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


METHODS
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.
D000223:Adaptation, Psychological; D000328:Adult; D000553:Ambulatory Care; D001714:Bipolar Disorder / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012917:Social Adjustment; D016019:Survival Analysis; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid