Early intervention in bipolar disorder may improve outcome

Targeting symptoms of co-morbid anxiety and substance misuse early in the course of bipolar disorder may result in improved outcomes later on, say US researchers.The researchers analysed data for 112 patients admitted to hospital with first lifetime manic/mixed bipolar I episode. Inpatients were assessed weekly until discharge from hospital, then at six, 12 and 24 months after discharge. The primary clinical outcome measure used was syndromal recovery from mania.Patients in the study were split into three groups: group 1, no substance use disorder (n=75); group 2, abuse of a single agent (n=22); and group 3, abuse of two or more substances (n=15). The researchers observed an increase in the combined prevalence rate of substance misuse in groups 2 and 3 over the study period, from 33% at baseline to 39% at 24 months.The proportion of people achieving syndromal recovery did not differ significantly among the three groups although there was a trend towards better rates of recovery in patients without a substance use disorder (96% compared with 90.9% and 86.7% in groups 2 and 3, respectively [p=0.36]).However, patients who abused more than one substance spent significantly more time being ill (depression, mania or mixed) in the first two years than patients in the other two groups (65.9 weeks versus 34.4 weeks in group 1 and 36.4 weeks group 2 [pIn addition, patients in group 1 had faster recovery times (median time = 5.6 weeks) compared with groups 2 and 3 (8.1 weeks and 7.1 weeks, respectively) (p=0.30).Anxiety disorders were found to occur more commonly in patients who abused one or more substances (27.3% and 33.3%, respectively) than in those without a substance use disorder (13.3%).The researchers also observed an association between cannabis dependence and mania and between alcohol dependence and depression. Although not significant, the researchers say that these findings are worthy of further study. Substance use disorders occur commonly in early bipolar disorder and are associated with anxiety disorders and poor outcomes, say the researchers. Therefore, very early clinical intervention in new bipolar disorder to limit symptoms of substance misuse and anxiety might contribute to improved outcomes, they conclude.Reference...