Five-year outcome of bipolar I and II disorders: findings of the Jorvi Bipolar Study.
OBJECTIVE
The long-term outcome of bipolar disorder (BD) has been extensively investigated. However, previous studies may be biased towards hospitalized patients with bipolar I disorder (BD-I), and generalizability to the current treatment era remains uncertain. In this naturalistic study, we followed a secondary-care cohort of patients with BD.


METHODS
In the Jorvi Bipolar Study, 191 patients with BD-I and bipolar II disorder (BD-II) were followed using a life-chart method. Interviews were conducted at six months, 18 months, and five years. Time to full remission, time to first recurrence, total time ill, their predictors, and BD-I versus BD-II differences were investigated among the 151 patients remaining in follow-up.


RESULTS
Nearly all subjects recovered from the index episode, but almost all (90%) had a recurrence, and most had multiple recurrences. The patients spent about one-third of their time in illness episodes and 15% of their time with subthreshold symptoms; half of the time they were euthymic. After controlling for confounders, no difference in time spent in depressive states between patients with BD-I and BD-II persisted. Among patients with a depressive index phase, cluster C personality disorders [hazard ratio (HR) = 0.452, p = 0.040] and higher 17-item Hamilton Depression Scale score (HR = 0.951, p = 0.022) predicted longer time to remission, whereas lifetime psychotic symptoms (HR = 2.162, p = 0.016) predicted shorter time to first recurrence.


CONCLUSIONS
Among patients with BD, chronicity as uninterrupted persistence of illness was rare, but multiple recurrences were the norm. Patients with BD spent only half of their time euthymic. Patients with BD-I and BD-II may differ little in proneness to depressive states. Severity of depression, cluster C personality disorders, and psychotic symptoms predicted outcome.
Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland.|Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland.
Sanna
S
Pallaskorpi
Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland.|Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland.
Kirsi
K
Suominen
Operations and Technology Department, IE Business School-IE University, Madrid, Spain.
Mikko
M
Ketokivi
Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland.|Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.|Department of Psychiatry, University of Helsinki, Helsinki, Finland.
Outi
O
Mantere
Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland.|Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland.
Petri
P
Arvilommi
Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland.|Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland.
Hanna
H
Valtonen
Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.|Finnish Institute of Occupational Health, Helsinki, Finland.
Sami
S
Leppämäki
Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland.|Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.|Department of Psychiatry, University of Helsinki, Helsinki, Finland.
Erkki
E
Isometsä
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D063127:Secondary Health Care; D016896:Treatment Outcome
bipolar disorder; cohort studies; outcome; recurrence; remission