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Relapse and impairment in bipolar disorder
M J Gitlin1, J Swendsen, T L Heller
1Department of Psychiatry, University of California, Los Angeles 90024-6968, USA.
The American Journal of Psychiatry
|November 1, 1995
Summary
Maintenance pharmacotherapy for bipolar disorder shows a high 5-year relapse risk of 73%, indicating limited effectiveness. Even without relapse, patients experience significant affective morbidity impacting psychosocial functioning.
Area of Science:
- Psychiatry
- Clinical Psychology
Background:
- Bipolar disorder (BD) is a chronic mental health condition.
- Effective long-term management strategies for BD are crucial.
Purpose of the Study:
- To assess the long-term outcomes of bipolar disorder patients undergoing maintenance pharmacotherapy.
- To evaluate the efficacy of ongoing medication in preventing relapse and maintaining psychosocial functioning.
Main Methods:
- Prospective follow-up of 82 bipolar outpatients for a mean of 4.3 years.
- Utilized symptom rating scales and psychosocial outcome measures.
- Pharmacotherapy was systematically rated for adherence and adequacy.
Main Results:
- A 73% risk of relapse into mania or depression within 5 years was observed, despite continuous treatment.
- Two-thirds of relapsed patients experienced multiple episodes.
- Cumulative affective morbidity, rather than relapse frequency, correlated more strongly with psychosocial functioning.
- Poor psychosocial functioning, particularly occupational disruption, predicted shorter time to relapse.
Conclusions:
- Aggressive pharmacological maintenance treatment does not guarantee favorable outcomes for many bipolar disorder patients.
- Significant affective morbidity and psychosocial dysfunction persist even with consistent treatment.
- Further research is needed to improve long-term management and outcomes for bipolar disorder.