Dissimilar morbidity following initial mania versus mixed-states in type-I bipolar disorder. Academic Article uri icon

start page

  • 299

end page

  • 302


  • Mixed-states of bipolar disorders (BPD) may predict worse future illness and more depressive than manic morbidity, challenging a tendency to conflate mixed-states and mania.Patients (N=247) were followed-up systematically for 24 months following hospitalization for initial major episodes of DSM-IV type-I BPD and scored for weekly interval morbidity-types.Overall morbidity during follow-up was 1.6-times greater following mixed (n=97) versus manic (n=150) first-episodes of BPD (60.0 vs. 37.8%-of-weeks; p<0.0001). Patients with initial mixed-states had a nearly 12-fold later excess of mixed-states, 6.5-times more major depression, and 69% more dysthymia during follow-up than those presenting in mania. In contrast, manic first-episodes were followed by over 10-times more mania, 6-times more hypomania, and 35% more psychotic illness.Estimates of longitudinal morbidity may be inaccurate, and ongoing treatment may distort them.Based on detailed, prospective assessments among first-episode BPD patients, those presenting in mixed-states were more ill, and much more likely to experience mixed, depressive and dysthymic morbidity during follow-up, versus much more mania, hypomania, and perhaps more psychosis following mania. The findings support two markedly dissimilar subtypes of BPD, and call for more explicit therapeutic studies of mixed-states.Copyright 2010 Elsevier B.V. All rights reserved.

date/time value

  • October 2010

Digital Object Identifier (DOI)

  • 10.1016/j.jad.2010.03.014

PubMed Identifier

  • 20427091


  • 126


  • 1-2


  • Adult
  • Analysis of Variance
  • Bipolar Disorder
  • Chi-Square Distribution
  • Depressive Disorder, Major
  • Disease Progression
  • Dysthymic Disorder
  • Female
  • Hospitalization
  • Humans
  • Male
  • Psychiatric Status Rating Scales
  • Time Factors