Early treatment dropout common in bipolar disorder
medwireNews: Results from a South Korean study show that around one-third of patients with bipolar disorder (BD) discontinue psychiatric treatment within 12 months of initiation.
In a study of 275 BD patients receiving planned maintenance treatment, the researchers found that dropout rates increased rapidly during the first 3 months of treatment and slowed after 12 months.
Specifically, dropout rates at 1, 3, 6, 12, 24, and 36 months after treatment initiation were 10.9%, 20.4%, 24.7%, 33.8%, 44.0%, and 50.2%, respectively.
Writing in the Journal of Affective Disorders, Kyooseob Ha (Seoul National University College of Medicine) and colleagues comment: "The optimal duration of treatment for bipolar disorders has not been established… However, given the high rates of relapse and recurrence, maintenance treatment of less than 1 year may not be recommended for bipolar disorders."
Patients with a previous diagnosis of BD or other axis I disorders had a significantly lower risk for dropout than those with no prior psychiatric diagnosis, at hazard ratios (HRs) of 0.242 and 0.434, respectively.
And the time to dropout was 76% shorter in patients with no previous diagnosis compared with those with a prior BD diagnosis.
A history of psychotic symptoms (HR=0.523) and longer illness duration were also associated with a reduced risk for dropout, while a previous history of dropout was associated with an increased risk (HR=1.746).
Gender, age, bipolar subtype, and mood state at the time of the first visit had no significant effect on dropout rates.
The researchers note that the most common reason for treatment dropout was "denial of therapeutic need" (34.8%), followed by "lack of treatment efficacy" (23.2%), and "adverse drug events" (13.0%).
Ha and team conclude: "A high early dropout rate for subjects with bipolar disorders was observed in this study, suggesting an increased risk for insufficient maintenance treatment."
As the main reasons for dropout were impaired insight regarding diagnosis and treatment, they add that the findings provide support for "the development of individualized psychoeducational programs to improve treatment adherence, along with social approaches to help improve public awareness of bipolar disorders."
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By Mark Cowen, Senior medwireNews Reporter