Outcome of single manic episode in bipolar I disorder: a six-month follow-up after hospitalization

BACKGROUND: Bipolar I Disorder (BID) considered as the sixth leading cause of disability worldwide. After remission of a manic episode, most of patients spend about 50% of the following time with mood or cognitive symptoms. The aim of this study was to investigate the 6-month outcome of BID patients following their single manic episode. METHODS: Adult bipolar patients (n = 13) with single manic episode admitted to Noor Hospital, Isfahan, Iran, from December 6 2008 to June 5 2009 were evaluated using diagnostic, symptomatic, and functional assessments. Patients were also evaluated monthly for six months to assess syndromic, symptomatic, and functional outcomes, self reported treatment adherence, and serum levels of major mood stabilizers. The Kaplan-Meier method and log-rank test at a significance level of < 0.05 were used. RESULTS: Kaplan-Meier estimates of the cumulative probabilities of syndromal, symptomatic, and functional recovery during the first 6 months after admission for single manic episode were 0.89, 0.75, and 0.64, respectively. At the 3rd month 54% of BID patients reported full medication adherence while it decreased to 38% at the 6th month. Patients with full adherence revealed shortened time to functional recovery based on LIFE-RIFT compared with non-adherent patients (log rank: χ 2 = 4.5, df = 1, p = 0.03). Substance abuse also associated with longer time to functional recovery based on LIFE-RIFT (log rank: χ 2 = 4.36, p = 0.037). CONCLUSIONS: Despite high rates of experienced syndromic and symptomatic recoveries for BID patients in single manic episode, functional recovery was much lower following hospitalization.