More pernicious course of bipolar disorder in the United States than in many European countries: Implications for policy and treatment

R. M. Post, L. Altshuler, R. Kupka, S. McElroy, Mark A Frye, M. Rowe, G. S. Leverich, H. Grunze, T. Suppes, P. E. Keck, W. A. Nolen

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries. Methods We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics. Results Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment. Limitations Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation. Conclusions The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.

Original languageEnglish (US)
Pages (from-to)27-33
Number of pages7
JournalJournal of Affective Disorders
Volume160
DOIs
StatePublished - 2014

Fingerprint

Bipolar Disorder
Comorbidity
Selection Bias
Sex Offenses
Therapeutics
Anxiety Disorders
Informed Consent
Mood Disorders
Netherlands
Substance-Related Disorders
Germany
Psychiatry
Outpatients
Parents
Morbidity

Keywords

  • Early onset
  • Epigenetics
  • Genetics
  • Rapid cycling
  • Stress
  • Substance abuse disorders

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology
  • Medicine(all)

Cite this

More pernicious course of bipolar disorder in the United States than in many European countries : Implications for policy and treatment. / Post, R. M.; Altshuler, L.; Kupka, R.; McElroy, S.; Frye, Mark A; Rowe, M.; Leverich, G. S.; Grunze, H.; Suppes, T.; Keck, P. E.; Nolen, W. A.

In: Journal of Affective Disorders, Vol. 160, 2014, p. 27-33.

Research output: Contribution to journalArticle

Post, RM, Altshuler, L, Kupka, R, McElroy, S, Frye, MA, Rowe, M, Leverich, GS, Grunze, H, Suppes, T, Keck, PE & Nolen, WA 2014, 'More pernicious course of bipolar disorder in the United States than in many European countries: Implications for policy and treatment', Journal of Affective Disorders, vol. 160, pp. 27-33. https://doi.org/10.1016/j.jad.2014.02.006
Post, R. M. ; Altshuler, L. ; Kupka, R. ; McElroy, S. ; Frye, Mark A ; Rowe, M. ; Leverich, G. S. ; Grunze, H. ; Suppes, T. ; Keck, P. E. ; Nolen, W. A. / More pernicious course of bipolar disorder in the United States than in many European countries : Implications for policy and treatment. In: Journal of Affective Disorders. 2014 ; Vol. 160. pp. 27-33.
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AU - Post, R. M.

AU - Altshuler, L.

AU - Kupka, R.

AU - McElroy, S.

AU - Frye, Mark A

AU - Rowe, M.

AU - Leverich, G. S.

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AU - Suppes, T.

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AU - Nolen, W. A.

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N2 - Background There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries. Methods We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics. Results Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment. Limitations Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation. Conclusions The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.

AB - Background There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries. Methods We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics. Results Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment. Limitations Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation. Conclusions The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.

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