Diagnostic delay and differences by sex and clinical subtype in a cohort of outpatients with bipolar disorder

Abstract

Introduction

We describe the clinical and sociodemographic features at baseline of a cohort of bipolar patients included in a prospective study.

Methods

A total of 296 consecutive outpatients with bipolar disorder were recruited. Diagnosis relied on clinical judgment according to DSM-IV-TR criteria and the semistructured MINI Interview. Retrospective data on the course of the disease and crosssectional data on social adaptation (Social Adaptation Adjustment Self-Assessment Scale (SASS) and affective symptoms were collected. Affective symptomatology (euthymia, subsyndromal symptoms and episodes) was studied according to clinical criteria and the Hamilton Depression and Young rating scales. Differences between type I and II bipolar patients and between men and women were analyzed.

Results

The mean age was 48.8 years (95% CI 47.2–50.4); 56.8% were women and 43.2% were men. A total of 65.2% had a diagnosis of type I bipolar disorder and 23.3% of type II; 49.8% of the sample were euthymic, 32.7% had subsyndromal symptoms and 17.5% had had an affective episode. Diagnostic delay was 9.3 years (95% CI 8.2–10.3). In patients with type II bipolar disorder, the mean age (54.4 years; 95% CI 50.9–57.9 vs. 47.7 years; 95% CI 45.8–49.7, p=0.007), age at onset of illness (35.7 years; 95% CI 31.8–39.7 vs. 29.8 years; 95% CI 28–31.6, p=0.008) and age at diagnosis (47.7 years; 95% CI 44–51.3 vs. 37.9; 95% CI 35.9–39.8, p<0.0001) were higher than in patients with type I bipolar disorder. Manic polarity in the initial episode and psychotic episodes were more frequent in men, while depressive episodes and hypothyroidism were more frequent in women.

Conclusions

Our results confirm data published in our environment on sociodemographic and clinical variables but diagnostic delay in our study was longer. Compared with American samples, age at onset and at diagnosis were higher in our sample but comorbidity was much lower.

Resumen

Introducción

Descripción de las características clínicas de una cohorte de pacientes bipolares al inicio de un seguimiento en un estudio prospectivo.

Metodología

Se incluyen 296 pacientes bipolares ambulatorios (criterios DSM-IV-TR y entrevista MINI). Se recogen datos retrospectivos del curso de la enfermedad y transversales de adaptación social (SASS) y de sintomatología afectiva (eutimia, síntomas subsindrómicos y episodios) según criterios clínicos y psicométricos con las escalas de HAM-D y de Young. Se estudian diferencias entre bipolares I y II y por sexos.

Resultados

La edad media es 48,8 años (IC95% 47,2–50,4), 56,8% son mujeres, 65,2%

bipolares I y 23,3% bipolares II. 49,8% estaban eutímicos, 32,7% presentaba síntomas subsindrómicos y 17,5% sufría un episodio afectivo. El retraso diagnóstico es de 9,3 años (IC95% 8,2–10,3). La edad media en los bipolares II (54,4 IC95%50,9–57,9 vs 47,7 IC95% 45,8–49,7, p = 0,007), la de inicio de la enfermedad (35,7 IC95% 31,8–39,7 vs 29,8 IC95% 28–31,6 p = 0,008) y la de diagnóstico (47,7 IC95% 44–51,3 vs 37,9 IC95% 35,9–39,8, p < 0,0001) es más elevada que en los bipolares I. En los hombres es más frecuente iniciar la enfermedad con una fase maníaca y haber presentado episodios psicóticos mientras que las mujeres han tenido mayor número de episodios depresivos previos e hipotiroidismo.

Conclusiones

Nuestros resultados confirman los datos publicados en nuestro medio en cuanto a las características sociodemográficas y clínicas aunque en nuestro caso el retraso diagnóstico es mayor. En comparación con las muestras americanas, la edad de inicio y de diagnóstico es más tardía y la comorbilidad es mucho menor.