title: Predictive factors for time to remission and recurrence in patients treated for acute mania: health outcomes of manic episodes (HOME) study.
abstract: OBJECTIVE
  To determine the time to remission and recurrence in patients treated for acute mania and the predictive factors associated with these outcomes.
  
  
  METHODS
  This observational study, conducted in Turkey from April 2003 to January 2005, included patients with a DSM-IV diagnosis of bipolar I disorder, acute manic or mixed episode who were eligible to have an oral medication initiated or changed for the treatment of the episode. The patients were followed-up for 12 months.
  
  
  RESULTS
  A total of 584 patients (mean ± SD age = 33.9 ± 11.2, 55.2% outpatients) were enrolled in 53 centers. Eighty-five percent of patients had a manic episode at baseline, with a mean ± SD duration of 21.6 ± 24.4 days. The baseline mean ± SD Clinical Global Impressions scale for use in bipolar disorder and Young Mania Rating Scale (YMRS) scores were 4.9 ± 0.9 (median = 5.0) and 33.2 ± 9.3 (median = 33), respectively. 539 patients achieved remission and, of those, 141 patients had recurrence. One-year remission and recurrence rates were 99.0% and 35.7%, respectively. Mean ± SD times to remission and recurrence in descriptive statistics were 80.9 ± 73.8 (median = 50) and 159.0 ± 95.5 (median = 156) days, respectively. In Cox regression analysis, psychiatric comorbidities (p = .048), a higher YMRS score (p < .001), and a higher number of previous depressive episodes (p = .009) were statistically significant predictors of a longer time to reach remission. Index episodes of longer duration (p = .033) and mixed type (p = 0.49) were significant predictors of a shorter time to recurrence. Confounding factors like concomitant treatment, comorbidities, and lack of blinding and randomization were other limitations.
  
  
  CONCLUSIONS
  Predictors for a longer time to remission were psychiatric comorbidities, a higher YMRS score, and a higher number of previous depressive episodes. Predictors for a shorter time to recurrence were episodes of longer duration and mixed type.
authors.affiliation: Department of Psychiatry, Marmara University, Istanbul, Turkey.
authors.forename: Kaan
authors.initials: K
authors.lastname: Kora
authors.forename: Mete
authors.initials: M
authors.lastname: Saylan
authors.forename: Cengiz
authors.initials: C
authors.lastname: Akkaya
authors.forename: Nesrin
authors.initials: N
authors.lastname: Karamustafalioglu
authors.forename: Nesrin
authors.initials: N
authors.lastname: Tomruk
authors.forename: Aziz
authors.initials: A
authors.lastname: Yasan
authors.forename: Timucin
authors.initials: T
authors.lastname: Oral