Duration of untreated illness in bipolar disorder and its association with clinical features

INTRODUCTION: In regard to bipolar disorder (BD) DUI is defined as the time between the onset of the first mood episode and the beginning of the first mood stabilizing treatment. Mean values between two and eighteen years are reported for DUI in literature. It has been shown that DUI length is associated with some adverse course characteristics. In Turkey no research has been conducted about DUI or factors that may affect DUI length. Determining the factors causing prolongation of DUI and discussing what can be done for early initiation of treatment in the light of these data may contribute positively to the prognosis of BD and to the long term functional levels of patients. OBJECTIVE: Aim of this study is to determine DUI and to investigate association between DUI and clinical features of patients with BD in Ege University Psychiatry Department Mood Disorders Clinic. METHOD: Study was conducted at Ege University Psychiatry Department Mood Disorders Clinic between 1.2.2018-30.4.2018. Each consecutive patient whose diagnosis is bipolar disorder who had an appointment between those dates (178 patients) were invited to study. 156 patients agreed to participate in the study and gave written informed consent. 38 patients that did not meet the inclusion criteria were excluded from the study. 118 cases were included in the study. All possible information sources were evaluated to increase the reliability and quality of the information that collected retrospectively. A life chart was generated for each patient in the first step in the process of taking anamnesis from the patient and his / her relatives. RESULTS: 118 patients were included in the study. 104 patients had bipolar I disorder and 14 patients had bipolar II disorder diagnosis. Mean DUI was 6.3; mean duration of untreated illness after the first manic/hypomanic episode was 3.3 years. DUI length was found associated with some clinical features. Independent effects of the variables found associated with DUI on DUI were examined using step-wise regression analysis. At regression analysis, negative correlation was found between DUI and the frequency of episodes before the initiation of mood stabilizer treatment (p<0,001). Both total number of episodes before initiation of mood stabilizer treatment and total duration of disease were positively correlated with DUI at regression analysis (respectively p<0,001, p<0,001). DUI was found shorter in the patient group which shows manic predominant polarity when compared to the rest of the sample (p=0,002). DISCUSSION and CONCLUSION: Mean DUI was 6.3; mean duration of untreated illness after the first manic/hypomanic episode was 3.3 years. DUI length was found associated with some clinical features. These findings are most important results of our study, which is the first study in Turkey about DUI in bipolar disorder. Another important finding of our study is the positive correlation that found between DUI and total disease duration. This relationship may reflect changing of clinician attitudes and / or patients' treatment seeking behaviors in the last three decades in our country. It may be thought that, in recent years, psychiatrists give decision of initiating mood stabilizer treatment earlier and / or patients begin to seek help in the earlier stages of the disease. With contribution of results found in our study, it may be possible to contribute to shortening of DUI by investigating and presenting other possible factors which may cause prolongation of DUI in larger sample, multi-center further studies. Thus, it would be possible to decrease number of episodes before initiation of mood stabilizer treatment and to contribute positively to long term prognosis and quality of life of patients. KEYWORDS: Bipolar disorder, duration of untreated illness, clinical features, course