Dissimilar morbidity following initial mania versus mixed-states in type-I bipolar disorder

Abstract

Background Mixed-states of bipolar disorders (BPD) may predict worse future illness and more depressive than manic morbidity, challenging a tendency to conflate mixed-states and mania. Methods Patients ( N = 247) were followed-up systematically for 24 months following hospitalization for initial major episodes of DSM-IV type-I BPD and scored for weekly interval morbidity-types. Results Overall morbidity during follow-up was 1.6-times greater following mixed ( n = 97) versus manic ( n = 150) first-episodes of BPD (60.0 vs. 37.8%-of-weeks; p < 0.0001). Patients with initial mixed-states had a nearly 12-fold later excess of mixed-states, 6.5-times more major depression, and 69% more dysthymia during follow-up than those presenting in mania. In contrast, manic first-episodes were followed by over 10-times more mania, 6-times more hypomania, and 35% more psychotic illness. Limitations Estimates of longitudinal morbidity may be inaccurate, and ongoing treatment may distort them. Conclusions Based on detailed, prospective assessments among first-episode BPD patients, those presenting in mixed-states were more ill, and much more likely to experience mixed, depressive and dysthymic morbidity during follow-up, versus much more mania, hypomania, and perhaps more psychosis following mania. The findings support two markedly dissimilar subtypes of BPD, and call for more explicit therapeutic studies of mixed-states.