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Am J Psychiatry. 1995 Nov;152(11):1635-40.

Relapse and impairment in bipolar disorder.

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  • 1Department of Psychiatry, University of California, Los Angeles 90024-6968, USA.

Abstract

OBJECTIVE:

The purpose of this study was to evaluate the outcome of bipolar disorder in the context of maintenance pharmacotherapy.

METHOD:

Eighty-two bipolar outpatients were followed prospectively for a mean of 4.3 years (minimum of 2 years); symptom rating and psychosocial outcome scales were used, and pharmacotherapy was rated on a 5-point scale.

RESULTS:

Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. Of those who relapsed, two-thirds had multiple relapses. Relapse could not be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure of cumulative affective morbidity appeared to be a more sensitive correlate of psychosocial functioning than was the number of relapses. Poor psychosocial outcome paralleled poor syndromal course. Poor psychosocial functioning, especially occupational disruption, predicted a shorter time to relapse. Depressions were most strongly related to social and family dysfunction.

CONCLUSIONS:

Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients.

Comment in

  • Treatment of bipolar disorder. [Am J Psychiatry. 1996]
  • Treatment of bipolar disorder. [Am J Psychiatry. 1996]
PMID:
7485627
[PubMed - indexed for MEDLINE]
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