Research report History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder ☆ M. Berk b , S. Dodd b, ⁎ , P. Callaly b , L. Berk b , P. Fitzgerald a , A.R. de Castella a , S. Filia a , K. Filia a , S. Tahtalian a , F. Biffin a , K. Kelin c , M. Smith d , W. Montgomery c , J. Kulkarni a a Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychology, Psychiatry and Psychological Medicine, Commercial Road, Melbourne, 3004, Australia b Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, PO Box 281, Geelong, Victoria 3220, Australia c Eli Lilly Australia Pty Ltd., 112 Wharf Road, West Ryde NSW 2114, Australia d School of Applied Social and Human Sciences, University of Western Sydney, Penrith South NSW 2750, Australia Received 13 November 2006; received in revised form 23 January 2007; accepted 23 January 2007 Available online 26 February 2007 Abstract 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. © 2007 Elsevier B.V. All rights reserved. Keywords: Bipolar disorder; Schizoaffective disorder; Longitudinal study Journal of Affective Disorders 103 (2007) 181 – 186 www.elsevier.com/locate/jad ☆ Eli Lilly Australia provided funding for this study and was involved in the study design. Lilly had no role in the collection, analysis or interpretation of data for this particular manuscript, beyond providing assistance with the design of the spreadsheets for data collection. Outside of the Lilly employees listed as authors (W. Montgomery and K. Kelin), Lilly had no role in the development of this particular manuscript or the decision to submit the paper for publication. ⁎ Corresponding author. Postal address: Swanston Centre, PO Box 281, Geelong, Victoria 3220, Australia. Tel.: +61 3 5226 7666; fax: +61 3 5246 5165. E-mail address: seetald@barwonhealth.org.au (S. Dodd). 0165-0327/$ - see front matter © 2007 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2007.01.027