Bipolar Disorder: When DUI Means Duration of Untreated Illness

Longer duration of untreated illness (DUI) has been associated with poor clinical outcomes for many mood disorders, but not specifically bipolar disorder.

The presence of psychotic symptoms in bipolar patients increases the odds that clinicians will misdiagnose them. Consequently, clinicians often prescribe first-generation antipsychotics that reduce duration of untreated psychosis/untreated episode with psychotic symptoms (DUP), but not DUI.

In a recent naturalistic study, researchers suggested that early diagnosis and treatment with either a mood stabilizer or an atypical antipsychotic with mood-stabilizing effects could improve long-term outcomes in bipolar patients.

They enrolled 240 patients from 3 community mental health centers and conducted retrospective chart review, supplementing information from the clinical records with interviews with patients and their relatives, if necessary. For outcomes, the investigators looked for psychiatric and substance abuse comorbidity, occupational status, Global Assessment of Functioning (GAF), hospitalizations, suicide attempts, and depressive/manic recurrences.

Most patients (61.5%) were initially diagnosed with a condition different from bipolar disorder. In fact, the most frequent initial diagnosis was delusional disorder.

Patients with a DUI beyond the mean of 8 years had a greater number of hospitalizations, manic episodes, and depressive episodes than those diagnosed earlier. Longer DUI was also predictive of low GAF scores.

In contrast, patients with longer DUP had outcomes similar to those with shorter DUP.

Because these findings were the product of a naturalistic design, the authors noted that more controlled studies on this topic are needed. Their results do replicate clinical conditions, however, and suggest that early treatment with appropriate drugs can improve the lifelong course of illness for bipolar patients with psychotic symptoms.

This study was published ahead of print in the Journal of Affective Disorders.