Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients.

Objective As initial episode type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode types. Method We studied 263 first-episode, adult, DSM-IV-TR type I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first lifetime manic vs. other (mixed, depressive, or non-affective) major psychotic episodes. Results We identified 32 antecedents arising at early, intermediate or later times, starting 12.3 ± 10.7 years prior to first lifetime major psychotic episodes. Based on multi…