metricas
covid
Buscar en
Revista de Psiquiatría y Salud Mental (English Edition)
Toda la web
Inicio Revista de Psiquiatría y Salud Mental (English Edition) Diagnostic delay and differences by sex and clinical subtype in a cohort of outp...
Información de la revista
Vol. 3. Núm. 3.
Páginas 79-89 (enero 2009)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 3. Núm. 3.
Páginas 79-89 (enero 2009)
Acceso a texto completo
Diagnostic delay and differences by sex and clinical subtype in a cohort of outpatients with bipolar disorder
Retraso diagnóstico y diferencias por sexo y subtipo clínico en una cohorte de pacientes ambulatorios con trastorno bipolar
Visitas
1232
Aurelio García Lópeza,
Autor para correspondencia
eleaur@yahoo.com

Corresponding author.
, Elena Ezquiagab, Consuelo de Diosc, José Luis Agudd, Begoña Solere
a Servicio de Psiquiatría, Centro de Salud Mental distrito de San Blas, Madrid, Spain
b Servicio de Psiquiatría, Hospital Universitario de La Princesa, Madrid, Spain
c Servicio de Psiquiatría, Centro de Salud Mental de Fuencarral, La Paz University Hospital, Madrid, Spain
d Hospital Severo Ochoa de Leganés, Madrid, Spain
e E-C-Bio Estudios Científicos, Madrid, Spain
Este artículo ha recibido
Información del artículo
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.

Keywords:
Bipolar disorder
Sample characteristics
Sex differences
Comorbidity
Associated psychopathology
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.

Palabras clave:
Trastorno bipolar
Características de la muestra
Diferencias por sexos
Comorbilidad
Psicopatología asociada
El Texto completo está disponible en PDF
References
[1.]
K.R. Merikangas, H.S. Akiskal, J. Angst, P.E. Greenberg, R.M. Hirschfeld, M. Petukhova, et al.
Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication.
Arch Gen Psychiatry, 64 (2007), pp. 543-552
[2.]
R.S. McIntyre, J.Z. Konarski.
Bipolar disorder: a national health concern.
CNS Spectr, 9 (2004), pp. 6-15
[3.]
C. Murray, A. Lopez.
The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020.
Harvard University Press, (1996),
[4.]
L.L. Judd, H.S. Akiskal, P.J. Schettler, J. Endicott, J. Maser, D.A. Solomon, et al.
The long-term natural history of the weekly symptomatic status of bipolar I disorder.
Arch Gen Psychiatry, 59 (2002), pp. 530-537
[5.]
L.L. Judd, H.S. Akiskal, P.J. Schettler, W. Coryell, J. Endicott, J.D. Maser, et al.
A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder.
Arch Gen Psychiatry, 60 (2003), pp. 261-269
[6.]
R.T. Joffe, G.M. MacQueen, M. Marriott, L. Trevor Young.
A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders.
Bipolar Disord, 6 (2004), pp. 62-66
[7.]
C. De Dios, E. Ezquiaga, A. Garcia, B. Soler, E. Vieta.
Time spent with symptoms in a cohort of bipolar disorder outpatients in Spain: A prospective, 18-month follow-up study.
J Affect Disord, (2009),
[8.]
C. De Dios.
Evaluación de la presencia de síntomas afectivos en una cohorte de pacientes con Trastorno Bipolar: un estudio de seguimiento prospectivo hasta 18 meses, Tesis Doctoral.
Departamento de Psiquiatría, Universidad Autónoma, (2009),
[9.]
L.L. Altshuler, R.M. Post, D.O. Black, P.E. Keck, W.A. Nolen, M.A. Frye, et al.
Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: results of a large, multisite study.
J Clin Psychiatry, 67 (2006), pp. 1551-1560
[10.]
D.V. Sheehan, Y. Lecrubier, K.H. Sheehan, P. Amorim, J. Janavs, E. Weiller, et al.
The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
J Clin Psychiatry, 59 (1998), pp. 22-33
[11.]
E. Vieta Pascual, C. Torrent Font, A. Martinez-Aran, F. Colom Victoriano, M. Reinares Gabnepen, A. Benabarre Hernandez, et al.
A user-friendly scale for the short and long term outcome of bipolar disorder: the CGI-BP-M.
Actas Esp Psiquiatr, 30 (2002), pp. 301-304
[12.]
M.A. Frye, L.N. Yatham, J.R. Calabrese, C.L. Bowden, T.A. Ketter, T. Suppes, et al.
Incidence and time course of subsyndromal symptoms in patients with bipolar I disorder: an evaluation of 2 placebo-controlled maintenance trials.
J Clin Psychiatry, 67 (2006), pp. 1721-1728
[13.]
M. Tohen, C.L. Bowden, J.R. Calabrese, D. Lin, T.D. Forrester, G.S. Sachs, et al.
Influence of sub-syndromal symptoms after remission from manic or mixed episodes.
Br J Psychiatry, 189 (2006), pp. 515-519
[14.]
S. Gopal, D.C. Steffens, M.L. Kramer, M.K. Olsen.
Symptomatic remission in patients with bipolar mania: results from a doubleblind, placebo-controlled trial of risperidone monotherapy.
J Clin Psychiatry, 66 (2005), pp. 1016-1020
[15.]
M. Berk, F. Ng, W.V. Wang, J.R. Calabrese, P.B. Mitchell, G.S. Malhi, et al.
The empirical redefinition of the psychometric criteria for remission in bipolar disorder.
J Affect Disord, 106 (2008), pp. 153-158
[16.]
F. Colom, E. Vieta, C. Daban, I. Pacchiarotti, J. Sanchez-Moreno.
Clinical and therapeutic implications of predominant polarity in bipolar disorder.
J Affect Disord, 93 (2006), pp. 13-17
[17.]
PAHO, Epidat 3.1: Epidemiological analysis from tabulated data. 2006, Washington, DC. 20037: Pan American Health Organization Regional Office of the World Health Organization.
[18.]
M. Bosc, A. Dubini, V. Polin.
Development and validation of a social functioning scale, the Social Adaptation Self-evaluation Scale.
Eur Neuropsychopharmacol, 7 (1997), pp. S57-S70
[19.]
J. Bobes, M.P. Gonzalez, M.T. Bascaran, A. Corominas, A. Adan, J. Sanchez, et al.
Validation of the Spanish version of the social adaptation scale in depressive patients.
Actas Esp Psiquiatr, 27 (1999), pp. 71-80
[20.]
J.N. Kogan, M.W. Otto, M.S. Bauer, E.B. Dennehy, D.J. Miklowitz, H.W. Zhang, et al.
Demographic and diagnostic characteristics of the first 1000 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
Bipolar Disord, 6 (2004), pp. 460-469
[21.]
T. Suppes, G.S. Leverich, P.E. Keck, W.A. Nolen, K.D. Denicoff, L.L. Altshuler, et al.
The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients.
J Affect Disord, 67 (2001), pp. 45-59
[22.]
A.J. Rush, M.L. Crismon, T.M. Kashner, M.G. Toprac, T.J. Carmody, M.H. Trivedi, et al.
Texas Medication Algorithm Project, phase 3 (TMAP-3): rationale and study design.
J Clin Psychiatry, 64 (2003), pp. 357-369
[23.]
E.S. Paykel, R. Abbott, R. Morriss, H. Hayhurst, J. Scott.
Subsyndromal and syndromal symptoms in the longitudinal course of bipolar disorder.
Br J Psychiatry, 189 (2006), pp. 118-123
[24.]
L.V. Kessing.
Diagnostic subtypes of bipolar disorder in older versus younger adults.
Bipolar Disord, 8 (2006), pp. 56-64
[25.]
A. Montoya, J. Perez Sanchez Toledo, I. Gilaberte, A. Gonzalez-Pinto, J.M. Haro, E. Vieta, et al.
Patterns of drug treatment for manic episode in the clinical practice. Outcomes of the Spanish sample in the EMBLEM Study.
Actas Esp Psiquiatr, 35 (2007), pp. 315-322
[26.]
J.M. Montes, J. Saiz, C. De Dios, E. Ezquiaga, A. Garcia, I. Argudo, et al.
Profile of bipolar disorder outpatients: a cross-sectional study in the Madrid Community.
Actas Esp Psiquiatr, 36 (2008), pp. 277-284
[27.]
E. Vieta, J. Angst, C. Reed, J. Bertsch, J.M. Haro.
Predictors of switching from mania to depression in a large observational study across Europe (EMBLEM).
J Affect Disord, 118 (2009), pp. 118-123
[28.]
V. Hendrick, L.L. Altshuler, M.J. Gitlin, S. Delrahim, C. Hammen.
Gender and bipolar illness.
J Clin Psychiatry, 61 (2000), pp. 393-396
[29.]
E. Vieta, J.M. Montes, A. Gonzalez Pinto, S. Majadas, T. Diez, I. Leon.
Estudio EPIDEP: Epidemiología del trastorno bipolar en población española, in póster. 2009.
XIII Congreso Nacional de Psiquiatría,
[30.]
R.J. Baldessarini, L. Tondo, J. Hennen, G. Floris.
Latency and episodes before treatment: response to lithium maintenance in bipolar I and II disorders.
Bipolar Disord, 1 (1999), pp. 91-97
[31.]
J.F. Goldberg, C.L. Ernst.
Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder.
J Clin Psychiatry, 63 (2002), pp. 985-991
[32.]
C. De Dios, E. Ezquiaga, A. Garcia, J.M. Montes, C. Avedillo, B. Soler.
Usefulness of the Spanish version of the mood disorder questionnaire for screening bipolar disorder in routine clinical practice in outpatients with major depression.
Clin Pract Epidemol Ment Health, 4 (2008), pp. 14
[33.]
R.M. Hirschfeld, J.B. Williams, R.L. Spitzer, J.R. Calabrese, L. Flynn, P.E. Keck, et al.
Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire.
Am J Psychiatry, 157 (2000), pp. 1873-1875
[34.]
E. Vieta, F. Colom, B. Corbella, A. Martinez-Aran, M. Reinares, A. Benabarre, et al.
Clinical correlates of psychiatric comorbidity in bipolar I patients.
Bipolar Disord, 3 (2001), pp. 253-258
[35.]
M.P. Garcia-Portilla, P.A. Saiz, A. Benabarre, P. Sierra, J. Perez, A. Rodriguez, et al.
The prevalence of metabolic syndrome in patients with bipolar disorder.
J Affect Disord, 106 (2008), pp. 197-201
[36.]
S.L. McElroy, M.A. Frye, T. Suppes, D. Dhavale, P.E. Keck, G.S. Leverich, et al.
Correlates of overweight and obesity in 644 patients with bipolar disorder.
J Clin Psychiatry, 63 (2002), pp. 207-213
[37.]
C. Arango, J. Bobes, P. Aranda, R. Carmena, M. Garcia-Garcia, J. Rejas.
A comparison of schizophrenia outpatients treated with antipsychotics with and without metabolic syndrome: findings from the CLAMORS study.
Schizophr Res, 104 (2008), pp. 1-12
[38.]
R.M. Post, D.A. Luckenbaugh, G.S. Leverich, L.L. Altshuler, M.A. Frye, T. Suppes, et al.
Incidence of childhood-onset bipolar illness in the USA and Europe.
Br J Psychiatry, 192 (2008), pp. 150-151
[39.]
R.J. Baldessarini, L. Bolzani, N. Cruz, P.B. Jones, M. Lai, B. Lepri, et al.
Onset-age of bipolar disorders at six international sites.
J Affect Disord, (2009),
[40.]
E. Vieta, M. Berk, W. Wang, F. Colom, M. Tohen, R.J. Baldessarini.
Predominant previous polarity as an outcome predictor in a controlled treatment trial for depression in bipolar I disorder patients.
J Affect Disord, 119 (2009), pp. 22-27
Copyright © 2010. SEP y SEPB
Descargar PDF
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos