The McLean-Harvard First-Episode Mania Study: Prediction of Recovery and First Recurrence

doi:10.1176/appi.ajp.160.12.2099



	Full Text
	Full Text (PDF)
	Alert me when this article is cited
	Alert me if a correction is posted
	Citation Map



	Email this article to a Colleague
	Similar articles in this journal
	Similar articles in PubMed
	Alert me to new issues of the journal
	Add to My Articles & Searches
	Download to citation manager



	Citing Articles via HighWire
	Citing Articles via Google Scholar



	Articles by Tohen, M.
	Articles by Baldessarini, R. J.
	Search for Related Content



	PubMed Citation
	Articles by Tohen, M.
	Articles by Baldessarini, R. J.



	Bipolar Disorder
	Symptoms/Dimensions
	Related Article

Am J Psychiatry 160:2099-2107, December 2003
© 2003 American Psychiatric Association

Article

The McLean-Harvard First-Episode Mania Study: Prediction of Recovery and First Recurrence

Mauricio Tohen, M.D., Dr.P.H., Carlos A. Zarate, Jr., M.D., John Hennen, Ph.D., Hari-Mandir Kaur Khalsa, A.B., Stephen M. Strakowski, M.D., Priscilla Gebre-Medhin, M.S., Paola Salvatore, M.D., and Ross J. Baldessarini, M.D.

OBJECTIVE: Since improved prediction of illness course earlyin bipolar disorder is required to guide treatment planning,the authors evaluated recovery, first recurrence, and new illnessonset following first hospitalization for mania. METHOD: Bipolardisorder patients (N=166) were followed 2–4 years aftertheir first hospitalization for a manic or mixed episode toassess timing and predictors of outcomes. Three aspects of recoverywere measured: syndromal (DSM-IV criteria for disorder no longermet), symptomatic (Young Mania Rating Scale score $<=$ 5 and HamiltonDepression Rating Scale score $<=$ 8), and functional (regainingof premorbid occupational and residential status). Rates ofremission (syndromal recovery sustained $>=$ 8 weeks),switching (onset of new dissimilar illness before recovery),relapse (new episode of mania within 8 weeks of syndromal recovery),and recurrence (new episode postremission) were also assessed.RESULTS: By 2 years, most subjects achieved syndromal recovery(98%, with 50% achieving recovery by 5.4 weeks); 72% achievedsymptomatic recovery. Factors associated with a shorter timeto syndromal recovery for 50% of the subjects were female sex,shorter index hospitalization, and lower initial depressionratings. Only 43% achieved functional recovery; these subjectswere more often older and had shorter index hospitalizations.Within 2 years of syndromal recovery, 40% experienced a newepisode of mania (20%) or depression (20%), and 19% switchedphases without recovery. Predictors of mania recurrence wereinitial mood-congruent psychosis, lower premorbid occupationalstatus, and initial manic presentation. Predictors of depressiononset were higher occupational status, initial mixed presentation,and any comorbidity. Antidepressant treatment was marginallyrelated to longer time to recovery and earlier relapse. CONCLUSIONS:Within 2–4 years of first lifetime hospitalization formania, all but 2% of patients experienced syndromal recovery,but 28% remained symptomatic, only 43% achieved functional recovery,and 57% switched or had new illness episodes. Risks of new manicand depressive episodes were similar but were predicted by contrastingfactors.

Related Article:

In This Issue
Am J Psychiatry 2003 160: A46. [Full Text] [PDF]

This article has been cited by other articles:

S. Maeng, J. G. Hunsberger, B. Pearson, P. Yuan, Y. Wang, Y. Wei, J. McCammon, R. J. Schloesser, R. Zhou, J. Du, et al.
BAG1 plays a critical role in regulating recovery from both manic-like and depression-like behavioral impairments
PNAS, June 24, 2008; 105(25): 8766 - 8771.
[Abstract] [Full Text] [PDF]

L. L. Judd, P. J. Schettler, H. S. Akiskal, W. Coryell, A. C. Leon, J. D. Maser, and D. A. Solomon
Residual Symptom Recovery From Major Affective Episodes in Bipolar Disorders and Rapid Episode Relapse/Recurrence
Arch Gen Psychiatry, April 1, 2008; 65(4): 386 - 394.
[Abstract] [Full Text] [PDF]

M. Tohen
Clinical Trials in Bipolar Mania: Implications in Study Design and Drug Development
Arch Gen Psychiatry, March 1, 2008; 65(3): 252 - 253.
[Full Text] [PDF]

A. Pfennig, E. Littmann, and M. Bauer
Neurocognitive Impairment and Dementia in Mood Disorders
J Neuropsychiatry Clin Neurosci, November 1, 2007; 19(4): 373 - 382.
[Abstract] [Full Text] [PDF]

C. U. Correll, J. B. Penzner, A. M. Frederickson, J. J. Richter, A. M. Auther, C. W. Smith, J. M. Kane, and B. A. Cornblatt
Differentiation in the Preonset Phases of Schizophrenia and Mood Disorders: Evidence in Support of a Bipolar Mania Prodrome
Schizophr Bull, May 2, 2007; (2007) sbm028v1.
[Abstract] [Full Text] [PDF]

M. P. DelBello, D. Hanseman, C. M. Adler, D. E. Fleck, and S. M. Strakowski
Twelve-Month Outcome of Adolescents With Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode
Am J Psychiatry, April 1, 2007; 164(4): 582 - 590.
[Abstract] [Full Text] [PDF]

R. J. Baldessarini, L. Leahy, S. Arcona, D. Gause, W. Zhang, and J. Hennen
Patterns of Psychotropic Drug Prescription for U.S. Patients With Diagnoses of Bipolar Disorders
Psychiatr Serv, January 1, 2007; 58(1): 85 - 91.
[Abstract] [Full Text] [PDF]

M. TOHEN, C. L. BOWDEN, J. R. CALABRESE, D. LIN, T. D. FORRESTER, G. S. SACHS, A. KOUKOPOULOS, L. YATHAM, and H. GRUNZE
Influence of sub-syndromal symptoms after remission from manic or mixed episodes
The British Journal of Psychiatry, December 1, 2006; 189(6): 515 - 519.
[Abstract] [Full Text] [PDF]

B. Geller, R. Tillman, K. Bolhofner, B. Zimerman, N. A. Strauss, and P. Kaufmann
Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: morbid risk, age at onset, and comorbidity.
Arch Gen Psychiatry, October 1, 2006; 63(10): 1130 - 1138.
[Abstract] [Full Text] [PDF]

R. H. Perlis, M. J. Ostacher, J. K. Patel, L. B. Marangell, H. Zhang, S. R. Wisniewski, T. A. Ketter, D. J. Miklowitz, M. W. Otto, L. Gyulai, et al.
Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
Focus, September 1, 2006; 4(4): 553.
[Full Text] [PDF]

B. I. Goldstein and A. J. Levitt
Further Evidence for a Developmental Subtype of Bipolar Disorder Defined by Age at Onset: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Am J Psychiatry, September 1, 2006; 163(9): 1633 - 1636.
[Abstract] [Full Text] [PDF]

S. Tyrer
What does history teach us about factors associated with relapse in bipolar affective disorder?: Presentation at Hilton Hotel, Gateshead, 2 September 2005 at Symposium entitled Managing the aftermath of mania.
J Psychopharmacol, March 1, 2006; 20(2 Suppl): 4 - 11.
[Abstract] [PDF]

R. H. McAllister-Williams
Relapse prevention in bipolar disorder: a critical review of current guidelines.
J Psychopharmacol, March 1, 2006; 20(2 Suppl): 12 - 16.
[Abstract] [PDF]

S. Dando and M. Tohen
Olanzapine - relapse prevention following mania.
J Psychopharmacol, March 1, 2006; 20(2 Suppl): 31 - 38.
[Abstract] [PDF]

R. H. Perlis, M. J. Ostacher, J. K. Patel, L. B. Marangell, H. Zhang, S. R. Wisniewski, T. A. Ketter, D. J. Miklowitz, M. W. Otto, L. Gyulai, et al.
Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
Am J Psychiatry, February 1, 2006; 163(2): 217 - 224.
[Abstract] [Full Text] [PDF]

M. Tohen, J. R. Calabrese, G. S. Sachs, M. D. Banov, H. C. Detke, R. Risser, R. W. Baker, J. C.-Y. Chou, and C. L. Bowden
Randomized, Placebo-Controlled Trial of Olanzapine as Maintenance Therapy in Patients With Bipolar I Disorder Responding to Acute Treatment With Olanzapine
Am J Psychiatry, February 1, 2006; 163(2): 247 - 256.
[Abstract] [Full Text] [PDF]

B. Birmaher, D. Axelson, M. Strober, M. K. Gill, S. Valeri, L. Chiappetta, N. Ryan, H. Leonard, J. Hunt, S. Iyengar, et al.
Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders
Arch Gen Psychiatry, February 1, 2006; 63(2): 175 - 183.
[Abstract] [Full Text] [PDF]

M. Tohen, W. Greil, J. R. Calabrese, G. S. Sachs, L. N. Yatham, B. M. Oerlinghausen, A. Koukopoulos, G. B. Cassano, H. Grunze, R. W. Licht, et al.
Olanzapine Versus Lithium in the Maintenance Treatment of Bipolar Disorder: A 12-Month, Randomized, Double-Blind, Controlled Clinical Trial
Am J Psychiatry, July 1, 2005; 162(7): 1281 - 1290.
[Abstract] [Full Text] [PDF]

P. Baldwin, D. Browne, P. J Scully, J. F Quinn, M. G Morgan, A. Kinsella, J. M Owens, V. Russell, E. O'Callaghan, and J. L Waddington
Epidemiology of First-Episode Psychosis: Illustrating the Challenges Across Diagnostic Boundaries Through the Cavan-Monaghan Study at 8 Years
Schizophr Bull, July 1, 2005; 31(3): 624 - 638.
[Abstract] [Full Text] [PDF]

C. Baethge, R. J. Baldessarini, H.-M. K. Khalsa, J. Hennen, P. Salvatore, and M. Tohen
Substance Abuse in First-Episode Bipolar I Disorder: Indications for Early Intervention
Am J Psychiatry, May 1, 2005; 162(5): 1008 - 1010.
[Abstract] [Full Text] [PDF]

K. R. R. Krishnan
Psychiatric and Medical Comorbidities of Bipolar Disorder
Psychosom Med, January 1, 2005; 67(1): 1 - 8.
[Abstract] [Full Text] [PDF]

M. J Ostacher
Functional recovery is limited in people with bipolar disorder
Evid. Based Ment. Health, August 1, 2004; 7(3): 69 - 69.
[Full Text] [PDF]

B. Geller, R. Tillman, J. L. Craney, and K. Bolhofner
Four-Year Prospective Outcome and Natural History of Mania in Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype
Arch Gen Psychiatry, May 1, 2004; 61(5): 459 - 467.
[Abstract] [Full Text] [PDF]

F. Centorrino, J. L. Goren, J. Hennen, P. Salvatore, J. P. Kelleher, and R. J. Baldessarini
Multiple Versus Single Antipsychotic Agents for Hospitalized Psychiatric Patients: Case-Control Study of Risks Versus Benefits
Am J Psychiatry, April 1, 2004; 161(4): 700 - 706.
[Abstract] [Full Text] [PDF]

M. TOHEN, K. N. R. CHENGAPPA, T. SUPPES, R. W. BAKER, C. A. ZARATE, C. L. BOWDEN, G. S. SACHS, D. J. KUPFER, S. N. GHAEMI, P. D. FELDMAN, et al.
Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone
The British Journal of Psychiatry, April 1, 2004; 184(4): 337 - 345.
[Abstract] [Full Text] [PDF]

E. Bender
Return to Daily Functioning Elusive in Bipolar Disorder
Psychiatr News, January 16, 2004; 39(2): 40 - 40.
[Full Text]

New Findings About First Episode of Bipolar Disorder
Journal Watch Psychiatry, December 23, 2003; 2003(1223): 4 - 4.
[Full Text]

Get information about faster international access.