Predictors of recurrence during long-term treatment of bipolar I and II disorders. A 4 year prospective naturalistic study

• Published in: Journal of affective disorders Vol. 225; pp. 123 - 128
• Main Authors: Tundo, Antonio, Musetti, Laura, Benedetti, Alessandra, Massimetti, Enrico, Pergentini, Irene, Cambiali, Erika, Dell'Osso, Liliana
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2018
• Subjects: Adult; Antidepressive Agents - therapeutic use; Bipolar Disorder - drug therapy; Bipolar Disorder - psychology; Bipolar disorder I; Bipolar disorder II; Disease Progression; Female; Follow-Up Studies; Humans; Long-Term Care; Male; Middle Aged; Mixed states; Predictors; Prognosis; Prospective Studies; Recurrence; Recurrences; Relapse; Reproducibility of Results; Secondary Care - methods; Bipolar disorder I; Bipolar disorder II; Relapse; Mixed states; Recurrences; Predictors
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2017.08.013

Despite the large number of treatments available for bipolar disorder (BD), more than one half of patients have a recurrence within 2 years, and over 90% experience at least one additional affective episode during their lifetime. The aim of this study was to test the impact of a number of demographic and clinical features on the risk to recurrence in a real- word representative sample of 266 outpatients with BD-I or II treated in a naturalistic setting during a 4-years-follow-up period. We found that the number of episodes per year after study entry, compared to the number of episodes per year before study entry,significantly decreased and that about one third of patients had no recurrences during the observation period. The length of follow-up and the number of previous episodes, mainly depressive, predicted the risk of recurrence, while female gender, higher age at intake, and a higher frequency of past mixed episodes predicted a higher frequency of recurrences. The study had some limitations to consider: i.e. the risk of poor reliability of information on the previous course of illness or the naturalistic treatment during the follow-up. Our study suggests that (a) an evidence-based long-term treatment, with regular follow-up visits could improve the course of disease and prognosis; (b) clinicians should carefully consider the presence of a high number of mixed episodes, to provide more targeted treatment strategies; (c) an appropriate use of antidepressants in selected patients did not worsen the course of illness. •Many studies investigated the predictors of relapse and recurrence in BD, sometimes producing conflicting results.•An evidence-based long-term treatment could improve the course of disease and prognosis.•The presence of a high number of mixed episodes should orient towards targeted treatment strategies.•The use of antidepressants does not worsen the course of illness in BD if correctly prescribed.