12-Month Outcome of Patients With Bipolar Disorder Following Hospitalization for a Manic or Mixed Episode

Keck, Paul E.; McElroy, Susan L.; Strakowski, Stephen M.; West, Scott A.; Sax, Kenji W.; Hawkins, John; Bourne, Michelle L.; Haggard, Patrick

doi:10.1176/ajp.155.5.646

Cited by 416 publications

(243 citation statements)

References 47 publications

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“…Twenty-eight percent did not suffer relapse though it is not clear what percent of those not taking medication were relapse free. In a 1 year follow-up of hospitalized manies with high rates of comorbid substance/alcohol abuse at admission, Keck et al (1998) report that 52% continued to abuse alcohol and/or drugs and 26% discontinued medication after discharge; in this sample, there was a 48% syndromic, 26% symptomatic, and 24% functional recovery. Goldberg et al (1995) described patients hospitalized for acute mania and found 20% not taking medication at 2 year followup.…”

Section: Discussionmentioning

confidence: 84%

Medication Treatment in Adolescents vs. Adults with Psychotic Mania

Carlson¹,

Lavelle²,

Bromet³

1999

Journal of Child and Adolescent Psychopharmacology

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An epidemiologic sample of first admission psychotic patients is used to examine naturalistic treatment of psychotic mania. Specifically, we examined if 15-20 year olds receive different medications, or respond differently from patients over age 30 who are also early in their course of illness. The major difference in the two groups, besides their age, is the presence of comorbid externalizing disorder and substance abuse in the younger group. This report further examines the impact of this comorbidity on the presence of further episodes and overall outcome. The findings indicate that acute treatment is very similar in the two groups, and that over a 4 year follow-up, about 40% of patients discontinue medication. In spite of that, 32% of the YOUTH subjects and 48% of the ADULT group did not have a second episode. Of those externalizing YOUTH with a single episode, 64% took no medication during follow-up. However, the major difference between admission, 24 month follow-up and 48 month follow-up was the discontinuation of substance/alcohol use and the improvement in functioning. Medication did not invariably make that difference. This community sample reveals that at 48 months, a significant minority of young and adult subjects hospitalized with psychotic mania will have a single episode, and that short term course in younger patients is considerably worse than longer term course.

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Section: Discussionmentioning

confidence: 84%

Medication Treatment in Adolescents vs. Adults with Psychotic Mania

Carlson¹,

Lavelle²,

Bromet³

1999

Journal of Child and Adolescent Psychopharmacology

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“…Demographic variables, such as older age [120], male sex [121, 122] and low socio-economic status [17, 18, 123], may also be considered as variables that influence the functioning of bipolar patients, although these results have yet to be sufficiently replicated. Other aspects could be environmental factors, such as social support [9, 31, 32] or life events [33].…”

Section: Resultsmentioning

confidence: 99%

“…However, a substantial proportion of bipolar patients show persistent subsyndromal symptoms, and most individuals with bipolar disorder are symptomatic more than half of their lives despite receiving pharmacological treatment [3, 4]. Even those patients who achieve full clinical remission show difficulties in making a complete functional recovery, returning to their premorbid level of functioning [5,6,7,8,9,10,11,12,13,14,15,16,17,18]. Nevertheless, psychosocial outcomes in patients with bipolar disorder have generally received less attention than those in patients with psychosis [7].…”

Section: Introductionmentioning

confidence: 99%

Functioning and Disability in Bipolar Disorder: An Extensive Review

Sanchez-Moreno

Martínez-Àran

Tabarés‐Seisdedos

et al. 2009

Psychother Psychosom

367

282

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Background: Bipolar disorder has generally been regarded as having a better functional outcome than schizophrenia. However, studies have suggested low functioning in bipolar patients even when they are in clinical remission. Our aim was to determine the degree of functioning and disability in bipolar patients. Secondly, we reviewed factors potentially associated with the low functioning of bipolar patients. Method: The authors conducted an extensive Medline and Pubmed search of the published literature from 1980 up to December 2007, using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further analysed for publications of interest. Articles that reported clinically significant findings on functioning and disability, and research reports were reviewed in detail. Results: From these articles, we determined that bipolar disorder is associated with significant impairment in work, family and social life, beyond the acute phases of the illness. The aspects that appear to increase the risk of low functioning and disability in bipolar patients are mainly subsyndromal symptoms and neurocognitive impairment, among others. Conclusions: Suitable pharmacological and psychological interventions may improve the level of functioning and reduce the disability in bipolar patients. Potential targets to be considered for intervention should be residual symptoms, comorbid conditions and neurocognitive deficits. Further research is required to better identify the factors that best predict functioning in bipolar patients.

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“…Of course we know that these also are all potential terminal illnesses, given suicide rates between 10% and 19% [5,6]. And lest we believe that bipolar disorder has a "good" prognosis, recall that Keck and colleagues found that one year after hospitalization for a manic or mixed episode, only 24% of patients with bipolar type I achieved functional recovery [7]. Facts and figures such as these are absolutely necessary when talking with people in political office.…”

Section: Point: Open Access Is Important In Fact Vitalmentioning

confidence: 99%