The Stanley Foundation Bipolar Network: Results of the Naturalistic Follow-Up Study after 2.5 Years of Follow-Up in the German Centres

Abstract

The Stanley Foundation Bipolar Network (SFBN) is an international, multisite network investigating the characteristics and course of bipolar disorder. Methods (history, ratings and longitudinal follow-up) are standardized and equally applied in all 7 centres. This article describes demographics and illness characteristics of the first 152 German patients enrolled in the SFBN as well as the results of 2.5 years of follow-up. Patients in Germany were usually enrolled after hospitalisation. More than 72% of the study population suffered from bipolar I disorder and 25% from bipolar II disorder. The mean ± SD age of the study participants was 42.08 ± 13.5 years, and the mean ± SD age of onset 24.44 ± 10.9 years. More than 40% of the sample reported a rapid-cycling course in history, and even more a cycle acceleration over time. 37% attempted suicide at least once. 36% had an additional Axis I disorder, with alcohol abuse being the most common one, followed by anxiety disorders. During the follow-up period, only 27% remained stable, 56% had a recurrence, 12.8% perceived subsyndromal symptoms despite treatment and regular visits. 27% suffered from a rapid-cycling course during the follow-up period. Recurrences were significantly associated with bipolar I disorder, an additional comorbid Axis I disorder, rapid cycling in history, a higher number of mood stabilizers and the long-term use of typical antipsychotics. Rapid cycling during follow-up was only associated with a rapid-cycling course in history, a higher number of mood stabilizers and at least one suicide attempt in history.

Impact of Bipolar Disorder: Results From a Screening Study

“…These findings are consistent with reports from the Stanley Foundation Bipolar German cohort, in which 40% of "rapid cyclers" suffered a recurrent rapidcycling course during a 2.5-year follow-up period. 9 A Veterans Affairs study cohort found that 14% of bipolar patients had experienced rapid cycling in the 12 months prior to intake (and 33% during the follow-up period), 10 while Schneck and colleagues 11 report a rapid-cycling rate of 20% in their cohort of 500 bipolar patients.…”

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

“…The reported risk of mood episodes, however, does vary considerably between long-term randomized controlled trials (RCT) and prospective, naturalistic studies. Within naturalistic trials, a considerable variance in the rates of and delay to new mood episodes was observed [5,6,7,8,9,10,11]. …”

Comorbidity

“…This is partially responsible for the varying prevalence rates among studies and the confl icting opinions between authors. Any anxiety disorder is reported to be present in 42-93 % of patients during lifetime and in almost 11-70 % cross-sectionally (Young et al 2013 ;Tamam and Ozpoyraz 2002 ;Altshuler et al 2010 ;Zutshi et al 2006 ;Simon et al 2004b ;Kawa et al 2005 ;Kessler et al 1997 ;Levander et al 2007 ;Nakagawa et al 2008 ;Goldstein and Levitt 2008 ;Schaffer et al 2006 ;Otto et al 2006 ;Nery-Fernandes et al 2009 ;Mantere et al 2006Mantere et al , 2010Henry et al 2003 ;Freeman et al 2002 ;Dittmann et al 2002 ;Das 2013 ;Cosoff and Hafner 1998 ;Ciapparelli et al 2007 ;Bellani et al 2012 ;McElroy et al 2001 ;Boylan et al 2004 ;Szadoczky et al 1998 ;Weber et al 2011 ;Azorin et al 2009 ). Up to half of these BD patients with comorbid anxiety manifest at least two anxiety disorders (Henry et al 2003 ).…”

“…The relationship of comorbid anxiety with suicidality is questionable (Slama et al 2004 ). Probably it is more frequent in BD-II than in BD-I patients (Dittmann et al 2002 ), although rapid cycling and substance abuse might reverse this and dramatically increase anxiety rates in BD-I (Gao et al 2008 ).…”

“…Any eating disorder (ED) is seen in 0-21 % of BD patients (Cassano et al 1998 ;Dittmann et al 2002 ;Edmonds et al 1998 ;MacQueen et al 2003 ;Mantere et al 2006Mantere et al , 2010McElroy et al 1995McElroy et al , 2001McElroy et al , 2011Wildes et al 2008 ;Seixas et al 2012 ;Pashinian et al 2006 ) and especially in females (Seixas et al 2012 ). Reversely twothirds of patients with ED also suffer from BD (Simpson et al 1992 ).…”