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10-07-2013 | Mental health | Article

Manic episodes have lasting consequences


Free abstract

medwireNews: Having a history of manic episodes is associated with an increased risk for death later in life, report researchers.

Their population-based study involved 14,870 people, 1237 of whom reported a lifetime history of manic symptoms in the diagnostic interview schedule at baseline in 1980-1983.

Manic symptoms ranged from DSM-III-defined manic episodes to subclinical symptoms of mania. During 26 years of follow up, these people had a 1.41-fold increased risk for dying of any cause relative to those without manic symptoms, after accounting for age and demographic variables, including a history of depressive symptoms.

This risk increase is considerably lower than the more than threefold increase reported in a previous follow up of patients discharged from hospital after a manic episode, note lead study author Christine Ramsey (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) and team.

"Taken together, these findings may suggest that while patients with bipolar disorder severe enough to require inpatient treatment are at greatest risk, individuals with the more common manic spectrum episodes in the community are also at increased risk of mortality," they write in the Journal of Affective Disorders.

The rate of death was higher among people without manic symptoms than with, at 42.9% versus 27.1%; however, they were older at baseline interview, at 49.6 versus 37.5 years. Indeed, people with a history of mania tended to die at a younger age than those without mania, significantly so for the 195 people with hypomania, at 64.5 versus 78.2 years.

The association between manic symptoms and all-cause mortality was markedly attenuated by further adjustment for alcohol or drug addiction/abuse, especially among people who were aged 30-44 or 45-64 years at baseline. For these individuals, initially significant risk increases of 1.39- and 1.41-fold, respectively, were rendered nonsignificant.

In all, 31.4% of people with a history of manic symptoms reported previous alcohol or drug addiction/abuse, compared with just 10.5% of those without.

"These findings may suggest that premature mortality in individuals with a history of manic symptoms may be at least partially attributed to modifiable behavioral risk factors such as substance abuse/dependence," suggest Ramsey et al.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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