Also in accord with previous studies is the high rate of substance use disorders, suicidal behavior and other axis I disorders in these subjects (23–25). Furthermore, social functioning and depressive symptoms were worst in group 4 subjects, confirming previous results from both short-term (26–28) and prospective studies (14, 16). Moreover, previous investigations also reported that members of this group of individuals had a higher rate of manic episodes during follow-up (25, 29). Clearly, the more severe course of comorbid bipolar I disorder, and alcohol dependence was more pronounced in the prospective compared to the baseline analysis.
