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Course of BD Course in Adults

There have been a growing number of prospective studies of the course of BD in adults identified in treatment settings in the United States and Europe. Table 2.1 summarizes the methods and major findings of the ten prospective studies with greater than 1 year follow-up with direct assessments of patients. Many of these studies involved multicenter collaborative efforts in order to recruit large numbers of patients and increase the representativeness of the samples. These include the National Institutes of Mental Health (NIMH) Collaborative Depression Study (CSD),6-8 the Stanley Foundation Bipolar Network (SFBN),9 the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study,10 and the European Mania in Bipolar Evaluation of Medication study (EMBLEM) that included investigators in four European countries (Denmark, Germany, Spain, and Switzerland),11 and a number of other studies in the United States, Europe, and Australia.12-19 The duration of follow-up ranged from 2 years in studies in Australia19 and the STEP-BD study;10 to 4 years in the EMBLEM study,11 a recent Austrian BD sample,12 and a systematic county-wide study of first episode psychotic BD patients;13 to 7 years in the Stanley Foundation BP Course study;9 and to several decades in the Collaborative Study of Depression in the United States,6-8 a cohort of inpatients with BD in the United States,14 and a Swiss hospital cohort that has now been followed for nearly half a decade.15-17 The samples in these studies have generally been identified in specialty treatment settings, with some focusing solely on inpatients,12-14,17,18 whereas others recruited broader samples of both inpatients and outpatients.8-11,19 The study of first-episode psychosis in Suffolk County, New York, by Bromet et al.13 has the only population-based sample of first-incident treated cases.

Rich information on the precursors and sequelae of BD has also been obtained from large population registries in Denmark,20 Sweden,21 and the Netherlands.22 Although the lack of direct interview information precludes evaluation of specific clinical features of episodes, these studies can provide valuable data that complement clinical course studies through linked registries that provide data on premorbid risk factors, and correlates and indices of outcome and course. There are also a few prospective community studies, such as the Zurich Cohort Study23 and the NEMESIS study,24 that also investigated the longitudinal stability of mania/hypomania. More recently, Baek et al.25 assessed the stability of unipolar mania in the 3-year follow-up of a large US community-based sample who participated in the National Epidemiologic Survey on Alcohol and Related Conditions.

Author

Year

Site

N

Source

Duration

OUTCOMES

Syndrome

Recovery

Recurrence/

Relapse

Functional

Recovery

ADULTS

Tohen

Bromet

Suppes

Perlis

Angst

Solomon

  • 2003
  • 2005
  • 2005
  • 2006
  • 1995; 2003 2010

US

US

US; Europe US

Switzerland

US

  • 166
  • 123
  • 908
  • 1469
  • 210
  • 219

Inpt-1st

Inpt-1st

Outpt

Inpt/outpt

Inpt

Inpt/outpt

4 yrs 4 yrs 7 yrs 2 yrs 40 yrs 25 yrs

  • 98%
  • 84%
  • 57%
  • 58%
  • 16%
  • 75% 1 yr 89% 2 yrs
  • 61%
  • 43%
  • 48%
  • 31-47%

43%

Haro

Goldberg and Harrow

Kulkarni

Simhandl

  • 2011
  • 2011
  • 2012
  • 2014

Europe

US

Australia

Austria

  • 1656
  • 46
  • 222
  • 300

Inpt/Outpt

Inpt

Outpt

Inpt

4 yrs 15 yr 2 yr 4 yrs

  • 34%
  • 77%
  • 91%
  • 68%
  • 27%
  • 68%

35%

YOUTH

Strober

Carlson

Delbello

Geller

Birmaher

Wozniak

  • 1995
  • 2002
  • 2007
  • 2008
  • 2014
  • 2011

US

US

US

US

US

US

  • 52
  • 123
  • 71
  • 115
  • 367
  • 78

Inpt/Outpt

Inpt

Inpt

Inpt/Outpt

Outpt

Inpt/Outpt

5 yrs 2 yrs 1 yr 8 yrs 4 yrs 4 yrs

  • 90%
  • 86%
  • 73%
  • 27%
  • 42%
  • 54%
  • 22.30%

41%

 
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