Download Italian bipolar II vs I patients show a more favorable

Poster n°: P.1.k.016
Italian bipolar II vs I patients show a more favorable
individual functioning, despite an overall similar
severity of illness
Laura Cremaschi 1, Bernardo Dell'Osso 1,2 *, Cristina Dobrea 1, Benedetta Grancini 1, Matteo Vismara 1,
Francesca De Cagna 1, Alfredo Carlo Altamura 1
1 Department
2 Bipolar
*
of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Disorders Clinic, Stanford Medical School, Stanford University, CA, U.S.
[email protected]
INTRODUCTION
Bipolar Disorder (BD) has been conceptualized as a spectrum
of inter-related conditions with recurring mood/energy
fluctuations,
and
differential
epidemiologic,
sociodemographic, and illness characteristics1 . In terms of clinical
severity, the hypothesis that BD II represents a milder form of
illness than BD I has been increasingly questioned over the
last few years2, justifying additional investigation on this
topic. Therefore, the present study aimed to assess sociodemographic and clinical characteristics in patients with BD
II compared with BD I.
The following methodological limitations need to be taken into
consideration: the potential recall bias due to the retrospective
study design, and the cross-sectional analysis of collected data.
50
†
45
*
40
35
Figure 1. Statistically
significant differences in
categorical sociodemographic variables
of BDI vs II patients.
Values expressed in
percentage.
Statistics:*p<0.05;
†p=0.06
*
30
*
25
BDI
20
BDII
15
10
5
0
Unemployed
status
Lifetime
occupational
instability
Coabitation-with
family of origin
Single status
250
METHODS
Figure 2. Statistically
significant differences in
continuous clinical
variables of BDI vs II
patients. Values
expressed in mean±SD.
Statistics:*p<0.05;
**p≤0.001
The sample consisted of 362 bipolar patients (269 BD I, 93 BD
II) attending the psychiatric in- and out-patient services of the
Department of Mental Health, Ospedale Maggiore Policlinico,
Milan. They underwent clinical assessment with the
Structured Clinical Interviews for DSM-IV-TR (SCID I and
II), administered by expert psychiatrists with specific training.
The main socio-demographic and clinical characteristics of
BD I and II patients were collected. Statistical analyses were
then performed using SPSS version 22, in order to compare
demographic and clinical data across the bipolar subgroups.
200
*
**
150
BDI
100
**
50
0
DUI (months)
80
Duration of most
recent episode (days)
GAF (score)
**
**
70
**
60
50
*
40
RESULTS
**
30
BDI
BDII
20
BD II compared to BDI patients had significantly more
favorable socio-demographic features, showing a lower rate of
unemployment and lifetime occupational instability, and being
less likely to live with their family of origin. However, in
relation to clinical characteristics, BD II had significantly
longer duration of untreated illness, more frequent lifetime
anxiety disorders comorbidity, and more current
antidepressant use. Moreover, BD II individuals showed a
longer most recent episode duration as well as more common
depressive first and most recent episode.
In contrast, BD I patients had higher rate of elevated first and
most recent episode, more lifetime hospitalizations, lower GAF
score, and more current antipsychotic use.
BD I and II patients showed statistically similar results,
consistent with the perspective of BD II and BD I having
similar severity, with respect to duration of illness, psychiatric
family history, suicide attempts, subthreshold symptoms,
history of stressful life events, and overall psychiatric/medical
comorbidity. Nonetheless, BDI and BDII patients showed
specific differences in relation to socio-demographic and
clinical characteristics.
BDII
*
10
0
Depressive first
episode
Elevated most recent
episode
Involuntary
commitments
(lifetime)
Psychosis (lifetime)
Any anxiety disorder
comorbidity
Alcohol/Substance
use disorder
comorbidity
Figure 3. Statistically significant differences in categorical clinical varibles of BDI vs
II patients. Values expressed in percentage. Statistics:*p<0.05;*p≤0.001
CONCLUSIONS
BD II patients had more favorable socio-demographic features,
but a mixture of specific unfavorable illness characteristics. This
supports the notion that BD subtypes may be characterized by
distinct profiles, rather than being simply considered two
different expressions, in terms of severity, of the same illness.
REFERENCES
Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the
world mental health survey initiative. Arch Gen Psychiatry. 2011; 68(3): 241–51.
2 Dell’Osso B, Holtzman JN, Goffin KC, et al. American tertiary clinic-referred bipolar II disorder
compared to bipolar I disorder: more severe in multiple ways, but less severe in a few other ways. J
Affect Disord. 2015; 188:257-62.
1
Authors declare they do not have any affiliation or economic interest in any organization that may
imply a conflict of interest with the content of the present study.