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Cited by 249Bipolar Disorder and TreatmentTreatment of Major DepressionSchizophrenia research and treatment

A prospective follow-up of patients with bipolar and primary unipolar affective disorder

Winokur, George·1993·Archives of General Psychiatry
DOI 10.1001/archpsyc.1993.01820180059006
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Abstract

OBJECTIVE: As part of the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression, the comparative course of manic depressive (bipolar) and primary unipolar patients was assessed. 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 subjects varied somewhat depending on the analyses conducted. For a comparison of course in bipolar patients and unipolar patients, 148 bipolars were compared with 172 unipolar patients. RESULTS: Both unipolar and bipolar patients were more likely to have episodes if they had episodes prior to index admission. Likewise, prior hospitalizations predicted multiple hospitalizations in follow-up. Chronicity was significantly more prevalent among unipolar depressives but in both unipolar and bipolar patients, chronicity diminished over time. Bipolar patients were more likely than unipolar patients to have multiple episodes at the 2-year and 5-year follow-ups. In bipolar patients, there was no difference in the number of episodes in follow-up between males and females but in unipolar patients, females were significantly more likely to have subsequent hospitalizations and episodes than males. Treatment variables did not relate to these differences. A family history of mania or schizoaffective mania predicted multiple episodes in bipolar patients but not in primary unipolar depressives. A family history of all affective illness (mania, schizoaffective mania, bipolar II illness, and depression) did not predict a multiple-episode course in either bipolar 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 this systematic follow-up study, new data add to the distinction between bipolar and primary unipolar patients both as regards number of episodes in follow-up and also as regards risk factors that are associated with the multiple-episode course.

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Crossref · 10.1001/archpsyc.1993.01820180059006

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  • Results of studies on sociodemographic factors (age, gender, socioeconomic status, marital status) as risk factors for recurrence have been inconsistent.

    “Many studies showed that sociodemographic factors such as younger age, women, and those who have never been married were at higher risk of recurrence [7, 11–15]; however, results of other studies on these risk factors have been inconsistent.”

    From Predictors of recurrence of major depressive disorder (2020) · cites this paper as [11]

  • Clinical variables such as number of previous episodes, severity of last episode, and family history of MDD are strong predictors of recurrence.

    “However, clinical variables such as number of previous episodes [7, 11, 19–22], severity of last episode [21, 22] and family history of MDD [21– 23] were strong predictors of recurrence.”

    From Predictors of recurrence of major depressive disorder (2020) · cites this paper as [11]

  • In our study, family history of psychiatric illnesses was not associated with recurrence of MDD.

    “Results regarding family history and recurrence also have been inconsistent–a number of previous studies have reported that a family history of psychiatric illnesses was not associated with recurrence of MDD [11, 44, 64, 65], similar to what we have found in our study.”

    From Predictors of recurrence of major depressive disorder (2020) · cites this paper as [11]

  • Some other studies found that age at onset and gender predict recurrence.

    “This is contrary to what some other studies have found [7, 11–15].”

    From Predictors of recurrence of major depressive disorder (2020) · cites this paper as [11]

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Authors
Winokur, G.
Affiliations
National Institute of Mental Health (US)
Corresponding author
Winokur, George
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
1993-06-01
Volume
50
Issue
6
Pages
457
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.1993.01820180059006
OpenAlex
W1993734896
Cited by
249
References
17
Citations by year
2026: 1 · 2025: 16 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 5 · 2015: 1 · 2014: 4 · 2013: 4 · 2012: 8
FWCI
8.95
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01MH051415)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
bipolar disorder, clinical course, chronicity, hospitalization, remission, age of onset, sex differences, risk factors
MeSH terms
Adult, Age Factors, Bipolar Disorder, Chronic Disease, Depressive Disorder, Diagnosis, Differential, Family, Female, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Regression Analysis, Risk Factors, Sex Factors

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