Clinical dynamics of affective episodes in bipolar disorder

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BACKGROUND: Diagnosing bipolar disorder (BD) is a major clinical challenge during the disease course. Diagnostic uncertainty is probable in the early disease stages, particularly those associated with heterogeneity of clinical manifestations and concomitant psychiatric and somatic disorders. Delayed diagnosis of BD leads to the chronicity of the disease process, disability, and premature mortality from suicide and concomitant somatic pathology. The study of clinical dynamics and diagnosis of affective episodes in patients with bipolar affective disorder may contribute to the timely and adequate treatment and prevention of complications.

AIM: This study aimed to assess features of clinical dynamics and diagnosis of affective episodes in BD.

MATERIALS AND METHODS: Eighty-two patients diagnosed with bipolar affective disorder (F31) who were hospitalized in a psychiatric hospital (mean age 48.3±13.5 years) were examined. The study used clinical and psychopathological and statistical methods.

RESULTS: In 51.2% (n=42) of the patients, the diagnosis of BD was made at the first hospital admission and did not change at subsequent admissions. Depressive and manic episodes without psychotic symptoms predominated in this group. In 36.6% (n=30) of the patients, the diagnosis of BD was preceded by neurotic, stress-related, and somatoform disorders (F41.1–2) and recurrent depressive disorder (F33.2,9) for 2 or more hospitalizations. Moreover, in 12.2% (n=10) of patients on repeated hospitalizations, the diagnosis of BD was changed to others, that is, schizoaffective disorder (F25.1–2) and paranoid schizophrenia (F20.01). On average, 6.4±1.4 years elapsed from the first hospitalization to the development of disability (mean age of disability, 39.5±9.8 years).

CONCLUSIONS: BD is characterized by significant polymorphism of clinical manifestations during the disease course, which significantly complicates timely diagnosis. During the first hospitalization, symptoms were significantly severe, which may indicate a lack of adequate treatment at the pre-hospital stage. The presence of psychotic symptoms during affective episodes limited BD identification and led to difficulties in differential diagnosis with schizophrenia–spectrum disorders. Further study of the clinical dynamics of BD should include a thorough clinical analysis of affective episodes, clinical and dynamic follow-up, and the development of additional diagnostic criteria.

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About the authors

Natalya N. Osipova

Evdokimov Moscow State Medical and Dental University

Author for correspondence.
ORCID iD: 0000-0002-8034-4457

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, Moscow

Nikolay I. Beglyankin

Evdokimov Moscow State Medical and Dental University

ORCID iD: 0000-0002-4638-7461

MD, Cand. Sci. (Med.), professor

Russian Federation, Moscow

Dmitry A. Roganov

Filimonki Social Service House

ORCID iD: 0000-0002-6500-0779

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Vladimir A. Klyachin

Smolensk Regional Clinical Psychiatric Hospital

ORCID iD: 0000-0001-5649-7720
Russian Federation, Smolensk

Leonid M. Bardenshteyn

Evdokimov Moscow State Medical and Dental University

ORCID iD: 0000-0002-1171-5517

MD, Dr. Sci. (Med.), professor

Russian Federation, Moscow


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Supplementary files

Supplementary Files
1. Fig. 1. Age of disability in the female and male samples.

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2. Fig. 2. Affective episodes in patients with bipolar disorder (n = 42).

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3. Fig. 3. Distribution of nosological forms before the diagnosis of bipolar affective disorder: F41.1–2, neurotic, stress-related, and somatoform disorders; F33.2,9, mood disorders (affective disorders); F32.1–2, 8, 9, mild-to-moderate depressive episodes, unspecified depressive episode; F34.0, cyclothymia; F23.0, acute polymorphic psychotic disorder without schizophrenia symptoms; F60.1, disorders of adult personality and behavior.

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