title: Symptomatic and functional outcome 12 months after a first episode of psychotic mania: barriers to recovery in a catchment area sample.
abstract: OBJECTIVE
  Recent studies have shown that outcome in mania is worse than previously thought. Such studies have been conducted in selected samples with restrictive measures of outcome. We aimed to explore outcome and its predictors in a catchment area sample of first-episode psychotic mania of DSM-III-R bipolar I disorder.
  
  
  METHODS
  Prospective 6 and 12 months follow-up was conducted with 87 DSM-III-R first-episode psychotic mania patients admitted to Early Psychosis Prevention and Intervention Centre between 1989 and 1997. Syndromic and symptomatic outcome were determined with the Brief Psychiatric Rating Scale; functional outcome with the Quality of Life Scale and Premorbid Adjustment Scale subitems.
  
  
  RESULTS
  Symptomatic outcome was assessed in 67 patients at 6 months and 61 patients at 12 months, and functional outcome in 56 patients at 6 months and 49 patients at 12 months. Logistic regressions were conducted on 46 and 43 patients, respectively, to explore predictors of outcome. While 90% of patients achieved syndromic recovery at 6 and 12 months, 40% had not recovered symptomatically at 6 and 12 months, still presenting with anxiety or depression. A total of 66% of patients at 6 months and 61% of patients at 12 months failed to return to previous level of functioning. Age at intake, family history of affective disorder, illicit drug use and functional recovery at 6 months predicted functional outcome at 12 months.
  
  
  CONCLUSIONS
  This study confirms poor symptomatic and functional outcome after first-episode psychotic mania. It suggests possible usefulness of early intervention strategies in bipolar disorders and need for developing specific interventions addressing anxiety, depression and substance abuse comorbidity.
authors.affiliation: Département Universitaire de Psychiatrie CHUV, Université de Lausanne, Prilly, Switzerland. philippe.conus@chuv.ch
authors.forename: Philippe
authors.initials: P
authors.lastname: Conus
authors.forename: Sue
authors.initials: S
authors.lastname: Cotton
authors.forename: Amal
authors.initials: A
authors.lastname: Abdel-Baki
authors.forename: Martin
authors.initials: M
authors.lastname: Lambert
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy; D001315:Australia / Q000453:epidemiology; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D010054:Brief Psychiatric Rating Scale; D002391:Catchment Area, Health; D003710:Demography; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011788:Quality of Life / Q000523:psychology; D020127:Recovery of Function; D012917:Social Adjustment; D011795:Surveys and Questionnaires