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Age transitions in the course of bipolar I disorder

Published online by Cambridge University Press:  01 April 2009

W. Coryell ,
J. Fiedorowicz ,
D. Solomon  and
J. Endicott
W. Coryell*
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
J. Fiedorowicz
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
D. Solomon
Affiliation:
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
J. Endicott
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
*
*Address for correspondence: W. Coryell, M.D., Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA52242, USA. (Email: william-coryell@uiowa.edu)
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Abstract

Background

This analysis aimed to show whether symptoms of either pole change in their persistence as individuals move through two decades, whether such changes differ by age grouping, and whether age of onset plays an independent role in symptom persistence.

Method

Participants in the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) who completed at least 20 years of follow-up and who met study criteria for bipolar I or schizo-affective manic disorder, before intake or during follow-up, were divided by age at intake into youngest (18–29 years, n=56), middle (30–44 years, n=68) and oldest (>44 years, n=24) groups.

Results

The persistence of depressive symptoms increased significantly in the two younger groups. Earlier ages of onset were associated with higher depressive morbidity throughout the 20 years of follow-up but did not predict changes in symptom persistence. The proportions of weeks spent in episodes of either pole correlated across follow-up periods in all age groupings, although correlations were stronger for depressive symptoms and for shorter intervals.

Conclusions

Regardless of age at onset, the passage of decades in bipolar illness seems to bring an increase in the predominance of depressive symptoms in individuals in their third, fourth and fifth decades and an earlier age of onset portends a persistently greater depressive symptom burden. The degree to which either depression or manic/hypomanic symptoms persist has significant stability over lengthy periods and seems to reflect traits that manifest early in an individual's illness.

Keywords

Age of onsetage periodsmajor depressionsymptom persistence
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 8 , August 2009 , pp. 1247 - 1252
Copyright
Copyright © Cambridge University Press 2009

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