Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-25T11:01:33.468Z Has data issue: false hasContentIssue false
  • English
  • Français

Recurrence in affective disorder

II. Effect of age and gender

Published online by Cambridge University Press:  03 January 2018

Lars Vedel Kessing
Lars Vedel Kessing*
Affiliation:
Department of Psychiatry, University of Copenhagen, Rigshospitalet, and Department of Psychiatric Demography, University of Aarhus, Psychiatric Hospital, Risskov, Denmark
*
Lars Vedel Kessing, Department of Psychiatry, Rigshospitalet, Blegdamsvej 9, DK 2100 Copenhagen Ø, Denmark. Fax: 3545-6218
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The risk of recurrence in affective disorder has been found to increase with each new episode. It is unclear whether it is universal without regard to gender, age and type of disorder.

Method

Survival analysis was used to estimate the risk of recurrence in a case-register study including all hospital admissions with primary affective disorder in Denmark from 1971–1993. In this period 20 350 first-admission patients had been discharged with a diagnosis of affective disorder, depressive or manic/cyclic type.

Results

The risk of recurrence increased with the number of previous episodes regardless of the combination of gender, age and type of disorder. Initially in the course of illness, unipolar and bipolar women experienced an equal greater risk of recurrence than men. The risk of recurrence after the first episode was increased for middle-aged and older unipolar women compared with the risk for younger women, while after all other episodes younger age at first episode increased the risk of recurrence.

Conclusions

The course of severe unipolar and bipolar disorder seems to be progressive in nature irrespective of gender, age and type of disorder.

Type
Papers
Information
The British Journal of Psychiatry , Volume 172 , Issue 1 , January 1998 , pp. 29 - 34
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Altshulen, L.L., Post, R. M., Leverích, G. S., et al (1995) Antidepressant-induced mania and cycle acceleration: a controversy revisited. American Journal of Psychiatry. 152, 1130–1138.Google Scholar
Anderson, P. K., Borgan, Ø., Gill, R. D., et al (1993) Statistical Models Based on Counting Processes. New York: Springer Verlag.Google Scholar
Angst, J. (1981) Course of affective disorders. In Handbook of Biological Psychiatry. Part 5. Brain Mechanisms and Abnormal Behaviour (ed. Sachar, E. J.), pp. 225–242. New York: Marcel Dekker.Google Scholar
Baastrup, P., Grof, P., et al (1973) The course of nonpolar depression and bipolar psychoses. Psychiatry and Neurology, 76, 589–600.Google Scholar
Clayton, P. J., Gun, S. B., Cloninger, R., et al (1992) Unipolar depression: diagnostic inconsistency and its inriplications. Journal of Affective Disonäers, 26, 111–116.CrossRefGoogle Scholar
Coryell, W., Endkott, J. & Kdler, M. B. (1991) Predictors of relapse into nriajor depressive disorder in a nonclinical population. American Journal of Psychiatry, 148, 1353–1358.Google Scholar
Coryell, W., Endkott, J. & Wlnokur, G. (1992) Course and outcome. In Handbook of Affective Disorders (2nd edn) (ed. Paykel, E. S.). pp. 89–108. London: Churchill Livingstone.Google Scholar
Dupont, A. (1983) A national psychiatric case register as a tool for mental health planning, research, and administration. The Danish model. In Information Support to Mental Health Programs. An International Perspective (eds Laska, E. M. Gulbinat, W H., et al), pp. 257–274. New York: Human Sciences Press.Google Scholar
Frank, E., Prien, R. F., Jarret, R. B., et al (1991) Conceptualization and rationale for consensus definitions of terms in nriajor depressive disorder Remission, recovery, relapse and recurrence. Archives of General Psychiatry. 48, 851–855.Google Scholar
Fukuda, K., Etoh, T., Iwadate, T., et al (1983) The course and prognosis of manic-depressive psychosis: a quantitative analysis of episodes and intervals. Tohoku Journal of Experimental Medicine. 139, 299–307.Google Scholar
Gitlin, M. J., Swendsen, J., Heller, T. L., et al (1995) Relapse and impairment in bipolar disorder. American Journal of Psychiatry. 152, 1635–1640 Google Scholar
Goldberg, J. F., Harrow, M. & Grossman, L. S. (l995a) Course and outcome in bipolar affective disorder: a longitudinal follow-up study. American Journal of Psychiatry 152, 379–384.Google Scholar
Goldberg, J. F., Harrow, M. & Grossman, L. S. (1995b) Recurrent affective syndromes in bipolar and unipolar mood disorders at follow-up. Britísh Journal of Psychiatry, 166, 382–385.CrossRefGoogle ScholarPubMed
Goodwin, F. K. A. Jamison, K. R. (eds) (1990) Course and outcome. In Manic-Depressive Illness, pp. 127–156. Oxford: Oxford University Press.Google Scholar
Haghighat, R. (1996) Lifelong development of risk of recurrence in depressive disorders, Journal of Affective Disorders. 41, 141–147 Google Scholar
Haywood, T.W., Kravitz, H. M., Grosman, L. S., et al (1995) Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. American Journal of Psychiatry 152, 856–861.Google Scholar
Keller, M. B., Shapiro, R. W., Lavori, R W., et al (1982) Relapse in major depressive disorder. Analysis with the life table. Archives of General Psychiatry 39, 911–915.Google Scholar
Keller, M. B., Lavori, R. W., Lewis, C. B., et al (1983) Predictors of relapse in major depressive disorder. Journal of the American Medical Association. 250, 3299–3304.CrossRefGoogle ScholarPubMed
Kessing, L. V., Dam, H., Jergensen, O. S., et al (1996) Cognitive impairment in affective disorder- relation to illness characteristics. Nordic Journal of Psychiatry. 50, 305–316.Google Scholar
Kessing, L. V., Andersen, P. K., Mortensen, P. B., et al (1998a) Recurrence in affective disorder: I. Case register study. British Journal of Psychiatry, 172, 23–28.Google Scholar
Kessing, L. V., Mortensen, R. B. & Bolwig, T. G. (1998b) Clinical definitions of sensitisation in affective disorder- a case register study. Journal of Affective Disorders, in press.Google Scholar
Kessing, L. V., Mortensen, R. B. & Bolwig, T. G. (1998c) Clinical consequences of sensitisation in affective disorder- a case register study. Journal of Affective Disorders, in press.Google Scholar
Kiloh, L. G., Andrews, G. & Neilton, M. (1988) The long-term outcome of depressive illness. British Journal of Psychiatry. 153 752–757.Google Scholar
Koukopoulos, A., Reginaldi, D., Minnai, G., et al (1995) The long term prophylaxis of affective disorders. In Depressiori and Mama: From Neurobiology to Treatment (eds Gessa, G. Fratta, W. Pani, L., et al), pp. 127–147. New York: Raven Press.Google Scholar
Kraepelin, E. (1921) Manic-Depressive Insanity and Paranoia. Edinburgh: Livingstone.Google Scholar
Lavori, P.W., Keller, M. B. & Klerman, G. L. (1984) Relapse in affective disorders: a reanalysis of the literature using life table methods, Journal of Psychiatric Research. 18, 13–25.CrossRefGoogle ScholarPubMed
Lee, A. & Murray, R. M., (1988) The long-term outcome of Maudsley depressives. British Journal of Psychiatry. 153 741–751.Google Scholar
Lundquist, G. (1945) Prognosis and course in manic- depressive psychoses. A follow-up study of 319 first admissions. Acta Psychiatrica et Neurologica, Suppl. 35.Google Scholar
Maj, M., Vellro, F., Pirozzi, R., et al (1992) Patterns of recurrence of illness after recovery from an episode of major depression: A prospective study American journal of Psychiatry. 149, 79S-S00.Google ScholarPubMed
Munk-Jorgensen, P., Kastrup, M. & Mortensen, P.B. (1993) The Danish psychiatric register as a tool in epidemiology Acta Psychiatrica Scandinavica. Suppl. 370, 27–32.Google Scholar
Munk-Jargensen, P., Lützhøft, J. K., Jensem, J., et al (1992) Trends in psychiatric hospitalization in Denmark: a 10-year registerbased investigation. Acta Psychiatrica Scandinavica. 86, 79–83.Google Scholar
National Board of Health, Denmark (1971) Classification of Diseases. The Danish Edition of ICD-8. Copenhagen: Sundhedsstyrelsen.Google Scholar
NIMH/NIH Consensus Development Conference Statement ((1985) Mood disorders: pharnriacologic prevention of recurrence. American Journal of Psychiatry. 142, 469–476.Google Scholar
Pott, R. M. (1992) Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. American Journal of fsychiatry. 149, 999–1010.Google Scholar
Pott, R. M., Rubinow, A. R. ft Ballenger, J. C. (1986) Conditioning and sensitisation in the longitudinal course of affective illness. British Journal of Psychiatry. 149, 191–201.Google Scholar
Pridmore, S., Homsby, H., Hay, D., et al (1994) Survival analysis and readmission in mood disorder British Journal of Psychiatry. 165, 824–827 Google Scholar
Roy-Byrne, R., Post, R. M., Uhde, T. W., et al (1985) The longitudinal course of recurrent affective illness: Life chart data from research patients at the NIMH. Acta Psychiatrica Scandinavica. 71, (suppl. 317), 1–34.Google Scholar
Segaard, H. J., Godt, H. H. ft Biinlcenberg, S. (1992) Trends in psychiatric hospitalization and changes in admission patterns in two counties in Denmark from 1977 to 1989. Social Psychiatry and Psychiatric Epidemiology 27. 263–269.Google Scholar
Solomon, D. A., Keitner, G. I., Miller, I.W., et al (1995) Course of illness and maintenance treatments for bipolar disorder journol of Clinical Psychiatry 56, 5–13.Google Scholar
Taschev, T. (1973) The course and prognosis of depression on the basis of 652 patients deceased. In Classification and Prediction of Outcome of Depression (Symposia Medica Hoechst 8). pp. 157–172. StuttgartNew York: Schattauer Verlag.Google Scholar
Tohen, M., Waternaux, C. M. & Tsuang, M.T. (1990) Outcome in mania. A 4 year prospective follow-up of 75 patients utilizing survival analysis. Archives of General Psychiatry 47. 1106–1111.CrossRefGoogle Scholar
Weeke, A. (1984) Admission pattern and diagnostic stability among unipolar and bipolar manic-depressive patients. Acta Psychiatrica Scandinavica. 70, 603–613.Google Scholar
Willen, J. B. & Singer, J. D. (1993) Investigating onset, cessation, relapse and recovery: Why you should, and how you can. use discrete-time survival analysis to examine event occurrence. Journal of Consulting and Clinical Psychology 61, 952–965.Google Scholar
Winokur, G., Coryell, W., Akiskal, H. S., et al (1994) Manic-depressive (bipolar) disorder: the course in the light of a prospective ten-year follow-up of 131 patients. Acta Psychiatrica Scandinavica. 89, 102–110.Google Scholar
Winokur, G., Coryell, W., Keller, M., et al (1993a) A prospective follow-up of patients with bipolar and primary unipolar affective disorder. Archives of General Psychiatry 50, 457–465.CrossRefGoogle ScholarPubMed
Winokur, G., Coryell, W. Endikott, J., et al (1993b) Further distinctions between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression). American journal of Psychiatry. 150, 1176–1181.Google ScholarPubMed
Winokur, G., Kadrmas, A. (1989) A polyepisodic course in bipolar illness: possible clinical relatkjnships. Comprehensive Psychiatry 30, 121–127 Google Scholar
Wittchen, H.-U. (1996) Critical issues in the evaluation of comorbidity of psychiatric disorders. British purnal of Psychiatry 168 (suppl. 30), 9–16.Google Scholar
Wolpert, E. A., Goldberg, J. F. & Harrow, M. (1990) Comorbidity of mental disorders and substance use disorders. European Addiction Research. 2. 36–47 Google Scholar
World Health Organization (1974) Rapid cycling in unipolar and bipolar affective disorders. American purnal of Psychiatry, 147, 725–728.Google Scholar
Worid Health Organization (1974) Glossary of Mental Disorders and Guide to their Classification fix use in Conjunction with the International Classification of Diseases. 8th Revision. Geneva: WHO.Google Scholar
Zis, A. P., Gror, P., Webster, M. A., et al (1980) The cyclicity of affective disorders and its modifications by drugs. Prediction of relapse in recurrent affective disorder Psychopharmacological Bulletin. 16, 47–49.Google Scholar
Zis, A. P., & Goodwin, F. K. (1979) Major affective disorder as a recurrent illness. A critical review. Archives of General Psychiatry 36, 835–839 Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.