{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T15:49:09Z","timestamp":1770133749745,"version":"3.49.0"},"reference-count":46,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,7,10]],"date-time":"2013-07-10T00:00:00Z","timestamp":1373414400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>As initial episode type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode types.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We studied 263 first\u2010episode, adult, <jats:styled-content style=\"fixed-case\">DSM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TR<\/jats:styled-content> type I bipolar disorder (<jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I) subjects within the McLean\u2010Harvard\u2010International First\u2010Episode Project. Based on blinded assessments of antecedents from <jats:styled-content style=\"fixed-case\">SCID<\/jats:styled-content> examinations and clinical records, we compared first lifetime <jats:italic>manic<\/jats:italic> vs. <jats:italic>other<\/jats:italic> (mixed, depressive, or non\u2010affective) major psychotic episodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 32 antecedents arising at early, intermediate or later times, starting 12.3\u00a0\u00b1\u00a010.7\u00a0years prior to first lifetime major psychotic episodes. Based on multivariate modeling, antecedents associated significantly and independently with <jats:italic>other<\/jats:italic> (<jats:italic>n<\/jats:italic>\u00a0=\u00a0113) more than <jats:italic>manic<\/jats:italic> (<jats:italic>n\u00a0<\/jats:italic>=\u00a0150) first lifetime major psychotic episodes ranked by odds ratio: more early attentional disturbances, more late depression, more early perplexity, more detoxification, more early unstable mixed affects, more antidepressants, more early dysphoria, more intermediate depression, more early impulsivity, more late anhedonia, longer early\u2010to\u2010intermediate intervals, more intermediate substance abuse, more family history of major depression, and younger at earliest antecedents. Antecedents selectively preceding <jats:italic>manic<\/jats:italic> more than <jats:italic>other<\/jats:italic> first psychotic episodes included more late behavioral problems and more risk of familial <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Clinical antecedents in adult, <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I patients, beginning a decade before first major episodes and progressing through sequential stages were dissimilar in <jats:italic>manic<\/jats:italic> vs. <jats:italic>other<\/jats:italic> first psychotic episodes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acps.12170","type":"journal-article","created":{"date-parts":[[2013,7,10]],"date-time":"2013-07-10T06:14:54Z","timestamp":1373436894000},"page":"275-285","source":"Crossref","is-referenced-by-count":38,"title":["Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients"],"prefix":"10.1111","volume":"129","author":[{"given":"P.","family":"Salvatore","sequence":"first","affiliation":[{"name":"Department of Psychiatry &amp; Neuroscience Program Harvard Medical School Boston MA USA"},{"name":"International Consortium for Psychotic &amp; Bipolar Disorders Research Mailman Research Center McLean Hospital Belmont MA USA"},{"name":"Section of Psychiatry Department of Neuroscience University of Parma Parma Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. 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