Lithium treatment of bipolar affective disorders under naturalistic followup conditions

A naturalistic followup was conducted on 41 bipolarmanic inpatients who sought ongoing treatment after hospital discharge. Standardized interviews were conducted 2 and 4.5 years after hospitalization to assess medication use, outcome, and relapse. At followup, 41 percent of the bipolar patients taking lithium had poor outcome. Nearly half met criteria for relapse and had been rehospitalized. Patients on lithium had the same work and overall functioning as those who were not taking it. Patients on lithium alone, however, had significantly better adjustment and fewer relapses compared with those taking lithium plus neuroleptics. A subgroup of good-prognosis bipolar patients may respond to lithium monotherapy under typical clinical conditions, however, those requiring adjunctive maintenance neuroleptics may be at higher risk for poor outcome. Lithium prophyliaxis may be less effective in routine clinical practice than in specialized treatment centers, possibly due to less rigorous treatment monitoring, medication noncompliance, complex affective symptoms, and poorer surveillance to defect recurrent prodromal illness.