Stability and treatment outcome of distinct classes of mania.
BACKGROUND
Psychopathological heterogeneity in manic syndromes may in part reflect underlying latent classes with characteristic outcome patterns. Differential treatment course and outcome after 12 weeks of treatment were examined for three distinct classes of patients with acute mania in bipolar disorder.


METHODS
Three thousand four hundred and twenty-five patients with acute mania were divided into three distinct mania classes: 'Typical', 'Psychotic' and 'Dual' (i.e. comorbid substance use) mania. Persistence of class differences and social outcomes were examined, using multilevel regression analyses and odds ratios.


RESULTS
The three classes showed substantial stability post-baseline in the pattern of associations with class-characteristic variables. Psychotic and Dual mania predicted poorer outcome in terms of psychosis comorbidity and overall bipolar and mania severity, while Dual mania additionally predicted poorer outcome of alcohol and substance abuse. Worse social outcomes were observed for both Dual and Psychotic mania.


CONCLUSIONS
The identified distinct classes are stable and associated with differential treatment outcome. Overall, Dual and Psychotic mania show less favourable outcomes compared to Typical mania. These findings additionally give rise to concern on the generalisability of randomized clinical trials RCTs.
van Rossum
Inge
I
Medical Department, Eli Lilly Nederland, Grootslag 1-5, Houten, The Netherlands.
Haro
Josep Maria
JM
Tenback
Diederik
D
Boomsma
Maarten
M
Goetz
Iris
I
Vieta
Eduard
E
van Os
Jim
J
D000208:Acute Disease; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000145:classification* / Q000188:drug therapy* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome
D014150:Antipsychotic Agents