History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder

J Affect Disord. 2007 Nov;103(1-3):181-6. doi: 10.1016/j.jad.2007.01.027. Epub 2007 Feb 26.


Background: There are obstacles to early identification of bipolar disorder. Identifying and treating illness early in its time course may be associated with a better prognosis.

Methods: A questionnaire was administered at interview, when the participant was euthymic, to participants (n=240) enrolled in the Bipolar Comprehensive Outcomes Study (BCOS). Information was collected about the sequential timeline of specific symptoms of mental illness up to when they first received a diagnosis of Bipolar Disorder or Schizoaffective Disorder.

Results: Any symptoms of mental illness were first experienced at 17.5 years (median; Inter Quartile Range (IQR) 13.8-24.3; n=216) and mood swings at 18.0 years (IQR 14-25; n=197). Symptoms of depression were experienced at 18.0 years (IQR 14-25; n=197), a full episode of depression at 21.2 years (IQR 17-28.5; n=200), symptoms of mania at 21.0 years (IQR 16.8-29.5; n=212) and a full episode of mania at 24.1 years (IQR 19-30.5; n=205). Medical treatment was sought at 24.0 years (IQR 19-31.5; n=217). Participants received a diagnosis of Bipolar Disorder or Schizoaffective Disorder at 30.0 years (IQR 23-37.3; n=215). Having had a previous diagnosis other than Bipolar Disorder or Schizoaffective Disorder was reported by 120 of 216 participants who answered this question, most commonly unipolar depression (26.6%). Diagnostic delay was greater in individuals with early onset disorder.

Conclusions: Participants typically experience a long sequential course of symptoms, episodes, treatments and diagnosis. The polarity of onset is most commonly depressive, and subthreshold symptoms tend to precede threshold symptoms of both polarities.

Limitations: Data were collected retrospectively.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / drug therapy
  • Bipolar Disorder / psychology
  • Cohort Studies
  • Depressive Disorder / diagnosis
  • Depressive Disorder / drug therapy
  • Depressive Disorder / psychology
  • Diagnosis, Differential
  • Disease Progression
  • Early Diagnosis
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Medical History Taking
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / psychology
  • Psychotropic Drugs / therapeutic use
  • Victoria


  • Psychotropic Drugs