Objective: Recent studies have shown that outcome in mania is worse than previously thought. Such studies have been conducted in selected samples with restrictive measures of outcome. We aimed to explore outcome and its predictors in a catchment area sample of first episode psychotic mania of DSM-III-R bipolar I disorder.
Methods: Prospective 6 and 12 months follow up was conducted with 87 DSM-IIIR first episode psychotic mania patients admitted to EPPIC between 1989 and 1997. Syndromic and symptomatic outcome were determined with the BPRS; functional outcome with the QLS and PAS sub-items.
Results: Symptomatic outcome was assessed in 67 patients at 6 months and 61 patients at 12 months, and functional outcome in 56 patients at 6 months and 49 patients at 12 months. 46 and 43 patients respectively were used to conduct logistic regressions to explore predictors of outcome. While 90% of patients achieved syndromic recovery at 6 and 12 months, 40% hadn't recovered symptomatically at 6 and 12 months, still presenting with anxiety or depression. 66% of patients at 6 months and 61% of patients at 12 months failed to return to previous levels of function. Age at intake, family history of affective disorder, illicit drug use and functional recovery at 6 months predicted functional outcome at 12 months.
Conclusions: This study confirms poor symptomatic and functional outcome after first episode psychotic mania. It suggests possible usefulness of early intervention strategies in bipolar disorders and need for developing specific interventions addressing anxiety, depression and substance abuse co-morbidity.