Characteristics and profiles of bipolar I patients according to age-at-onset: Findings from an admixture analysis

Background: Many studies have used admixture analysis to separate age-at-onset (AAO) subgroups in bipolar patients, but few have looked at the phenomenological characteristics of these subgroups, in order to find out phenotypic markers. Methods: Admixture analysis was applied to identify the model best fitting the observed AAO distribution of a sample of 1082 consecutive DSM-IV bipolar l manic inpatients who were assessed for demographic, clinical, course of illness, comorbidity, and temperamental characteristics. Results: The model best fitting the observed distribution of AAO was a mixture of three Gaussian distributions. We could identify three AAO subgroups: early, intermediate, and late age-at-onset (FAO, IAO, and LAO, respectively). Patients in the FAO subgroup were more often single young males exhibiting severe mania with psychotic features, a subcontinuous course of illness with substance use and panic comorbidity, more suicide attempts, and temperamental components sharing hypomanic features. Patients with LAO showed a less severe picture with more depressive temperamental components, alcohol use and comorbid general medical conditions. A less typical phenotype was present in IAO patients. Limitations: The following are the limitations of this study: retrospective design, and bias toward preferential enrollment of patients with manic predominant polarity. Conclusions: This study confirms that bipolar l disorder can be subdivided into three subgroups based On AAO distribution and shows that patients from these subgroups differ in phenotypes. (C) 2013 Elsevier B.V. All rights reserved.