Relationship between duration of undiagnosed illness, clinical features and cognitive impairment in bipolar disorder

Purpose: It is believed that a delay in the diagnosis of bipolar disorder may adversely affect the clinical course and outcome. This study aimed to investigate the relationship between diagnostic delay and clinical variables, as well as neurocognitive and social cognitive disorders Materials and methods: Eighty-four patients with bipolar disorder in remission were included in the study. Participants were evaluated using a neuropsychological battery that assessed verbal memory and learning, visual memory and learning, verbal fluency, attention, processing speed, executive functions, working memory, and social cognition. Results: The duration of undiagnosed illness was longer in patients with bipolar II disorder, those without psychotic features, those with at least one suicide attempt, those whose first episode was depressive, and those currently on antidepressants. A significant positive correlation was found between the duration of undiagnosed illness and scores on the Controlled Oral Word Association Test, total number of episodes, hypomanic episodes, depressive episodes, and their respective durations. Conversely, a significant negative correlation was found between the duration of undiagnosed illness and both the number and duration of manic episodes. Conclusion: We found that a delay in diagnosis and treatment was associated with more recurrences in bipolar disorder, an increased number of depressive episodes, and at least one lifetime suicide attempt. However, the association between extended periods of untreated illness and poor clinical and functional outcomes did not align with cognitive impairment.