title: Predictors of good outcome in patients with refractory bipolar disorder after a drug or a drug and cognitive-behavioral treatment.
abstract: OBJECTIVE
  The objective of the present research study was to analyze the variables involved in the favorable prognosis of patients with refractory bipolar disorder after a drug or a drug and cognitive-behavioral treatment.
  
  
  METHODS
  A sample of 40 patients was divided into 2 groups: (1) combined drug plus psychoeducational and cognitive-behavioral treatment or (2) drug treatment only (control group). We used a multigroup design with repeated measures at different times (baseline, posttreatment, 6-month follow-up, and 12-month follow-up) to evaluate the following variables: age, sex, number of hospitalizations, type of treatment, mania (Young Mania Rating Scale, or YMRS) and depression (Beck Depression Index, or BDI) symptoms, subsyndromal symptoms (BDI >7; YMRS >6), global suffering index, general index of social ability, self-esteem (Rosenberg scale), inadaptation (inadaptation Scale), anxiety (State-Trait Anxiety Inventory), quality of life (Global Activity Functioning), and health (European Quality of Life Scale). We considered favorable prognosis for subjects without persistent affective symptoms (BDI <7; YMRS <6) and/or without relevant difficulties in adaptation (Inadaptation Scale <14) in a 12-month follow-up.
  
  
  RESULTS
  A binary logistic regression showed that the type of treatment (combined therapy corresponded to better progression), the number of prior hospitalizations (fewer hospitalizations corresponded to better progression), and self-esteem (higher self-esteem corresponded to better prognosis) were statistically significant.
  
  
  CONCLUSIONS
  The type of treatment, the number of prior hospitalizations, and the level of self-esteem were the most influencing factors for a favorable progression of refractory bipolar disorder. Differently from other studies, no significant influences of age, sex, subsyndromal symptoms, anxiety, and depression symptoms on the prognosis of refractory bipolar disorder were observed in our study.
authors.affiliation: Servicio de Psiquiatría, Complejo Hospitalario Universitario Materno-Infantil de Gran Canaria, Las Palmas, Spain. anagonis@hotmail.com
authors.forename: Ana
authors.initials: A
authors.lastname: González-Isasi
authors.forename: Enrique
authors.initials: E
authors.lastname: Echeburúa
authors.forename: José María
authors.initials: JM
authors.lastname: Limiñana
authors.forename: Ana
authors.initials: A
authors.lastname: González-Pinto
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds