COMMENTARY

The Year in Psychiatry: Studies Not to Miss From 2011

Christoph U. Correll, MD; Maren Carbon, MD

Disclosures

November 23, 2011

In This Article

Impact of Prior Illness in Bipolar Disorder

Berk M, Brnabic A, Dodd S, et al. Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention. Bipolar Disord. 2011;13:87-98.

Predicting and enhancing response and remission during the treatment of bipolar disorder are crucial goals. In this study, Berk and colleagues highlight the importance of early, efficient intervention in bipolar disorder. They reassessed pooled data of olanzapine treatment in patients with bipolar mania, bipolar depression, and during maintenance treatment, categorizing patients by their number of earlier episodes of their bipolar disorder illness (ie, 1-5; 6-10; > 10 episodes). Of note, results from these post-hoc analyses revealed that response rates differed significantly by the number of previous episodes. Patients experiencing their first episode of mania (depression and maintenance studies did not have sufficient first-episode subjects) had twice the chance to respond than those having already experienced 1-5 episodes. In patients with 1-5 earlier episodes, response rates were 52%-69% for mania and 10%-50% during maintenance treatment. Response rates in patients with more than 5 episodes were significantly lower, ie, reduced to 29%-59% for mania and to 11%-40% for maintenance.

The chance of relapse to either depression or mania, despite olanzapine treatment, doubled in those patients with more than 5 episodes, compared with patients with 1-5 episodes. However, compared with the mania studies, in the depression studies, response rates were significantly higher for the 1- to 5-relapses group for 2 measures only. In the maintenance studies, the chance of relapse to either mania or depression was reduced by 40%-60% for those who had experienced 1-5 episodes or 6-10 episodes compared with the >10-episode group, respectively. However, again, this trend was statistically significant only for relapse into mania for the 1- to 5-episode group, suggesting that the number of relapses have an even stronger effect on promoting new manic episodes.

Taken together, these data emphasize the importance of early identification of bipolar disorders, timely treatment during the first episode, and a focus on preventing each and every relapse. Because other data have shown that residual symptoms, comorbidities, and nonadherence to treatment are relevant factors fueling relapse, these areas clearly also deserve close attention for improving long-term course and outcomes in patients with bipolar disorder.

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