A PROSPECTIVE FOLLOW-UP OF PATIENTS WITH BIPOLAR AND PRIMARY UNIPOLARAFFECTIVE-DISORDER

Objective: As part of the National Institute of Mental Health Collabor ative Study of the Psychobiology of Depression, the comparative course of manic depressive (bipolar) and primary unipolar patients was asses sed. Design: Systematic evaluation using structured instruments every 6 months for a period of 5 years with the recording of remissions, new episodes, and subsequent hospitalizations. Patients: The number of su bjects varied somewhat depending on the analyses conducted. For a comp arison of course in bipolar patients and unipolar patients, 148 bipola rs were compared with 172 unipolar patients. Results: Both unipolar an d bipolar patients were more likely to have episodes if they had episo des prior to index admission. Likewise, prior hospitalizations predict ed multiple hospitalizations in follow-up. Chronicity was significantl y more prevalent among unipolar depressives but in both unipolar and b ipolar patients, chronicity diminished over time. Bipolar patients wer e more likely than unipolar patients to have multiple episodes at the 2-year and 5-year follow-ups. In bipolar patients, there was no differ ence in the number of episodes in folloW-Up between males and females but in unipolar patients, females were significantly more likely to ha ve subsequent hospitalizations and episodes than males. Treatment vari ables did not relate to these differences. A family history of mania o r schizoaffective mania predicted multiple episodes in bipolar patient s but not in primary unipolar depressives. A family history of all aff ective illness (mania, schizoaffective mania, bipolar II illness, and depression) did not predict a multiple-episode course-in either bipola r or unipolar illness. In unipolar patients, the independent variables leading to multiple-episode course in follow-up are being female, an early age of onset, and prior episodes. Conclusions: As a result of th is systematic follow-up study, new data add to the distinction between bipolar and primary unipolar patients both as regards number of episo des in follow-up and also as regards risk factors that are associated with the multiple-episode course.