The social, psychopathological and consumer context of rate of symptom improvement in acute mania.
BACKGROUND
Knowledge of moderators of symptom improvement over time in acute mania improves predictability of individual patient outcomes. This study attempted to identify such moderators of the rate of symptom improvement.


METHODS
In 3459 patients with high levels of mania in whom a change in psychotropic treatment was initiated and who were assessed six times over three months, clinical and social moderators of the rate of response were examined. Additionally, moderators of symptom improvement in individuals with high baseline levels of comorbid depression (n = 815) and psychosis (n = 1849) were identified.


RESULTS
Within three months, mania symptoms were reduced by 52%, psychotic symptoms by 56% and depressive symptoms by 36%. High levels of baseline depression, greater illness severity in the past year, lower age of onset and rapid cycling reduced the rate of mania symptom improvement by 5-15%. Social variables indicating disadvantage similarly had negative contributions (5%-14%). Several reasons for change of medication involving patient choice, patient compliance, side effects and lack of effectiveness impacted negatively (reductions of 10%, 6%, 14% and 9% respectively). For the psychosis dimension, both low mania scores (22% reduction) and high depression scores (14% reduction) at baseline impacted negatively, whereas rate of reduction in depression was not conditional on baseline psychopathology.


CONCLUSIONS
The rate of symptom improvement in acute mania is to a large extent conditional on the context as provided by the social, psychopathological and consumer environment. Understanding the context of treatment response offers valuable insights into treatment approaches aimed at moderation of traditional pharmacological interventions.
van Os
Jim
J
Dept. of Psychiatry and Neuropsychology, Maastricht University, European Graduate School of Neuroscience, PO Box 616, 6200, MD, Maastricht, The Netherlands. j.vanos@sp.unimaas.nl
van Rossum
Inge
I
Boomsma
Maarten
M
Vieta
Eduard
E
Goetz
Iris
I
Reed
Catherine
C
Haro
Josep Maria
JM
D000208:Acute Disease; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D003256:Community Participation / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011599:Psychopathology / Q000379:methods; D011618:Psychotic Disorders / Q000523:psychology; D012720:Severity of Illness Index; D012919:Social Behavior; D013997:Time Factors; D016896:Treatment Outcome