Clinical dynamics of affective episodes in bipolar disorder

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.