Relapsing a global issue in bipolar disorder
medwireNews: International study findings highlight the high risk for relapse and the extensive healthcare requirements of patients with bipolar disorder.
The Wide AmbispectiVE study of the clinical management and burden of bipolar disorder (WAVE-bd) included 2896 patients from nine European countries plus Venezuela, who were followed up for at least 9 months.
In all, 18.2% of patients had a relapse and 40.5% had a recurrence. The corresponding incidence rates were 1.562 and 0.691 per person-year, reflecting that many patients had multiple relapses in 1 year. Depressive relapses and recurrences were most common, at 0.798 and 0.352 per person-year, respectively, followed by hypomanic, manic, and mixed episodes.
Lead researcher Eduard Vieta (University of Barcelona, Spain) and co-workers identified several independent predictors of relapses, including rapid cycling. "Short periods of euthymia may be a proxy of subclinical symptoms, which have been consistently reported to predict recurrences," they note in the International Journal of Neuropsychopharmacology.
Other predictors for relapse included having made least one suicide attempt, older age, living alone, having a family history of mental illness, and being prescribed antidepressants during the study index episode. Predictors for recurrence included current alcohol or drug abuse, having a family history of mental illness, rapid cycling, and being prescribed anxiolytics, sedatives, or hypnotics.
"Taken together, the predictors identified in this study are clinical markers of longitudinal severity, which confirm the findings of previous studies," says the team.
The study shows that patients with bipolar disorder made extensive use of healthcare resources, making 7.5 psychiatrist visits per person-year, and 11.2 total healthcare visits per person-year, including to the psychiatrist, primary care physician, group therapy, and the emergency department.
The patients' disease characteristics tended to be consistent across the 10 study countries, but there were marked variations in therapeutic approach, particularly regarding the type and intensity of treatment during different mood episodes.
The team reports that patients received about three different drugs across all phases, "confirming that polytherapy is the rule rather than the exception, regardless of guideline recommendations."
Patients were given an average of 2.84 drugs during mania, 2.61 during hypomania, 3.11 during depression, 3.17 during mixed episodes, and 2.87 during euthymia. Interestingly, euthymia was the phase in which patients were least likely to be untreated, with just 6.1% receiving no medication, compared with 6.3-11.0% during the other phases.
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By Eleanor McDermid, Senior medwireNews Reporter