A longitudinal syndrome-oriented approach to phenotypic heterogeneity

Objectives: To describe a) the complex comorbidity of bipolar II (BP-II) and unipolar (UP) major depressives, b) differences and shared characteristics between BP-II and UP and c) longitudinal changes of the comorbidity patterns. Methods: In the Zurich community cohort study 591 subjects were selected after screening at the age of 19 and studied prospectively by 6 interviews from 20 to 40; weighted they represent 2599 subjects of the normal population. Psychopathology was defined as 1) formal diagnoses (DSM and ICD manuals), 2) subdiagnostic syndromes or 3) symptoms. Comorbidity patterns of BP-II and UP in subjects aged 20–23, 27–30 and 34–41 will be compared. Preliminary results: BP-II cases demonstrated more comorbidity with higher variability over time than MDD; in both MDD and BP-II comorbidity became more stable with age. Over 20 years subjects with MDD showed a decrease of concomitant panic, agoraphobia and social phobia; in contrast to this subjects with BP-II showed an increase of generalised anxiety and neurasthenia; in both there was growing alcohol consumption.