{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:27:48Z","timestamp":1793366868999,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,10,24]],"date-time":"2013-10-24T00:00:00Z","timestamp":1382572800000},"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":[[2014,5]]},"abstract":"\n Objective<\/jats:title>\n \n Characteristics of initial illness in bipolar disorder (\n BD<\/jats:styled-content>\n ) may predict later morbidity.\n <\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n \n We reviewed computerized clinical records and life charts of\n DSM<\/jats:styled-content>\n \u2010\n IV<\/jats:styled-content>\n \u2010\n TR BD<\/jats:styled-content>\n \u2010I or\n BD<\/jats:styled-content>\n \u2010\n II<\/jats:styled-content>\n patients at affiliated mood\u2010disorder centers to ascertain relationships of initial major illnesses to later morbidity and other clinical characteristics.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Adult\n BD<\/jats:styled-content>\n patient\u2013subjects (\n N<\/jats:italic>\n \u00a0=\u00a01081; 59.8%\n BD<\/jats:styled-content>\n \u2010I; 58.1% women; 43% ever hospitalized) were followed 15.7\u00a0\u00b1\u00a012.8\u00a0years after onsets ranking: depression (59%)\u00a0>\u00a0mania (13%)\u00a0>\u00a0psychosis (8.0%)\u00a0\u2265\u00a0anxiety (7.6%)\u00a0\u2265\u00a0hypomania (6.7%)\u00a0>\u00a0mixed states (5.5%). Onset types differed in clinical characteristics and strongly predicted later morbidity. By initial episode types, total time\u2010ill ranked: mania\u00a0\u2265\u00a0hypomania\u00a0\u2265\u00a0mixed\u2010states\u00a0\u2265\u00a0psychosis\u00a0>\u00a0depression\u00a0>\u00a0anxiety. Depression was most prevalent long\u2010term, overall; its ratio to mania\u2010like illness (D\/M, by per cent\u2010time\u2010ill) ranked by onset type: anxiety (4.75)\u00a0>\u00a0depression (3.27)\u00a0>\u00a0mixed states (1.39)\u00a0>\u00a0others (all <1.00). The\n MDI<\/jats:styled-content>\n (mania or hypomania\u2013depression\u2013euthymia interval) course\u2010pattern was most common (34.4%) and associated with psychotic or manic onset; the depression before mania (\n DMI<\/jats:styled-content>\n ) pattern (25.0%) most often followed anxiety (38.8%), depression (30.8%), or mixed onsets (13.3%); both were predicted by initial mania depression sequences.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n First\u2010lifetime illnesses and cycles predicted later morbidity patterns among\n BD<\/jats:styled-content>\n patients, indicating value of early morbidity for prognosis and long\u2010term planning.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/acps.12204","type":"journal-article","created":{"date-parts":[[2013,10,24]],"date-time":"2013-10-24T02:40:55Z","timestamp":1382582455000},"page":"383-392","source":"Crossref","is-referenced-by-count":101,"title":["First\u2010episode types in bipolar disorder: predictive associations with later illness"],"prefix":"10.1111","volume":"129","author":[{"given":"R. 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