Relapse |
Psychosis, alcohol abuse. |
Tohen2828. Tohen M, Waternaux CM, Tsuang MT, Hunt AT. Four-year follow-up of twenty-four first-episode manic patients. J Affect Disord. 1990;19:79-86.
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Recurrence of mania |
Psychotic features, low prehospitalization occupational status, and non-mixed initial mania. |
Tohen3131. Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, et al. The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry. 2003;160:2099-107.
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Recurrence of depression |
Initial mixed dysphoric states and psychiatric or medical comorbidity. |
Tohen3131. Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, et al. The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry. 2003;160:2099-107.
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Quality of life |
Shorter illness duration, less severity of depressive symptoms at baseline and 6 months, lower number of depressive episodes. |
Tohen3131. Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, et al. The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry. 2003;160:2099-107.
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Early age at onset |
Family history of mood disorders, higher rates of suicide, higher cycling frequency, more episodes of mania and depression, higher measures of lifetime depressive symptoms. |
Hamsher3333. Hamshere ML, Gordon-Smith K, Forty L, Jones L, Caesar S, Fraser C, et al. Age-at-onset in bipolar-I disorder: mixture analysis of 1369 cases identifies three distinct clinical sub-groups. J Affect Disord. 2009;116:23-9.
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More comorbid anxiety and substance use, more recurrences, shorter euthymia, more suicide attempts. |
Perlis3434. Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP, et al. Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2004;55:875-81.
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Childhood abuse and neglect. |
Daruy-Filho3535. Daruy-Filho L, Brietzke E, Lafer B, Grassi-Oliveira R. Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatr Scand. 2011;124:427-34.
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Childhood abuse and neglect |
Suicide behaviors, substance abuse disorder, worse clinical course and response to treatment. |
Daruy-Filho3535. Daruy-Filho L, Brietzke E, Lafer B, Grassi-Oliveira R. Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatr Scand. 2011;124:427-34.
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Poorer cognitive performance. |
Bücker3636. Bücker J, Kapczinski F, Post R, Ceresér KM, Szobot C, Yatham LN, Kapczinski NS, Kauer-Sant'Anna M. Cognitive impairment in school-aged children with early trauma. Compr Psychiatry. 2012;53:758-64.
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Diagnostic shift from non-affective psychosis to bipolar disorder |
Female gender, short duration of untreated psychosis, high premorbid functioning, mood lability, mood elation, hyperactivity, delusions of a religious or grandiose nature. |
Kim3737. Kim JS, Baek JH, Choi JS, Lee D, Kwon JS, Hong KS. Diagnostic stability of first-episode psychosis and predictors of diagnostic shift from non-affective psychosis to bipolar disorder: a retrospective evaluation after recurrence. Psychiatry Res. 2011;188:29-33.
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Diagnostic shift from psychotic depressive disorder to bipolar disorder |
Mood lability, hypomanic symptoms. |
Tohen3838. Tohen M, Khalsa HM, Salvatore P, Vieta E, Ravichandran C, Baldessarini RJ. Two-year outcomes in first-episode psychotic depression the McLean-Harvard First-Episode Project. J Affect Disord. 2012;136:1-8.
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