Research report Correlates of first-episode polarity in a French cohort of 1089 bipolar I disorder patients: Role of temperaments and triggering events Jean-Michel Azorin a, ⁎, Arthur Kaladjian a , Marc Adida a , Eric Fakra a , Elie Hantouche b , Sylvie Lancrenon c a Department of Psychiatry, Sainte Marguerite Hospital, Marseilles, France b Anxiety and Mood Center, CTAH, Paris, France c Sylia-Stat, Bourg-La-Reine, France article info abstract Article history: Received 21 May 2010 Received in revised form 23 August 2010 Accepted 23 August 2010 Available online 19 September 2010 Objectives: As only a few studies so far systematically reported on bipolar patients subtyped according to first-episode polarity, we took the opportunity of having at disposal a large sample of bipolar I patients to specify the characteristics of patients included in these subtypes, with a special focus on temperament and triggering events. Methods: A total of 1089 consecutive DSM-IV bipolar I manic inpatients were subtyped in manic onset (MO), depressive onset (DO) and mixed onset (MXO), and assessed for demographic, illness course, clinical, psychometric, comorbidity and temperament characteristics. Results: The main characteristics of MO patients were a hyperthymic temperamental predisposition, a first episode triggered by substance abuse and an illness course with pure, severe and psychotic mania. In comparison, DO patients had more depressive temperaments, a first episode triggered by stress and alcohol, an illness course with more episodes, cyclicity, suicide attempts, anxious comorbidity and residual symptoms. Although sharing characteristics with either MO or DO, MXO patients had more mixed episodes and cyclothymic temperament. Limitations: The following are the limitations of this study: retrospective design, bias toward preferential enrolment of MO patients, and lack of information on the number and polarity of lifetime episodes. Conclusions: Findings from this study tend to confirm most of the differences previously evidenced among patients subtyped according to first-episode polarity. Differences found in temperamental predisposition and illness onset triggering events are worth noting and may help target early preventive interventions as well as orientate the search for specific genetic risk factors. © 2010 Elsevier B.V. All rights reserved. Keywords: Bipolar disorder First-episode polarity Polarity at onset Temperament Triggering events 1. Introduction It has been suggested that, in bipolar disorders, the polarity of the first episode could be indicative of the ongoing outcome and therefore help the professionals to take, early in the course of illness, clinically and therapeutically appropri- ate decisions (Daban et al., 2006). However, literature on the subject is scarce and most of our information about first- episode polarity has been indirectly obtained from studies in which this parameter was anecdotally documented. So far, to the best of our knowledge, only five studies have addressed this issue in a systematic way. The first one included 320 consecutive inpatients and day-hospital patients with a diagnosis of bipolar I disorder (Perugi et al., 2000); patients were further subtyped according to first-episode polarity in Journal of Affective Disorders 129 (2011) 39–46 ⁎ Corresponding author. SHU Psychiatrie Adultes, Hôpital Ste Marguerite, 13274 Marseille Cedex 9-France. Tel.: + 33 491 74 40 82; fax: + 33 491 74 55 78. E-mail address: jazorin@ap-hm.fr (J.-M. Azorin). 0165-0327/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2010.08.020 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad