Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
OBJECTIVE: Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines. The authors looked for the features associated with risk of recurrence. METHOD: The authors examined prospect...
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| Veröffentlicht in: | The American journal of psychiatry 2006-02, Vol.163 (2), p.217-224 |
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| creator | Perlis, Roy H. Ostacher, Michael J. Patel, Jayendra K. Marangell, Lauren B. Zhang, Hongwei Wisniewski, Stephen R. Ketter, Terence A. Miklowitz, David J. Otto, Michael W. Gyulai, Laszlo Reilly-Harrington, Noreen A. Nierenberg, Andrew A. Sachs, Gary S. Thase, Michael E. |
| description | OBJECTIVE: Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines. The authors looked for the features associated with risk of recurrence. METHOD: The authors examined prospective data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study for up to 24 months. For those who were symptomatic at study entry but subsequently achieved recovery, time to recurrence of mania, hypomania, mixed state, or a depressive episode was examined with Cox regression. RESULTS: Of 1,469 participants symptomatic at study entry, 858 (58.4%) subsequently achieved recovery. During up to 2 years of follow-up, 416 (48.5%) of these individuals experienced recurrences, with more than twice as many developing depressive episodes (298, 34.7%) as those who developed manic, hypomanic, or mixed episodes (118, 13.8%). The time until 25% of the individuals experienced a depressive episode was 21.4 weeks and until 25% experienced a manic hypomanic mixed episode was 85.0 weeks. Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence. Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic, hypomanic, or mixed episode recurrence. CONCLUSIONS: Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery. Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence. |
| doi_str_mv | 10.1176/appi.ajp.163.2.217 |
| format | Article |
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The authors looked for the features associated with risk of recurrence. METHOD: The authors examined prospective data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study for up to 24 months. For those who were symptomatic at study entry but subsequently achieved recovery, time to recurrence of mania, hypomania, mixed state, or a depressive episode was examined with Cox regression. RESULTS: Of 1,469 participants symptomatic at study entry, 858 (58.4%) subsequently achieved recovery. During up to 2 years of follow-up, 416 (48.5%) of these individuals experienced recurrences, with more than twice as many developing depressive episodes (298, 34.7%) as those who developed manic, hypomanic, or mixed episodes (118, 13.8%). The time until 25% of the individuals experienced a depressive episode was 21.4 weeks and until 25% experienced a manic hypomanic mixed episode was 85.0 weeks. Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence. Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic, hypomanic, or mixed episode recurrence. CONCLUSIONS: Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery. Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence.</description><identifier>ISSN: 0002-953X</identifier><identifier>EISSN: 1535-7228</identifier><identifier>DOI: 10.1176/appi.ajp.163.2.217</identifier><identifier>PMID: 16449474</identifier><identifier>CODEN: AJPSAO</identifier><language>eng</language><publisher>Washington, DC: American Psychiatric Publishing</publisher><subject>Adolescent ; Adult ; Adult and adolescent clinical studies ; Antidepressive Agents - therapeutic use ; Anxiety Disorders - diagnosis ; Anxiety Disorders - epidemiology ; Anxiety Disorders - psychology ; Biological and medical sciences ; Bipolar disorder ; Bipolar Disorder - diagnosis ; Bipolar Disorder - drug therapy ; Bipolar Disorder - epidemiology ; Bipolar Disorder - psychology ; Bipolar disorders ; Clinical outcomes ; Combined Modality Therapy ; Comorbidity ; Depressive Disorder - diagnosis ; Depressive Disorder - epidemiology ; Depressive Disorder - psychology ; Disease management ; Drug Therapy, Combination ; Female ; Humans ; Illnesses ; Longitudinal Studies ; Male ; Medical sciences ; Mental health care ; Mood disorders ; Prognosis ; Prospective Studies ; Psychiatric Status Rating Scales ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychotherapy ; Recurrence ; Risk Factors ; Treatment Outcome</subject><ispartof>The American journal of psychiatry, 2006-02, Vol.163 (2), p.217-224</ispartof><rights>2006 INIST-CNRS</rights><rights>Copyright American Psychiatric Association Feb 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a495t-c97406cb17c6f782a4d70abad50f072a41b87de4ef7043a8a407a674dfac67da3</citedby><cites>FETCH-LOGICAL-a495t-c97406cb17c6f782a4d70abad50f072a41b87de4ef7043a8a407a674dfac67da3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://psychiatryonline.org/doi/epdf/10.1176/appi.ajp.163.2.217$$EPDF$$P50$$Gappi$$H</linktopdf><linktohtml>$$Uhttps://psychiatryonline.org/doi/full/10.1176/appi.ajp.163.2.217$$EHTML$$P50$$Gappi$$H</linktohtml><link.rule.ids>315,782,786,2859,21635,21636,21637,27933,27934,77804,77809</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17474337$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16449474$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Perlis, Roy H.</creatorcontrib><creatorcontrib>Ostacher, Michael J.</creatorcontrib><creatorcontrib>Patel, Jayendra K.</creatorcontrib><creatorcontrib>Marangell, Lauren B.</creatorcontrib><creatorcontrib>Zhang, Hongwei</creatorcontrib><creatorcontrib>Wisniewski, Stephen R.</creatorcontrib><creatorcontrib>Ketter, Terence A.</creatorcontrib><creatorcontrib>Miklowitz, David J.</creatorcontrib><creatorcontrib>Otto, Michael W.</creatorcontrib><creatorcontrib>Gyulai, Laszlo</creatorcontrib><creatorcontrib>Reilly-Harrington, Noreen A.</creatorcontrib><creatorcontrib>Nierenberg, Andrew A.</creatorcontrib><creatorcontrib>Sachs, Gary S.</creatorcontrib><creatorcontrib>Thase, Michael E.</creatorcontrib><title>Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)</title><title>The American journal of psychiatry</title><addtitle>Am J Psychiatry</addtitle><description>OBJECTIVE: Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines. The authors looked for the features associated with risk of recurrence. METHOD: The authors examined prospective data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study for up to 24 months. For those who were symptomatic at study entry but subsequently achieved recovery, time to recurrence of mania, hypomania, mixed state, or a depressive episode was examined with Cox regression. RESULTS: Of 1,469 participants symptomatic at study entry, 858 (58.4%) subsequently achieved recovery. During up to 2 years of follow-up, 416 (48.5%) of these individuals experienced recurrences, with more than twice as many developing depressive episodes (298, 34.7%) as those who developed manic, hypomanic, or mixed episodes (118, 13.8%). The time until 25% of the individuals experienced a depressive episode was 21.4 weeks and until 25% experienced a manic hypomanic mixed episode was 85.0 weeks. Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence. Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic, hypomanic, or mixed episode recurrence. CONCLUSIONS: Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery. Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Anxiety Disorders - diagnosis</subject><subject>Anxiety Disorders - epidemiology</subject><subject>Anxiety Disorders - psychology</subject><subject>Biological and medical sciences</subject><subject>Bipolar disorder</subject><subject>Bipolar Disorder - diagnosis</subject><subject>Bipolar Disorder - drug therapy</subject><subject>Bipolar Disorder - epidemiology</subject><subject>Bipolar Disorder - psychology</subject><subject>Bipolar disorders</subject><subject>Clinical outcomes</subject><subject>Combined Modality Therapy</subject><subject>Comorbidity</subject><subject>Depressive Disorder - diagnosis</subject><subject>Depressive Disorder - epidemiology</subject><subject>Depressive Disorder - psychology</subject><subject>Disease management</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental health care</subject><subject>Mood disorders</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Psychiatric Status Rating Scales</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychotherapy</subject><subject>Recurrence</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>0002-953X</issn><issn>1535-7228</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9u1DAQhy0EokvhBTggCwkEh6T-l0zCjbZbQKrUFV0kbtasY9Oskji1k0OfglfG211RCSQ42SN98xt7PkJecpZzDuUJjmOb43bMeSlzkQsOj8iCF7LIQIjqMVkwxkRWF_L7EXkW4zaVTIJ4So54qVStQC3Iz1WwTWsmHyL1jn61Zg7BDsbSdqCn7eg7DPS8jT40Nnygq9D2GO7o1TwZ39tIL4Lv6XRj6fVdnGyPU2voOlicejtMdDncYMq6v6-C_xGwp86Hv4Lpu-v1cpWdnr9_Tp447KJ9cTiPybeL5frsc3Z59enL2cfLDFVdTJmpQbHSbDiY0kElUDXAcINNwRyDVPJNBY1V1gFTEitUDLAE1Tg0JTQoj8nbfe4Y_O1s46T7NhrbdThYP0cNKYXJovovyGuQUrIyga__ALd-DkP6hBaCFawCqBMk9pAJPsZgnR73G9Wc6Z1UvZOqk1SdpGqhk9TU9OqQPG962zy0HCwm4M0BwGiwcyEtvY0PHOwguQs62XP3Q34_7x-jfwGc77zH</recordid><startdate>20060201</startdate><enddate>20060201</enddate><creator>Perlis, Roy H.</creator><creator>Ostacher, Michael J.</creator><creator>Patel, Jayendra K.</creator><creator>Marangell, Lauren B.</creator><creator>Zhang, Hongwei</creator><creator>Wisniewski, Stephen R.</creator><creator>Ketter, Terence A.</creator><creator>Miklowitz, David J.</creator><creator>Otto, Michael W.</creator><creator>Gyulai, Laszlo</creator><creator>Reilly-Harrington, Noreen A.</creator><creator>Nierenberg, Andrew A.</creator><creator>Sachs, Gary S.</creator><creator>Thase, Michael E.</creator><general>American Psychiatric Publishing</general><general>American Psychiatric Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7TK</scope><scope>7X8</scope></search><sort><creationdate>20060201</creationdate><title>Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)</title><author>Perlis, Roy H. ; Ostacher, Michael J. ; Patel, Jayendra K. ; Marangell, Lauren B. ; Zhang, Hongwei ; Wisniewski, Stephen R. ; Ketter, Terence A. ; Miklowitz, David J. ; Otto, Michael W. ; Gyulai, Laszlo ; Reilly-Harrington, Noreen A. ; Nierenberg, Andrew A. ; Sachs, Gary S. ; Thase, Michael E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a495t-c97406cb17c6f782a4d70abad50f072a41b87de4ef7043a8a407a674dfac67da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Antidepressive Agents - therapeutic use</topic><topic>Anxiety Disorders - diagnosis</topic><topic>Anxiety Disorders - epidemiology</topic><topic>Anxiety Disorders - psychology</topic><topic>Biological and medical sciences</topic><topic>Bipolar disorder</topic><topic>Bipolar Disorder - diagnosis</topic><topic>Bipolar Disorder - drug therapy</topic><topic>Bipolar Disorder - epidemiology</topic><topic>Bipolar Disorder - psychology</topic><topic>Bipolar disorders</topic><topic>Clinical outcomes</topic><topic>Combined Modality Therapy</topic><topic>Comorbidity</topic><topic>Depressive Disorder - diagnosis</topic><topic>Depressive Disorder - epidemiology</topic><topic>Depressive Disorder - psychology</topic><topic>Disease management</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental health care</topic><topic>Mood disorders</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Psychiatric Status Rating Scales</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Psychotherapy</topic><topic>Recurrence</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Perlis, Roy H.</creatorcontrib><creatorcontrib>Ostacher, Michael J.</creatorcontrib><creatorcontrib>Patel, Jayendra K.</creatorcontrib><creatorcontrib>Marangell, Lauren B.</creatorcontrib><creatorcontrib>Zhang, Hongwei</creatorcontrib><creatorcontrib>Wisniewski, Stephen R.</creatorcontrib><creatorcontrib>Ketter, Terence A.</creatorcontrib><creatorcontrib>Miklowitz, David J.</creatorcontrib><creatorcontrib>Otto, Michael W.</creatorcontrib><creatorcontrib>Gyulai, Laszlo</creatorcontrib><creatorcontrib>Reilly-Harrington, Noreen A.</creatorcontrib><creatorcontrib>Nierenberg, Andrew A.</creatorcontrib><creatorcontrib>Sachs, Gary S.</creatorcontrib><creatorcontrib>Thase, Michael E.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Perlis, Roy H.</au><au>Ostacher, Michael J.</au><au>Patel, Jayendra K.</au><au>Marangell, Lauren B.</au><au>Zhang, Hongwei</au><au>Wisniewski, Stephen R.</au><au>Ketter, Terence A.</au><au>Miklowitz, David J.</au><au>Otto, Michael W.</au><au>Gyulai, Laszlo</au><au>Reilly-Harrington, Noreen A.</au><au>Nierenberg, Andrew A.</au><au>Sachs, Gary S.</au><au>Thase, Michael E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)</atitle><jtitle>The American journal of psychiatry</jtitle><addtitle>Am J Psychiatry</addtitle><date>2006-02-01</date><risdate>2006</risdate><volume>163</volume><issue>2</issue><spage>217</spage><epage>224</epage><pages>217-224</pages><issn>0002-953X</issn><eissn>1535-7228</eissn><coden>AJPSAO</coden><abstract>OBJECTIVE: Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines. The authors looked for the features associated with risk of recurrence. METHOD: The authors examined prospective data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study for up to 24 months. For those who were symptomatic at study entry but subsequently achieved recovery, time to recurrence of mania, hypomania, mixed state, or a depressive episode was examined with Cox regression. RESULTS: Of 1,469 participants symptomatic at study entry, 858 (58.4%) subsequently achieved recovery. During up to 2 years of follow-up, 416 (48.5%) of these individuals experienced recurrences, with more than twice as many developing depressive episodes (298, 34.7%) as those who developed manic, hypomanic, or mixed episodes (118, 13.8%). The time until 25% of the individuals experienced a depressive episode was 21.4 weeks and until 25% experienced a manic hypomanic mixed episode was 85.0 weeks. Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence. Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic, hypomanic, or mixed episode recurrence. CONCLUSIONS: Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery. Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence.</abstract><cop>Washington, DC</cop><pub>American Psychiatric Publishing</pub><pmid>16449474</pmid><doi>10.1176/appi.ajp.163.2.217</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Adult Adult and adolescent clinical studies Antidepressive Agents - therapeutic use Anxiety Disorders - diagnosis Anxiety Disorders - epidemiology Anxiety Disorders - psychology Biological and medical sciences Bipolar disorder Bipolar Disorder - diagnosis Bipolar Disorder - drug therapy Bipolar Disorder - epidemiology Bipolar Disorder - psychology Bipolar disorders Clinical outcomes Combined Modality Therapy Comorbidity Depressive Disorder - diagnosis Depressive Disorder - epidemiology Depressive Disorder - psychology Disease management Drug Therapy, Combination Female Humans Illnesses Longitudinal Studies Male Medical sciences Mental health care Mood disorders Prognosis Prospective Studies Psychiatric Status Rating Scales Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychotherapy Recurrence Risk Factors Treatment Outcome |
| title | Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) |
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