Long term course of bipolar I disorder in India: Using retrospective life chart method

- Course of bipolar disorder seems to be quite different in tropical countries like India as compared to temperate Western countries.
- Mania predominates the picture and recurrent manias may comprise about half of the clinical sample of bipolar disorder.
- First episode is mania in an overwhelming majority of the cases.
- Time to recurrence after first affective episode is about 21 months, and is shorter among females.

BackgroundThere are grounds to believe that the course of bipolar disorder may be different in tropical countries such as India when compared to temperate nations. There is a dearth of literature about the course of bipolar I disorder from India.MethodsThis study was conducted in a multispecialty teaching hospital in southern India. Patients with a DSM-IV TR diagnosis of bipolar I disorder, confirmed using SCID-I, with a minimum duration of illness of 3 years were assessed. Information was gathered on demographic and clinical variables, and the life course of episodes was charted using the National Institute of Mental Health - Life Chart Methodology Clinician Retrospective Chart (NIMH-LCM-CRC).ResultsA total of 150 patients with bipolar disorder were included. The mean age at onset of illness was 24.8 (±8.2) years. Mania was the first episode in a majority (85%) of the cases, and was the most frequent episode in the course of the illness, followed by depression. Patients spent an average of 11.1% of the illness duration in a mood episode, most commonly a manic episode. The median duration of manic or depressive episode was 2 months. Median time to recurrence after the first episode was 21 months (inter-quartile range of 10-60 months), and was shorter for women than men.LimitationsThe hospital based sample from a particular region limits generalizability. Recall bias may be present in this retrospective information based study. Medical illness, personality disorders, other Axis I psychiatric disorders (apart from substance use disorder) and influence of adherence to treatment on the course of the disorder were not assessed systematically.ConclusionsBipolar I disorder among Indian patients has a course characterized by predominantly manic episodes, which is in line with previous reports from tropical countries and substantially different from that of temperate regions.