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07-07-2011 | Mental health | Article

Factors predicting refractory bipolar outcomes identified


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MedWire News: Patients with refractory bipolar disorder have better outcomes if they receive combined therapy, have fewer prior hospitalizations, and have better self-esteem, conclude Spanish researchers.

Refractory bipolar disorder is typically linked to a poor prognosis, with residual symptoms, rapid cycling, and suicide attempts. However, previous studies have indicated that there are a wide range of factors that influence outcomes in such patients.

To examine predictors of good outcomes, Ana González-Isasi, from Hospital Universitario Insular de Gran Canaria in Las Palmas, and colleagues studied 40 patients with refractory bipolar disorder randomized to combined drug plus psycho-educational and cognitive-behavioral treatment or drug treatment alone.

The team collected data on age, gender, and number of hospitalizations, and administered questionnaires to assess mania and depression symptoms, subsyndromal symptoms, global suffering, social ability, self-esteem, inadaptation, anxiety, quality of life, and health at baseline, post-treatment, and at 6- and 12-month follow-up.

Subsyndromal symptoms coupled with severe difficulties in social-occupational functioning were identified in 75% of patients, while 25% had frequent relapses with a rapid cycling course and had suicide attempts with additional poor functional outcomes.

Logistic regression analysis of therapeutic outcome at 12 months revealed that age, gender, psychiatric comorbidity, subsyndromal symptoms, and anxiety and depression were not significant predictors.

However, type of treatment, number of prior admissions, and self-esteem were found to be significant predictors of outcome at 12 months, which together accounted for 82.5% of cases, the researchers note in the journal Comprehensive Psychiatry.

Discussing the clinical implications of the findings, they write: "Patients with refractory bipolar disorder should benefit from a combined (drug and cognitive-behavioral) therapy, and it would be necessary to provide additional or more intensive therapy to patients with a high number of prior hospitalizations and to those with a more stable low self-esteem."

The team adds: "It would be interesting to test if the predictors found in this study are also applicable to nonrefractory bipolar patients."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Liam Davenport

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