A review of psychosocial outcome in patients with bipolar disorder

MacQueen, Glenda; Young, L.; Joffe, Russell T.

doi:10.1034/j.1600-0447.2001.00059.x

Cited by 305 publications

(200 citation statements)

References 77 publications

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“…31,32 However, contradictions about which factors predict outcomes are frequent in the literature. [13][14][15]31,33 The major reason of this inconsistency and higher number of previous depressive episodes predict the occurrence of new depressive episodes and their greater intensity. Therefore, more effective BD treatments should be developed, particularly for the management of depressive episodes, as they seem to have a greater impact on outcome.…”

Section: Resultsmentioning

confidence: 99%

The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up

Novis

Cirillo

Silva

et al. 2014

Trends Psychiatry Psychother.

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Introduction: Prospective studies have shown that the course of bipolar disorder (BD) is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. Objectives: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. Methods: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D17). Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. Results: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. Conclusion: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.

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Section: Resultsmentioning

confidence: 99%

The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up

Novis

Cirillo

Silva

et al. 2014

Trends Psychiatry Psychother.

View full text Add to dashboard Cite

show abstract

“…It is possible that the high number of episodes may determine brain long-lasting biochemical changes that could have some consequences on global functioning in bipolar patients (Young et al 1993, Post 1993. Moreover, some investigators have found that cognitive dysfunctions could worsen psychosocial outcome and employment in bipolar illness (Zarate, Jr. et al 2000, MacQueen et al 2001, Martinez-Aran et al 2004a. Patients with multi-episode bipolar disorder would be more prone to have cognitive impairment (Martinez-Aran et al 2004b), and this fact may be on the basis of poor social and occupational adjustment.…”

Section: Discussionmentioning

confidence: 99%

“…Data from 1450 patients showed that 30-60% of bipolar patients had detectable levels of psychosocial impairment (MacQueen et al 2001). Long duration illness has been associated with impaired social functioning (Hajek et al 2005).…”

Section: Introductionmentioning

confidence: 99%

The impact of the number of episodes on the outcome of Bipolar Disorder

et al. 2006

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-Background: Bipolar disorder is a highly recurrent severe psychiatric disorder. The number of episodes has been found consistently associated with poor outcome. It has been suggested that bipolar patients with long duration of illness and highly recurrent course show great impairment of global functioning.Objectives: The aim of this study is to assess the clinical course and outcome of patients with bipolar disorder I and II with a high number of mood episodes.Methods: We compared a group of bipolar I and II subjects whose number of episode was higher than ten (N = 167) with a similar-size representative sample of bipolar patients whose number of episodes was lower or equal than ten (N = 131).Results: Bipolar patients with more than 10 episodes have a more severe outcome of bipolar disorder. Qualification and occupational status was clearly worse for the highly recurrent group which showed a predominance of depressive polarity.Conclusions: These data suggest that bipolar patients with a highly recurrent course have significant functional impairment. With the passing of time, bipolar illness tends to be ruled by depressive features. Treatment strategies may need to address this issue.

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“…3 Of course, a clear relationship exists between symptom/syndromal outcome and functional outcome. 4 This relationship, however, is far from linear and may best be described as circular, with poor outcome in either domain predicting poor outcome in the other domain.…”

Section: Natural History Of Treated Bipolar Disordermentioning

confidence: 99%

Treatment-resistant bipolar disorder

2006

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Despite the remarkable increase in medications validated as effective in bipolar disorder, treatment is still plagued by inadequate response in acute manic or depressive episodes or in long-term preventive maintenance treatment. Established first-line treatments include lithium, valproate and second-generation antipsychotics (SGAs) in acute mania, and lithium and valproate as maintenance treatments. Recently validated treatments include extended release carbamazapine for acute mania and lamotrigine, olanzapine and aripiprazole as maintenance treatments. For treatment-resistant mania and as maintenance treatments, a number of newer anticonvulsants, and one older one, phenytoin, have shown some promise as effective. However, not all anticonvulsants are effective and each agent needs to be evaluated individually. Combining multiple agents is the most commonly used clinical strategy for treatment resistant bipolar patients despite a relative lack of data supporting its use, except for acute mania (for which lithium or valproate plus an SGA is optimal treatment). Other approaches that may be effective for treatment-resistant patients include high-dose thyroid augmentation, clozapine, calcium channel blockers and electroconvulsive therapy (ECT). Adjunctive psychotherapies show convincing efficacy using a variety of different techniques, most of which include substantial attention to education and enhancing coping strategies. Only recently, bipolar depression has become a topic of serious inquiry with the dominant controversy focusing on the place of antidepressants in the treatment of bipolar depression. Other than mood stabilizers alone or the combination of mood stabilizers and antidepressants, most of the approaches for treatment-resistant bipolar depression are relatively similar to those used in unipolar depression, with the possible exception of a more prominent place for SGAs, prescribed either alone or in combination with antidepressants. Future work in the area needs to explore the treatments commonly used by clinicians with inadequate research support, such as combination therapy and the use of antidepressants as both acute and adjunctive maintenance treatments for bipolar disorder. With the first report of lithium's efficacy in 1949 by Cade, bipolar disorder has the longest record of treatment efficacy among the major Axis I disorders. Furthermore, after more than half a century of clinical research, multiple agents from many different pharmacological classes have shown at least some efficacy, while many other agents (albeit without a consistent database demonstrating their utility) are prescribed regularly by clinicians. Yet, despite this plethora of choices, treatment of bipolar disorder remains suboptimal from the points of view of clinicians and patients alike. Whether measured by recovery time from manic or depressive episodes or preventive efficacy of maintenance treatments, bipolar disorder is characterized by sluggish responses, inadequate responses, poor compliance and recurrences in controlled cli...

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A review of psychosocial outcome in patients with bipolar disorder

Abstract: This review highlights the fact that inter-episode functional recovery is incomplete in some patients, suggesting that comprehensive rehabilitative assessment and intervention may be essential to reduce the morbidity associated with this disorder.

Cited by 305 publications

References 77 publications

The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up

The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up

The impact of the number of episodes on the outcome of Bipolar Disorder

Treatment-resistant bipolar disorder

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