被定义为从第一次情感发作到情绪稳定剂开始的几个月。根据 Alda 量表总分 (TS)，在短期（<24 个月）或长期 DUI 患者之间比较锂、丙戊酸盐或拉莫三嗪的功能评估短期测试 (FAST) 评分和治疗反应评分。分析了对每种情绪稳定剂的好 (GR；TS≥7)、差 (PR；TS=2-6) 或无反应者 (NR；TS<2) 的 FAST 分数差异。使用 FAST 全局评分作为因变量计算线性回归。

结果

DUI 和 FAST 分数没有显示出统计学上的显着相关性。DUI 时间较长的患者对锂的反应较差（Z=-3.196；p<0.001），但对丙戊酸盐或拉莫三嗪没有反应。对锂的反应（β=-1.814；p<0.001）、住院次数（β=0.237；p<0.001）和病程（β=0.160；p=0.028）与 FAST 总分相关。与 PR 或 NR 相比，GR 转锂与更好的整体功能相关 [H=27.631；p<0.001]。

限制

回顾性设计可能会使我们的数据暴露于召回偏差中。此外，只有少数患者接受丙戊酸盐或拉莫三嗪治疗。

结论

BD 功能不良可能是多次情感复发的结果，而不是 DUI 的直接影响。及时诊断并进行后续有效的预防性治疗，例如锂盐，可能会防止现实世界中的 BD 患者出现不良的功能结果。