Course of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985.

This paper reports the results of a 27 year prospective study of 186 unipolar depressives and 220 bipolar disorders meeting DSM-III criteria for major depression or mania. Subjects were classified into four diagnostic subgroups, according to polarity and presence or absence of schizophrenic symptoms: unipolar depression, bipolar disorder, unipolar schizoaffective disorder and bipolar schizoaffective disorder. Course parameters were assessed for all samples. As the sequence of subtypes of affective and schizoaffective disorders progresses from unipolar depression, schizodepression, pure affective bipolar disorder to schizobipolar disorder, a systematic decrease in age of onset and length of episode can be observed. When compared to unipolar disorders (unipolar depression and schizodepressive disorder), bipolar (bipolar and schizobipolar) disorders showed more periodicity, characterized by greater number of total episodes, more episodes per year, but with shorter episodes and cycles. Despite the lower age of onset among schizoaffective subjects compared to pure affective disorders, the only difference in course between the two groups was a greater frequency in episodes requiring hospitalization among schizoaffectives.