Prophylaxis latency and outcome in bipolar disorders.
OBJECTIVE
To analyze new and reviewed findings to evaluate relations between treatment response and latency from onset of bipolar disorder (BD) to the start of mood-stabilizer prophylaxis.


METHODS
We analyzed our own new data and added findings from research reports identified by computerized searching.


RESULTS
We found 11 relevant studies, involving 1485 adult patients diagnosed primarily with BD. Reported latency to prophylaxis averaged 9.6 years (SD 1.3), and follow-up in treatment averaged 5.4 years (SD 3.1). Greater illness intensity and shorter treatment latency were closely associated, resulting in a greater apparent reduction in morbidity with earlier treatment. However, this finding was not sustained after correction for pretreatment morbidity, and treatment latency did not predict morbidity during treatment. Therefore, assessments based on improvement with treatment, or without correction for pretreatment morbidity, can be misleading.


CONCLUSIONS
Available evidence does not support the proposal that delayed prophylaxis may limit response to prophylactic treatment in BD and related disorders.
Baethge
Christopher
C
Consolidated Department of Psychiatry, Harvard Medical School, Bipolar and Psychotic Disorders Program, McLean Division of Massachusetts General Hospital, Belmont, Massachusetts, USA. cbaethge@mclean.harvard.edu
Tondo
Leonardo
L
Bratti
Irene M
IM
Bschor
Tom
T
Bauer
Michael
M
Viguera
Adele C
AC
Baldessarini
Ross J
RJ
D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D008134:Long-Term Care; D055502:Secondary Prevention; D016896:Treatment Outcome
D000927:Anticonvulsants; D018692:Antimanic Agents