RELAPSE AND IMPAIRMENT IN BIPOLAR DISORDER

Objective: The purpose of this study was to evaluate the outcome of bi polar 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 out come scales were used, and pharmacotherapy was rated on a 5-point scal e. Results: Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. O f those who relapsed two-thirds had multiple relapses. Relapse could n ot be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure of c umulative affective morbidity appeared to be a more sensitive correlat e of psychosocial functioning than was the number of relapses. Poor ps ychosocial 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 maint enance treatment does not prevent relatively poor outcome in a signifi cant number of bipolar patients.