Hostname: page-component-cb9f654ff-mx8w7 Total loading time: 0 Render date: 2025-08-03T07:33:51.508Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome of Bipolar Disorder on Long-Term Treatment with Lithium

Published online by Cambridge University Press:  02 January 2018

Ralph A. O'Connell ,
Julia A. Mayo ,
Leslie Flatow ,
Beverly Cuthbertson  and
Barbara E. O'Brien
Ralph A. O'Connell*
Affiliation:
St Vincent's Hospital and Medical Center, New York Medical College
Julia A. Mayo
Affiliation:
Clinical Studies, Clinical Associate Professor of Psychiatry
Leslie Flatow
Affiliation:
Preventive Treatment Program
Beverly Cuthbertson
Affiliation:
Chief Outpatient Service
Barbara E. O'Brien
Affiliation:
Chief Outpatient Service
*
∗ Department of Psychiatry, St Vincent's Hospital, 153 West 11th Street, New York, NY 10011, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

The long-term treatment outcome of 248 bipolar patients in an out-patient lithium programme was assessed. Over half of the patients (138 or 56%) had no affective episodes in the year observed. Patients were divided into outcome groups according to GAS scores: the outcome for 40% of patients was good, for 41% fair, and for 19% poor. More frequent psychiatric admissions before starting lithium treatment was the best predictor of poor outcome, followed by a negative affective style in the family and lower social class. Current alcohol and drug abuse was associated with poor outcome. Although familial and psychosocial factors were significantly associated with outcome, the findings suggest there may be inherent differences in the pathophysiology of bipolar disorder reflected in an increased frequency of episodes which account for a large variance in lithium treatment outcome.

Information

Type
Papers
Information
The British Journal of Psychiatry , Volume 159 , Issue 1 , July 1991 , pp. 123 - 129
Copyright
Copyright © 1991 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ambelas, A. (1987) Life events and mania: a special relationship? British Journal of Psychiatry, 150, 235–240.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Angst, J. (1986) The course of affective disorders. Psychopathology, 19 (suppl. 2), 47–52.Google Scholar
Baron, M., Risch, N., Hamburger, R., et al (1987) Genetic linkage between X-chromosome markers and bipolar affective disorders. Nature, 326, 289–292.Google Scholar
Brown, G. W., Bifulco, A. & Harris, T. O. (1987) Life events, vulnerability and the onset of depression: Some refinements. British Journal of Psychiatry, 150, 30–42.CrossRefGoogle ScholarPubMed
Carroll, B. J. (1979) Prediction of treatment outcome with lithium. Archives of General Psychiatry, 36, 870–878.Google Scholar
Clayton, P., Hirschfeld, R. M. A. & Larkin, B. H. (1974) Personal Resources Inventory (PRI). Rockville, Maryland: National Institutes of Mental Health.Google Scholar
Consensus Development Panel (1985) Mood disorders: pharmacological prevention of recurrences. American Journal of Psychiatry, 142, 469–475.Google Scholar
Coryell, W. & Winokur, G. (1982) Course and outcome. In Handbook of Affective Disorders (ed. Paykel, E. S.). New York: Guilford Press.Google Scholar
Coryell, W., Keller, M., Endicott, J., et al (1989) Bipolar II illness: course and outcome over a five-year period. Psychological Medicine, 19, 129–141.CrossRefGoogle ScholarPubMed
Dunner, D. L. & Fieve, R. R. (1974) Clinical factors in lithium carbonate prophylaxis failure. Archives of General Psychiatry, 30, 229–233.CrossRefGoogle ScholarPubMed
Egeland, J. A., Gerhard, D. S., Pauls, D. L., et al (1987) Bipolar affective disorder linked to DNA markers on chromosome 11. Nature, 325, 783–787.Google Scholar
Freyhan, F. A., O'Connell, R. A. & Mayo, J. A. (1970) Treatment of mood disorders with lithium carbonate. International Pharmacopsychiatry, 5, 137–148.Google Scholar
Harrow, M., Goldberg, J. F., Grossman, L. S., et al (1990) Outcome in manic disorders: A naturalistic follow-up study. Archives of General Psychiatry, 47, 665–671.Google Scholar
Hodgkinson, H., Sherrington, B., Gurland, H., et al (1987) Molecular genetic evidence for heterogeneity in manic depression. Nature, 325, 805–806.Google Scholar
Hollingshead, A. & Redlich, F. (1958) Social Class and Mental Illness. New York: Wiley.Google Scholar
Holmes, T. H. & Rahe, R. H. (1967) The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213–218.Google Scholar
Keller, M. B., Lavori, P. W., Friedman, B., et al (1987) The longitudinal interval follow-up evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.CrossRefGoogle ScholarPubMed
Keller, M. B., Lavori, P. W., Coryell, W., et al (1988) Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. Journal of the American Medical Association, 255, 3138–3142.Google Scholar
Kelsoe, J. R., Ginns, E. I., Egeland, J. A., et al (1989) Re-evaluation of the linkage relationship between chromosome 11p loci and the gene for bipolar affective disorder in the Old Order Amish. Nature, 342, 238–243.Google Scholar
Kocsis, J. H. & Stokes, P. E. (1979) Lithium maintenance: factors affecting outcome. American Journal of Psychiatry, 136, 563–566.Google Scholar
Koenigsberg, H. W. & Handley, R. (1986) Expressed emotion: from predictive index to clinical construct. American Journal of Psychiatry, 143, 1361–1373.Google Scholar
Mayo, J. A., O'Connell, R. A. & O'Brien, J. D. (1979) Families of manic-depressives: effects of treatment. American Journal of Psychiatry, 136, 1535–1539.Google Scholar
Mendlewicz, J., Fieve, R. R. & Stallone, F. (1973) Relationship between the effectiveness of lithium therapy and family history. American Journal of Psychiatry, 130, 1011–1013.CrossRefGoogle ScholarPubMed
Miklowitz, D. J., Goldstein, M. J., Nuechterlein, K. H., et al (1988) Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45, 225–231.CrossRefGoogle ScholarPubMed
O'Connell, R. A. & Mayo, J. A. (1981) Lithium: A biopsychosocial perspective. Comprehensive Psychiatry, 22, 87–93.CrossRefGoogle ScholarPubMed
O'Connell, R. A., Mayo, J. A., Eng, L. K., et al (1985) Social support and long-term lithium outcome. British Journal of Psychiatry, 147, 272–275.Google Scholar
Paykel, E. S., Prusoff, B. A. & Uhlenhuth, E. H. (1971) Scaling of life events. Archives of General Psychiatry, 25, 340–347.CrossRefGoogle ScholarPubMed
Post, R. M., Rubinow, D. R. & Ballenger, J. C. (1986) Conditioning and sensitisation in the longitudinal course of affective illness. British Journal of Psychiatry, 149, 191–201.Google Scholar
Post, R. M., Rubinow, D. R., Uhde, T. W., et al (1989) Dysphoric mania. Archives of General Psychiatry, 46, 353–358.Google Scholar
Prien, R. F., Kupfer, D. J., Mansky, P. A., et al (1984) Drug therapy in the prevention of recurrences of unipolar and bipolar affective disorders. Archives of General Psychiatry, 41, 1096–1104.CrossRefGoogle ScholarPubMed
Rosen, L. N., Rosenthal, N. E., Dunner, D. L., et al (1983) Social outcome compared in psychotic and non-psychotic bipolar I patients. Journal of Nervous and Mental Disorders, 171, 272–275.Google Scholar
Schou, M. (1988) Lithium treatment of manic-depressive illness: Past, present and perspectives. Journal of the American Medical Association, 12, 1834–1836.Google Scholar
Silverstone, T. & Romans-Clarkson, S. (1989) Bipolar affective disorder: Causes and prevention of relapse. British Journal of Psychiatry, 154, 321–335.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978a) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders (3rd edn). New York: New York State Psychiatric Institute.Google Scholar
Spitzer, R. L., Gibbon, M. & Endicott, J. (1978b) Global Assessment Scale (GAS). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Tennant, C. C. (1985) Stress and schizophrenia: a review. Integrative Psychiatry, 3, 248–261.Google Scholar
Tsuang, M. T., Woolson, R. F. & Fleming, J. A. (1979) Long-term outcome of major psychoses. Archives of General Psychiatry, 36, 1295–1301.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976) The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129, 125–137.Google Scholar
Winokur, G. & Kadramas, A. (1989) A polyepisodic course in bipolar illness: clinical relationships. Comprehensive Psychiatry, 30, 121–127.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.