Lithium prophylaxis of recurrent bipolar affective disorder: Long-term outcome and its psychosocial correlates

Background: Discrepancy between efficacy of prophylactic lithium and its ef fectiveness in ordinary clinical practice necessitates long-term follow-up data from specialised lithium clinics. Also, role of psychosocial factors i n influencing the outcome is unclear. Methods: One hundred and eighteen pat ients of bipolar affective disorder attending a lithium clinic were followe d-up for similar to 11 years (range 2-27 years). Demographic and clinical d ata, measures of social support and psychosocial stress were obtained at th e intake in 1989-1990. Study design combined retrospective chart-review (ti ll the time of intake) with prospective follow-up till July 1995. Results: On lithium, the patients had a mean of 0.43 relapses per year (manic, 0.26; depressive, 0.17) which was significantly less (p < 0.01) than the pre-lit hium episode frequency. The figure for entirely relapse-free patients was 2 4%, and 62% had relapses up to one episode per year (median = 0.3 per year) . Fifty-eight (49%) patients were good responders to lithium (relapses less than or equal to 0.30 per year). In comparison to good responders, partial /poor responders had a significantly greater number of pre-lithium depressi ve episodes, poor lithium compliance, more psychosocial stress and lower so cial support at intake. These variables correlated well with relapses and e xplained 32% of the variance of the data. Conclusions: Lithium had a defini te prophylactic effect on long-term outcome. Social support and stressful l ife events are significant correlates of response to lithium. Clinical Impl ications: Lithium prophylaxis of bipolar affective disorders seems justifie d though psychosocial factors appear to modulate its effectiveness. Limitat ions: Other psychstropic medications were used during relapse and the asses sment of psychosocial factors was cross-sectional. (C) 1999 Elsevier Scienc e B.V. All rights reserved.