Book chapter
Bipolar I affective disorder: predictors of outcome after 15 years
The Science of Mental Health, pp.69-75
Routledge, 1
2001
DOI: 10.4324/9781315054308-8
Abstract
Background
Robust predictors of long-term outcome in bipolar affective disorder would have substantial importance to both clinicians and researchers. Such predictors are not available, however, perhaps because of the limitations of previous efforts to find them.
Methods
In this study, 113 patients with bipolar affective disorder were followed semiannually for 5 years and annually for a subsequent 15 years. Of these, 23 (20.4%) had a poor long-term outcome indicated by the presence of mania or major depressive disorder throughout the 15th year.
Results
Among the baseline demographic and clinical variables tested, only active alcoholism and low levels of optimum functioning in the preceding 5 years characterized poor outcome patients. The persistence of depressive symptoms in the first 2 years of follow-up predicted depressive symptoms 15 years later but the early persistence of manic symptoms seemed to have no predictive value. A regression analysis eliminated alcoholism as an independent predictor. Thus, only poor optimal functioning in the 5 years before baseline assessment, and the persistence of depressive symptoms in the two subsequent years, were independently associated with poor, long-term prognosis.
Limitations
Patients were recruited at tertiary care centers and sampling was therefore biased toward greater severity and chronicity. As is true of all naturalistic studies of course, treatment was not controlled.
Conclusion
These findings suggest the existence of a poor outcome, depression-prone subtype of bipolar affective disorder. © 1998 Elsevier Science B.V. All rights reserved.
All somatic treatments directed at mental disorders were carefully quantified on a week-by-week basis, though, and raters recorded individual drugs and their doses. Though bipolar affective disorder is a remitting illness, and has a prognosis which compares favorably to certain other psychiatric illnesses, a substantial number of those with this disorder face an unfavorable longterm outcome. Despite a number of efforts to characterize the eventual outcomes of particular disorders, and to identify robust predictors, conclusions are severely limited by methodological weaknesses and by inconsistencies across studies. The variables which were statistically significant predictors of outcome status in the univariate analyses were entered as independent variables in an analysis of covariance. Of the five poor outcome patients with active alcoholism at intake, one met criteria for definite alcoholism at any point in the 15th year of follow-up. The use of structured interviews insured the uniform assessment of potential predictors and the direct interview of subjects determined all outcome measures.
Details
- Title: Subtitle
- Bipolar I affective disorder: predictors of outcome after 15 years
- Creators
- William CoryellCarolyn TurveyJean EndicottAndrew C LeonTimothy MuellerDavid SolomonMartin Keller - University of Iowa
- Resource Type
- Book chapter
- Publication Details
- The Science of Mental Health, pp.69-75
- Edition
- 1
- DOI
- 10.4324/9781315054308-8
- Publisher
- Routledge
- Alternative title
- W. Coryell et al. / Journal of Affective Disorders 50(1998) 109–116
- Language
- English
- Date published
- 2001
- Academic Unit
- Psychiatry; Epidemiology
- Record Identifier
- 9984281754702771
Metrics
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