Relapse and impairment in bipolar disorder

TLDR

The study evaluated the long‑term outcomes of bipolar disorder under maintenance pharmacotherapy by prospectively following 82 outpatients for an average of 4.3 years, assessing symptoms and psychosocial functioning, and finding a 5‑year relapse risk of 73% despite ongoing treatment. Findings revealed that most relapsers experienced multiple episodes, cumulative affective morbidity—not merely relapse count—was a stronger predictor of psychosocial dysfunction, and that occupational disruption and depression were associated with poorer outcomes, indicating that aggressive pharmacotherapy alone does not prevent poor long‑term functioning.

Abstract

The purpose of this study was to evaluate the outcome of bipolar disorder in the context of maintenance pharmacotherapy.Eighty-two bipolar outpatients were followed prospectively for a mean of 4.3 years (minimum of 2 years); symptom rating and psychosocial outcome scales were used, and pharmacotherapy was rated on a 5-point scale.Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. Of those who relapsed, two-thirds had multiple relapses. Relapse could not be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure of cumulative affective morbidity appeared to be a more sensitive correlate of psychosocial functioning than was the number of relapses. Poor psychosocial outcome paralleled poor syndromal course. Poor psychosocial functioning, especially occupational disruption, predicted a shorter time to relapse. Depressions were most strongly related to social and family dysfunction.Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients.