OBJECTIVE: The purpose of this study was to evaluate the outcome of
bipolar disorder in the context of maintenance pharmacotherapy. METHOD:
Eighty-two bipolar outpatients were followed prospectively for a mean of
4.3 years (minimum of 2 years); symptom rating and psychosocial outcome
scales were used, and pharmacotherapy was rated on a 5-point scale.
RESULTS: Despite continual maintenance treatment, survival analysis
indicated a 5-year risk of relapse into mania or depression of 73%. Of
those who relapsed, two-thirds had multiple relapses. Relapse could not be
attributed to inadequate medication. Even for those who did not relapse,
considerable affective morbidity was observed. A measure of cumulative
affective morbidity appeared to be a more sensitive correlate of
psychosocial functioning than was the number of relapses. Poor psychosocial
outcome paralleled poor syndromal course. Poor psychosocial functioning,
especially occupational disruption, predicted a shorter time to relapse.
Depressions were most strongly related to social and family dysfunction.
CONCLUSIONS: Even aggressive pharmacological maintenance treatment does not
prevent relatively poor outcome in a significant number of bipolar