The course of bipolar disorder in rural India

Aim: To examine the naturalistic course of bipolar disorder in a rural, community-based, partially treated cohort. Methods: All patients diagnosed with bipolar disorder during an epidemiological survey (n=34) in a rural area in India were followed longitudinally using standardized instruments, and the life-chart method used to examine their course. Results: Seven (26%) of the 27 patients evaluated directly had not received any treatment whatsoever. Four patients (15%) had experienced rapid-cycling at some time; patients without rapid-cycling had experienced a mean 0.22 episodes/year. Episodes of mania accounted for 72% of all episodes. None of the variables examined appeared to predict the total number of episodes experienced by individual patients, although rapid-cycling occurred significantly more often if the patients had not received any psychopharmacological treatment. Conclusions: A mania-predominant course was observed in this small cohort, similar to reports from other developing countries.