title: Treatment and outcomes of an Australian cohort of outpatients with bipolar I or schizoaffective disorder over twenty-four months: implications for clinical practice.
abstract: BACKGROUND
  The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with 'real-world' treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication.
  
  
  METHODS
  Participants prescribed either conventional mood stabilizers (CMS; n = 155) alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84) were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale - Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data.
  
  
  RESULTS
  On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine ± CMS (61%;) cohorts.
  
  
  CONCLUSIONS
  Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, Central Clinical School, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia. jayashri.kulkarni@monash.edu
authors.forename: Jayashri
authors.initials: J
authors.lastname: Kulkarni
authors.forename: Sacha
authors.initials: S
authors.lastname: Filia
authors.forename: Lesley
authors.initials: L
authors.lastname: Berk
authors.forename: Kate
authors.initials: K
authors.lastname: Filia
authors.forename: Seetal
authors.initials: S
authors.lastname: Dodd
authors.forename: Anthony
authors.initials: A
authors.lastname: de Castella
authors.forename: Alan J M
authors.initials: AJ
authors.lastname: Brnabic
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lowry
authors.forename: Katarina
authors.initials: K
authors.lastname: Kelin
authors.forename: William
authors.initials: W
authors.lastname: Montgomery
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018692:Antimanic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001315:Australia; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000523:psychology; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D017063:Outcome Assessment, Health Care; D010045:Outpatients / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000188:drug therapy*; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D014635:Valproic Acid / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid; D000077152:Olanzapine