Original Article

Evaluation of Bipolar Disorder in Several Recurrences over the Time Using Generalized Estimating Equations

Abstract

Objective: Bipolar disorder is characterized by periods of manic, depression, or mixed episodes. The purpose of this study was to assess the development of bipolar disorder episode over the time as well as determining the risk factors affecting bipolar disorder.
Methods: This retrospective cohort study was conducted in Hamadan Province, the west of Iran, from April 2008 to September 2014 including 124 patients with bipolar disorder. All patients had experienced four recurrences. Generalized Estimating Equation (GEE) as a longitudinal modeling approach was used due to longitudinally recording of bipolar disorders. A significant level of 0.05 was considered for the tests.
Results: The mean (SD) age of the 124 patients was 33.2 (11.55). GEE showed that the odds of manic males than depressed or mixed (as well as manic or depressed than mixed female patients according to proportionality of odds) is 1.99 times than those of females. The odds ratio of mania than depression or mixed (as well as mania or depression than mixed) is 0.441 for patients who used both drugs and psychotherapy comparing to only drugs. As well, the odds ratios comparing spring to winter and autumn are 2.01 and 1.82, respectively
Conclusion: The results from this study using GEE method showed that in an Iranian bipolar disorder patients, mania is much more prevalent than depression or mixed as well as mania and depression than mixed. Sex, treatments and the seasons of recurrence can determine the episode of bipolar disorder.

Salvatore P, Tohen M, Khalsa H-MK, Baethge C, Tondo L, Baldessarini RJ. Longitudinal research on bipolar disorders. Epidemiologia e psichiatria sociale 2007; 16: 109-117.

Kleinman LS, Lowin A, Flood E, Gandhi G, Edgell E, Revicki DA. Costs of bipolar disorder. Pharmacoeconomics 2003; 21: 601-622.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM) Washington, DC: American psychiatric association; 1994. p. 143–147.

Brunello N, Burrows G, Jonsson B, Judd L, Kasper S, Keller M, et al. Critical issues in the treatment of affective disorders. Depression 1995; 3: 187-198.

Angst J, Marneros A. Bipolarity from ancient to modern times: conception, birth and rebirth. J Affect Disord 2001; 67: 3-19.

Solomon DA, Keitner GI, Miller IW, Shea MT, Keller MB. Course of illness and maintenance treatments for patients with bipolar disorder. J Clin Psychiatry 1995; 56: 5-13.

Gelenberg AJ, Kane JM, Keller MB, Lavori P, Rosenbaum JF, Cole K, et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med 1989; 321: 1489-1493.

Gitlin MJ, Swendsen J, Heller TL, Hammen C. Relapse and impairment in bipolar disorder. The American journal of psychiatry. 1995;152:1635-1640.

Murray CJ, Lopez AD. Global Health Statistics: A compendium of incidence, prevalence and mortality estimates for over 200 conditions. Boston: Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1996.

Schulze TG, Detera-Wadleigh SD, Akula N, Gupta A, Kassem L, Steele J, et al. Two variants in Ankyrin 3 (ANK3) are independent genetic risk factors for bipolar disorder. Mol Psychiatry 2009; 14: 487-491.

Hawton K, Sutton L, Haw C, Sinclair J, Harriss L. Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry 2005; 66: 693-704.

Kennedy N, Everitt B, Boydell J, Van Os J, Jones PB, Murray RM. Incidence and distribution of first-episode mania by age: results from a 35-year study. Psychol Med 2005; 35: 855-863.

Laursen TM, Munk-Olsen T, Nordentoft M, Bo Mortensen P. A comparison of selected risk factors for unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia from a danish population-based cohort. J Clin Psychiatry 2007; 68: 1673-1681.

Lloyd T, Kennedy N, Fearon P, Kirkbride J, Mallett R, Leff J, et al. Incidence of bipolar affective disorder in three UK cities: results from the AESOP study. Br J Psychiatry 2005; 186: 126-131.

Najafi-Vosough R, Ghaleiha A, Faradmal J, Mahjub H. Recurrence in Patients with Bipolar Disorder and Its Risk Factors. Iran J Psychiatry 2016; 11: 173-177.

Verbeke G. Models for Discrete Longitudinal Data. Springer Series in Statistics: Springer; 2005.

Diggle P, Liang K-Y, Zeger SL. Longitudinal data analysis. New York: Oxford University Press 1994; 5: 13.

Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis: John Wiley & Sons; 2012.

Lipsitz S, Fitzmaurice G. Generalized estimation equations for longitudinal data analysis. Longitudinal data analysis New York: Chapman & Hall/CRC 2008: 43-78.

Scotia N. Explaining odds ratios. J Can Acad Child Adolesc Psychiatry 2010; 19: 227.

Kupka RW, Altshuler LL, Nolen WA, Suppes T, Luckenbaugh DA, Leverich GS, et al. Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder. Bipolar Disord 2007; 9: 531-535.

Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002; 59: 530-537.

Gonzalez-Pinto A, Ballesteros J, Aldama A, De Heredia JP, Gutierrez M, Mosquera F. Principal components of mania. Journal of affective disorders 2003; 76: 95-102.

Post RM. The impact of bipolar depression. J Clin Psychiatry 2005; 66 Suppl 5: 5-10.

Suppes T, Mintz J, McElroy SL, Altshuler LL, Kupka RW, Frye MA, et al. Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon. Arch Gen Psychiatry 2005; 62: 1089-1096.

Sit D. Women and bipolar disorder across the life span. J Am Med Womens Assoc (1972) 2004; 59: 91-100.

Kupka RW, Luckenbaugh DA, Post RM, Leverich GS, Nolen WA. Rapid and non-rapid cycling bipolar disorder: a meta-analysis of clinical studies. J Clin Psychiatry 2003; 64: 1483-1494.

Nivoli AM, Pacchiarotti I, Rosa AR, Popovic D, Murru A, Valenti M, et al. Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity. J Affect Disord 2011; 133: 443-449.

Swartz HA, Swanson J. Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. Focus (Am Psychiatr Publ) 2014; 12: 251-266.

Swartz HA, Frank E. Psychotherapy for bipolar depression: a phase-specific treatment strategy? Bipolar Disord 2001; 3: 11-22.

Cakir S, Ozerdem A. [Psychotherapeutic and psychosocial approaches in bipolar disorder: a systematic literature review]. Turk Psikiyatri Derg 2010; 21: 143-154.

Hakkarainen R, Johansson C, Kieseppä T, Partonen T, Koskenvuo M, Kaprio J, Lönnqvist J. Seasonal changes, sleep length and circadian preference among twins with bipolar disorder. BMC psychiatry. 2003; 3: 6-12.

Geoffroy PA, Bellivier F, Scott J, Etain B. Seasonality and bipolar disorder: a systematic review, from admission rates to seasonality of symptoms. J Affect Disord 2014; 168: 210-223.

Akhter A, Fiedorowicz JG, Zhang T, Potash JB, Cavanaugh J, Solomon DA, et al. Seasonal variation of manic and depressive symptoms in bipolar disorder. Bipolar Disord 2013; 15: 377-384.

MacKinnon DF, Zandi PP, Cooper J, Potash JB, Simpson SG, Gershon E, et al. Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. Am J Psychiatry 2002; 159: 30-35.

Baethge C, Hennen J, Khalsa HM, Salvatore P, Tohen M, Baldessarini RJ. Sequencing of substance use and affective morbidity in 166 first-episode bipolar I disorder patients. Bipolar Disord 2008; 10: 738-741.

Jaffee WB, Griffin ML, Gallop R, Meade CS, Graff F, Bender RE, et al. Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders. J Clin Psychiatry 2009; 70: 171-176.

Gunderson JG, Weinberg I, Daversa MT, Kueppenbender KD, Zanarini MC, Shea MT, et al. Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder. Am J Psychiatry 2006; 163: 1173-1178.

Olfson M, Mojtabai R, Merikangas KR, Compton WM, Wang S, Grant BF, et al. Reexamining associations between mania, depression, anxiety and substance use disorders: results from a prospective national cohort. Mol Psychiatry 2017; 22: 235-241.

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IssueVol 12 No 3 (2017) QRcode
SectionOriginal Article(s)
Keywords
Bipolar Disorder Generalized Estimating Equation model Iran

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How to Cite
1.
Amini P, Najafi-Vosough R, Ghaleiha A, Mahjub H. Evaluation of Bipolar Disorder in Several Recurrences over the Time Using Generalized Estimating Equations. Iran J Psychiatry. 2017;12(3):182-187.