Abstract
BackgroundBipolar disorder presents with diverse clinical manifestations. Numerous investigators have sought to identify variables that may predict a more severe illness course.MethodsWith the objective of studying the clinical characteristics of bipolar patients between South and North America, a comparison was performed between a sample from Argentina (n = 449) and a sample from the United States (n = 503) with respect to demographics and clinical characteristics, including presence of comorbidities.ResultsThe Argentinian sample had more unfavorable demographics and higher rates of prior psychiatric hospitalization and prior suicide attempt but a better social outcome. However, the sample from the United States had a higher rate of prior year rapid cycling, as well as younger bipolar disorder onset age (mean ± SD, 17.9 ± 8.4 vs. 27.1 ± 11.4 years) and more severe clinical morbidity, though there was no significant difference in terms of the total duration of the illness. Argentinian compared to American patients were taking more mood stabilizers and benzodiazepines/hypnotics, but fewer antipsychotics and other psychotropic medications, when considering patients in aggregate as well as when stratifying by illness subtype (bipolar I versus bipolar II) and by illness onset age (≤21 vs. >21 years). However, there was no significant difference in rate of antidepressant prescription between the two samples considered in aggregate.ConclusionsAlthough possessing similar illness durations, these samples presented significant clinical differences and distinctive prescription patterns. Thus, though the Argentinian compared to North American patients had more unfavorable demographics, they presented a better social outcome and, in several substantive ways, more favorable illness characteristics. In both samples, early onset (age ≤ 21 years) was a marker for poor prognosis throughout the illness course, although this phenomenon appeared more robust in North America.
Highlights
Bipolar disorder presents with diverse clinical manifestations
We studied Argentinian (n = 449) and North American (n = 503) bipolar I and II patients that visited a variety of psychiatric hospitals throughout Argentina or who were referred to the Stanford Bipolar Disorders Clinic in suburban Northern California
Total social outcome was found to be better in the Argentinian sample as compared to the North American sample (9.3 ± 3.2 vs. 8.2 ± 5.9, p = 0.0001)
Summary
Bipolar disorder presents with diverse clinical manifestations. Numerous investigators have sought to identify variables that may predict a more severe illness course. Bipolar disorder is a severe and enduring condition that affects a significant portion of the population globally (Weissman et al 1996). Though specific annual rates of occurrence can vary by geographic region of the world (Soutullo et al 2005), a large, international study of ten countries revealed consistent lifetime rates of bipolar disorder (Weissman et al 1996). Such studies of the Americas, Europe, and Asia have revealed a 2.4% lifetime prevalence of bipolar spectrum disorders (Merikangas et al 2011). Given the similarities in the lifetime incidence across geographic regions of the world, culture specific risk factors - both social and genetic - may impact the observed cross-regional differences in the comorbidities and clinical expression of bipolar disorder.
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