Sociodemographic and Clinical Predictors of Response in Manic Episodes: A Naturalistic, Prospective, Cohort Study

Abstract

Background:Response to treatment of a manic episode is dependent on several sociodemographic and clinical factors as reported by researchers from other countries. The prescription of mood stabilizers and/or antipsychotics for manic episode depends on these factors. There is a lack of availability of data from India on this topic. Hence, this study was planned to identify the predictors of pharmacological response.Materials and Methods:Forty-two patients with a diagnosis of bipolar affective disorder current episode manic were enrolled and assessed for sociodemographic variables and clinical variables such as age of onset, family history, comorbidities, index episode, and number of past episodes. They were divided into four groups depending on the treatment they were receiving, namely, lithium with an antipsychotic (n = 25), lithium with divalproex and an antipsychotic (n = 8), divalproex with an antipsychotic (n = 5), and the miscellaneous group (n = 4). The primary outcome measure was improvement in the Young Mania Rating Scale score and secondary outcome measure was duration of ward stay.Results:There was a significant improvement in all the treatment modalities and it was comparable. There was no significant impact of any sociodemographic or clinical variable on treatment outcome except that females had significantly better response than males. There was nearly significant shorter duration of hospitalization in the lithium and antipsychotics groups compared to divalproex group.Conclusion:All treatment modalities are equally efficacious in the management of manic episode in short term. However, lithium and antipsychotics tend to produce early response than divalproex. Other sociodemographic and clinical predictors were not significantly associated with response.

Are There Any Differences in Clinical and Biochemical Variables between Bipolar Patients with or without Lifetime Psychotic Symptoms?

“…Different factors can explain the greater difficulty in obtaining clinical stabilization of psychotic versus non-psychotic bipolar patients, including more severity of illness at the time of admission to the hospital [ 44 , 45 , 46 ], the negative impact of the more numerous previous manic episodes [ 15 , 47 , 48 ] and the predominance of male gender that is more frequently characterized by comorbid substance use disorders [ 49 ]. Of note, some authors argued that bipolar women can have a better response to pharmacotherapy compared to men [ 50 ]. In addition, male hormones would favor the onset of psychotic symptoms in patients suffering from mood disorders [ 51 ], as revealed in previous studies, which showed that how higher dehydroepiandrosterone sulfate plasma levels could be associated with the presence of lifetime psychotic symptoms [ 52 , 53 ].…”