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Am J Psychiatry 1995; 152:385-390
Copyright © 1995 by American Psychiatric Association
Long-term stability of polarity distinctions in the affective disorders
W Coryell, J Endicott, JD Maser, MB Keller, AC Leon and HS Akiskal
Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City 52242.
OBJECTIVE: This analysis aimed to quantify the long-term stability of
distinctions between nonbipolar, bipolar II, and bipolar I affective
disorders and to determine the predictors of shifts in patients' diagnoses
among these categories. METHOD: Probands entered the study as they sought
treatment for manic, major depressive, or schizoaffective disorder
diagnosed according to the Research Diagnostic Criteria. After thorough
baseline evaluations, 605 patients with nonbipolar major depressive
disorder or schizoaffective disorder, depressed type; 96 with bipolar II
disorder; and 231 with bipolar I disorder or schizoaffective disorder,
manic type, began the follow-up study. Direct interviews took place at
6-month intervals for the first 5 years and annually thereafter. RESULTS:
Only 20 (5.2%) of the 381 initially nonbipolar probands who completed 10
years of follow-up developed mania during that time, and only 19 (5.0%)
developed hypomania. A slightly higher proportion of the 67 who began with
bipolar II disorder developed mania during the 10 years. Although 101
(66.4%) of the 152 bipolar I or schizoaffective manic probands developed
subsequent manic episodes, only 11 (7.2%) developed hypomanic episodes and
no mania. Young age at intake and at onset and chronicity of the index
episode predicted shifts from nonbipolar to bipolar II disorder. Psychosis
and a family history of mania predicted shifts from nonbipolar to bipolar I
disorder. CONCLUSIONS: The high stability of baseline distinctions between
nonbipolar, bipolar II, and bipolar I disorders, in combination with
previously described family study data, strongly supports the separation of
these disorders for both clinical and research purposes.
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