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Clinical course predicts long-term outcomes in bipolar disorder

Published online by Cambridge University Press:  28 June 2018

Rudolf Uher ,
Sanna Pallaskorpi ,
Kirsi Suominen ,
Outi Mantere ,
Barbara Pavlova  and
Erkki Isometsä
Rudolf Uher*
Affiliation:
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Sanna Pallaskorpi
Affiliation:
Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
Kirsi Suominen
Affiliation:
Helsinki City Department of Social Services and Healthcare, Mental Health and Substance Abuse Services, Helsinki, Finland
Outi Mantere
Affiliation:
Department of Psychiatry, McGill University, Montréal, QC, Canada Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, QC, Canada
Barbara Pavlova
Affiliation:
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Erkki Isometsä
Affiliation:
Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
*
Author for correspondence: Rudolf Uher, E-mail: uher@dal.ca
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Abstract

Background

The long-term outcomes of bipolar disorder range from lasting remission to chronic course or frequent recurrences requiring admissions. The distinction between bipolar I and II disorders has limited utility in outcome prediction. It is unclear to what extent the clinical course of bipolar disorder predicts long-term outcomes.

Methods

A representative sample of 191 individuals diagnosed with bipolar I or II disorder was recruited and followed for up to 5 years using a life-chart method. We previously described the clinical course over the first 18 months with dimensional course characteristics and latent classes. Now we test if these course characteristics predict long-term outcomes, including time ill (time with any mood symptoms) and hospital admissions over a second non-overlapping follow-up period in 111 individuals with available data from both 18 months and 5 years follow-ups.

Results

Dimensional course characteristics from the first 18 months prospectively predicted outcomes over the following 3.5 years. The proportion of time depressed, the severity of depressive symptoms and the proportion of time manic predicted more time ill. The proportion of time manic, the severity of manic symptoms and depression-to-mania switching predicted a greater likelihood of hospital admissions. All predictions remained significant after controlling for age, sex and bipolar I v. II disorder.

Conclusions

Differential associations with long-term outcomes suggest that course characteristics may facilitate care planning with greater predictive validity than established types of bipolar disorders. A clinical course dominated by depressive symptoms predicts a greater proportion of time ill. A clinical course characterized by manic episodes predicts hospital admissions.

Keywords

Bipolar disorderclinical coursehospital admissionslong-term follow-upoutcome prediction
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 7 , May 2019 , pp. 1109 - 1117
Copyright
Copyright © Cambridge University Press 2018 

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