title: Predictors of relapse in bipolar disorder: A review.
abstract: BACKGROUND
  Bipolar disorder is the sixth leading cause of disability in the United States. Moreover, repeated episodes and non-responsiveness to treatment continue to present a significant problem, and little is known about the factors that may precipitate relapse. This article reviews the available literature on predictors of bipolar relapse.
  
  
  METHODS
  We conducted a literature search on Medline from 1996 to March 2006, using the keywords "relapse," "recurrence," "compliance," "adherence," "life events," "kindling," and "predictors" combined with the term "bipolar disorder(s)." References from the resulting articles also supplemented the initial search. Thirty-eight articles were included in the analysis.
  
  
  RESULTS
  Predictors of episodes include stressful life events, increased number of previous episodes, decreased interval between episodes, and persistence of affective symptoms and episodes. Factors associated with longer survival times include psychotherapy, social support, and medication adherence.
  
  
  CONCLUSIONS
  Our review suggests several reliable predictors of bipolar episodes. Knowledge of these factors has significant clinical implications and could aid in treatment and prevention strategies. However, further research is clearly needed to address the limitations of the existing research and to increase our understanding of predictors of relapse, with the intent of improving quality of life and preventing episodes in patients with bipolar disorder.
authors.affiliation: Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Altman
authors.forename: Sophia
authors.initials: S
authors.lastname: Haeri
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Cohen
authors.forename: Aleksey
authors.initials: A
authors.lastname: Ten
authors.forename: Elysa
authors.initials: E
authors.lastname: Barron
authors.forename: Igor I
authors.initials: II
authors.lastname: Galynker
authors.forename: Katherine N
authors.initials: KN
authors.lastname: Duhamel
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D011237:Predictive Value of Tests; D012008:Recurrence
chemical_list: D014150:Antipsychotic Agents