Objective: To describe clinical characteristics, course, and outcome during a 1-year period after the first manic episode in patients with bipolar disorder (BD).Methods: This paper describes the project design, demographics, clinical outcomes, and predictors at 6 months to 1 year of follow-up of the first 53 recruited subjects with first-episode mania from the Systematic Treatment Optimization Program for Early Mania.Results: Survival analysis for recurrence of mood episodes showed that 46.7% of patients survived without a mood episode during 1-year of follow-up, and the mean time-to-mood event was 7.9 months. Earlier age of onset was the only variable that significantly predicted recurrence of mood episodes. When examined separately, the survival rates were 76% for a manic episode and 58.7% for a depressive episode.
Conclusion:These results suggest that recurrences are common after the first manic episode with more than one-half of the patients experiencing a mood event within 12 months. Aggressive treatment strategies aimed at preventing depressive episodes are needed in the management of early course BD.Can J Psychiatry. 2009;54(2):105-112.
Clinical Implications· Depressive recurrences are common after the first manic episode and deserve special clinical attention. · Younger age at onset of mood episodes was significantly associated with worse outcome, reinforcing the need for preventive strategies. · As these patients received comprehensive treatments, the data suggests that currently available treatments are not adequate in preventing depression for a significant proportion of patients.
Limitations· The sample size may have restricted the ability to detect smaller effect sizes of other predictors of recurrence. · This study design does not allow an assessment of the impact of different treatments on outcome. · The relatively shorter period of follow-up limits the conclusions about outcome to the early recovery phase of BD.