Relapse and impairment in bipolar disorder
Abstract
Objective The purpose of this study was to evaluate the outcome of bipolar disorder in the context of maintenance pharmacotherapy. Method 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. Results 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. Conclusions Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients.
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Depressive symptoms are the largest contributor to impaired functioning in people with bipolar disorders.
“Depression was chosen as the key outcome, rather than mania or hypomania, as depressive symptoms are the largest contributor to impaired functioning in people with bipolar disorders (Gitlin, Swendsen, Heller, & Hammen, 1995; Morriss et al., 2007).”
From What are People's Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial. (2017) · cites this paper as Gitlin, Swendsen, Heller, & Hammen, 1995
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- Authors
- Gitlin, M. J., Swendsen, J. D., Heller, T., & Hammen, C. L.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- American Journal of Psychiatry
- Published
- 1995-11-01
- Volume
- 152
- Issue
- 11
- Pages
- 1635-1640
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W1747641688
- Cited by
- 762
- References
- 3
- Citations by year
- 2025: 11 · 2024: 10 · 2023: 11 · 2022: 16 · 2021: 13 · 2020: 24 · 2019: 16 · 2018: 21 · 2017: 26 · 2016: 40 · 2015: 39 · 2014: 38 · 2013: 27 · 2012: 29
- FWCI
- 10.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar disorder, relapse, maintenance pharmacotherapy, long-term outcomes, psychosocial functioning, occupational disruption, time to relapse, mania, depression
- MeSH terms
- Adaptation, Psychological, Adult, Ambulatory Care, Bipolar Disorder, Carbamazepine, Drug Therapy, Combination, Family Health, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Social Adjustment, Valproic Acid, Survival Analysis, Lithium Carbonate, Treatment Outcome
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