Seasonality, Smoking and History of Poor Treatment Compliance are Strong Predictors of Dropout in a Naturalistic 6 Year Follow-Up of Bipolar Patients

Abstract

Bipolar disorder is a highly recurrent disease which requires long-term treatment. Dropout is a major problem, poorly understood. The objectives of this study were to know the risk of dropout of a cohort of bipolar patients under ambulatory treatment and to identify the clinical profile of patients more likely to abandon the follow-up. A sample of 285 BD I and II patients was followed up for a mean of 2.87 years. A significant proportion of patients failed regular follow-up. The dropout rates were 6.3 % at three months, 12.7 % at 6 months, and 17.6, 27.2, 37.3, 44.0, 47.2 and 49.0 % at 1, 2, 3, 4, 5 and 6 years respectively. Very few variables at baseline predicted dropout. Patients under 35 years of age were more likely to dropout than older cases. Seasonality, smoking and specially history of poor treatment compliance were strong predictors of dropout. Given the magnitude of dropout, additional early clinical interventions should be considered for high-risk patients.

A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults

“…Table describes 51 samples of patients with bipolar disorder from 16 different countries. A total of 41,710 patients are described (45% were current smokers).…”

“…The upper panel in Table 2 describes 26 samples from ten different countries, which included a total of 2,987 men with bipolar disorder (48% were current smokers). Current smoking prevalences for men with bipolar disorder were always higher than those for men from the general population, regardless of country.…”

“…Supplementary Table 1 details our computer search, describing the excluded articles ( see Supplementary Data File #1 ) and the 55 articles on adults ( see Supplementary Data File #2 ) included in at least one of the data tables (Tables and Supplementary Tables 2–7 ). Forty‐eight of the 55 articles were obtained from a PubMed computer search and the remaining seven came from the senior author's collection . Twelve additional articles with data on bipolar disorder were included in the text of the present review but not in the data tables; 11 of these were from the PubMed search and one came from the senior author's collection .…”

“…The authors also thank the reviewers who helped to make this complex article easier to read. The following authors of prior published articles provided additional unpublished data that allowed the inclusion of their articles in other data tables: V. L. Ellingrod for reference , E. Ezquiaga for reference , L. Sylvia and the Bipolar Trials Network for reference , D. Castle and S. G. Mancuso for reference . Lital Keinan‐Boker, M.D., Ph.D., MPH, Deputy Director, Israel Center for Disease Control, Israel Ministry of Health, provided data on tobacco smoking from the Israeli general population in 2013 stratified by gender, which was not included in the publication .…”

Cigarette Smoking in an Acute Partial Hospital Program

“…Despite the well-known risks of smoking, it is estimated that approximately 37.8 million Americans (15.5% of adults) continue to smoke, and the percentage who smoke is significantly greater among people with “severe psychological distress” (35.8%) than among people without such distress (14.7%) (Jamal et al, 2018). Associations have been established between cigarette smoking and many psychiatric conditions, including the development of several psychiatric disorders (Covey et al, 1998; Gurillo et al, 2015; Hersi et al, 2017; Isensee et al, 2003; Luger et al, 2014; Moylan et al, 2012), suicidality (Aubin et al, 2011; Baek et al, 2013; Goodwin et al, 2013; Li et al, 2012; Poorolajal and Darvishi, 2016), clinical course (Bakhshaie et al, 2015, 2016; Ezquiaga et al, 2014; Graff et al, 2008; Ostacher et al, 2006), and retention in psychiatric treatment (Ezquiaga et al, 2014; Graff et al, 2008; Ostacher et al, 2006), although the causes and mechanisms of these associations are not well understood.…”