Impact of Duration of Untreated Bipolar Disorder on Clinical Outcomes: A Systematic Review.

Abstract

<h4>Background</h4>Bipolar disorder (BD) prognosis is influenced by multiple factors, including age, sex and comorbid conditions. This review focuses on the concept termed 'duration of untreated bipolar disorder' (DUB), defined as the interval between the onset of affective symptoms and the initiation of appropriate treatment. This variable may significantly influence the course and recovery of individuals with BD.<h4>Objectives</h4>The main objective is to determine whether an association exists between DUB and clinical outcomes in patients with BD, and to examine the potential implications of reducing DUB on the long-term prognosis of the disorder.<h4>Methods</h4>A systematic literature search was conducted using MeSH descriptors across the PubMed, Scopus, and Cochrane Library databases. A total of 1573 articles were initially identified. Following a rigorous screening and eligibility assessment process, a total of 15 articles met the inclusion criteria and were included in this review. The results obtained have been systematically analysed and synthesised for further evaluation.<h4>Results</h4>A prolonged DUB was associated with several clinical variables, including BD II, a longer duration of the illness, early age of onset, first episode of depressive polarity, higher number of depressive episodes and higher number of suicide attempts.<h4>Limitations</h4>There is currently no consensus on the definition or standardised measurement of DUB, which limits comparability across studies.<h4>Conclusions</h4>DUB appears to be a modifiable factor associated with poorer clinical outcomes in BD patients. Reducing DUB may improve long-term management of BD. Tailored early treatment strategies might be implemented to address this.