{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:08:54Z","timestamp":1785557334831,"version":"3.56.0"},"reference-count":36,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T00:00:00Z","timestamp":1584921600000},"content-version":"unspecified","delay-in-days":1026,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T00:00:00Z","timestamp":1496275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["europsy-journal.com","clinicalkey.jp","clinicalkey.com","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","em-consulte.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Eur. psychiatr."],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0924933800068942_abst0005\" sec-type=\"other\"><jats:title>Objectives:<\/jats:title><jats:p>Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800068942_abst0010\" sec-type=\"methods\"><jats:title>Methods:<\/jats:title><jats:p>We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D\/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800068942_abst0015\" sec-type=\"results\"><jats:title>Results:<\/jats:title><jats:p>Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; <jats:italic>P<\/jats:italic> = 0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D\/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; <jats:italic>P<\/jats:italic> &lt; 0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated\/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D\/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.<\/jats:p><\/jats:sec><jats:sec id=\"S0924933800068942_abst0020\" sec-type=\"conclusions\"><jats:title>Conclusions:<\/jats:title><jats:p>Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D\/M morbidity ratio, than BD-I. More time depressed was predicted by agitated\/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.eurpsy.2017.02.480","type":"journal-article","created":{"date-parts":[[2017,2,22]],"date-time":"2017-02-22T02:30:21Z","timestamp":1487730621000},"page":"35-43","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":16,"title":["Early clinical predictors and correlates of long-term morbidity in bipolar disorder"],"prefix":"10.1017","volume":"43","author":[{"given":"G.","family":"Serra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Koukopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"De Chiara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.E.","family":"Koukopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Sani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Tondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Girardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Reginaldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.J.","family":"Baldessarini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,3,23]]},"reference":[{"key":"S0924933800068942_bib0230","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2006.10.070"},{"key":"S0924933800068942_bib0350","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.161.12.2222"},{"key":"S0924933800068942_bib0360","doi-asserted-by":"publisher","DOI":"10.1080\/13811118.2016.1227004"},{"key":"S0924933800068942_bib0355","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2013.13020185"},{"key":"S0924933800068942_bib0325","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(02)00359-2"},{"key":"S0924933800068942_bib0330","volume-title":"Manic-depressive illness: bipolar disorders and recurrent depression","author":"Goodwin","year":"2007"},{"key":"S0924933800068942_bib0310","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.03.054"},{"key":"S0924933800068942_bib0300","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.133.5.429"},{"key":"S0924933800068942_bib0290","first-page":"68","article-title":"Criteria for the \u201csoft\u201d bipolar spectrum: treatment implications","volume":"23","author":"Akiskal","year":"1987","journal-title":"Psychopharmacol Bull"},{"key":"S0924933800068942_bib0285","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2015.10.058"},{"key":"S0924933800068942_bib0280","doi-asserted-by":"publisher","DOI":"10.1080\/hrp.11.5.245.256"},{"key":"S0924933800068942_bib0305","doi-asserted-by":"publisher","DOI":"10.1002\/da.1078"},{"key":"S0924933800068942_bib0335","doi-asserted-by":"publisher","DOI":"10.1002\/da.20053"},{"key":"S0924933800068942_bib0240","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291710002199"},{"key":"S0924933800068942_bib0185","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2015.02.011"},{"key":"S0924933800068942_bib0205","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-014-0495-7"},{"key":"S0924933800068942_bib0245","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2004.07.004"},{"key":"S0924933800068942_bib0190","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v65n0612"},{"key":"S0924933800068942_bib0235","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2009.00686.x"},{"key":"S0924933800068942_bib0250","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2004.01.022"},{"key":"S0924933800068942_bib0220","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2013.05.059"},{"key":"S0924933800068942_bib0255","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.07.025"},{"key":"S0924933800068942_bib0345","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.59.10.905"},{"key":"S0924933800068942_bib0275","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-5618.2003.00030.x"},{"key":"S0924933800068942_bib0195","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2009.08.002"},{"key":"S0924933800068942_bib0200","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2006.00969.x"},{"key":"S0924933800068942_bib0210","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2011.01818.x"},{"key":"S0924933800068942_bib0215","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12204"},{"key":"S0924933800068942_bib0265","doi-asserted-by":"publisher","DOI":"10.1177\/070674370304800704"},{"key":"S0924933800068942_bib0270","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2007.00385.x"},{"key":"S0924933800068942_bib0320","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2009.01523.x"},{"key":"S0924933800068942_bib0295","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.23.1.56"},{"key":"S0924933800068942_bib0315","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.10.050"},{"key":"S0924933800068942_bib0225","doi-asserted-by":"publisher","DOI":"10.3109\/10673229509017185"},{"key":"S0924933800068942_bib0340","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.08.019"},{"key":"S0924933800068942_bib0260","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0447.2003.02057.x"}],"container-title":["European Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0924933817327517?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0924933817327517?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0924933800068942","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T08:27:32Z","timestamp":1584952052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0924933800068942\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6]]},"references-count":36,"alternative-id":["S0924933800068942"],"URL":"https:\/\/doi.org\/10.1016\/j.eurpsy.2017.02.480","relation":{},"ISSN":["0924-9338","1778-3585"],"issn-type":[{"value":"0924-9338","type":"print"},{"value":"1778-3585","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Early clinical predictors and correlates of long-term morbidity in bipolar disorder","name":"articletitle","label":"Article Title"},{"value":"European Psychiatry","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.eurpsy.2017.02.480","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2017 Elsevier Masson SAS. All rights reserved.","name":"copyright","label":"Copyright"}]}}