Researchers Identify Predictors of Outcomes in Bipolar Disorders with Psychosis

A team of researchers led by Stony Brook Professor of Psychiatry Gabrielle Carlson, MD, has identified several factors which predict clinical outcomes during the four years following an initial hospitalization with a diagnosis of bipolar disorder with psychosis. Their findings were published in the February 13, 2012 issue of Bipolar Disorders.
Although bipolar disorder with psychosis is a common diagnosis for people admitted for inpatient psychiatric care, few studies have examined factors other than psychosis which might predict outcomes such as recurrence of symptoms, rates of rehospitalization, need for treatment, and overall functioning during the years following the initial discharge.
Drawing on data from the Suffolk County Mental Health Project, a large prospective study conducted by the Department of Psychiatry and Behavioral Science at Stony Brook University, the researchers analyzed information regarding 126 participants who were diagnosed with bipolar disorder with psychosis at the time of their first hospitalization and followed closely by the research team over the ensuing four years.
The team used bivariate and multiple regression analyses to examine the associations between various outcomes and various demographic and clinical factors which might predict them. These factors included age at the time of first hospitalization, family history of psychiatric disorder, a history of psychiatric disorder during childhood, results of psychiatric assessments and medications prescribed at time of discharge, among others. The team discovered, as they expected, a complex series of relationships between potential predictive factors and clinical outcomes. They identified four factors of particular significance: the type and severity of psychotic symptoms, factors associated with depression, psychiatric problems in childhood, and the age at which the illness first occurred. Their findings support the distinction between primarily manic and primarily depressive subtypes of bipolar disorder, which tend to have different outcomes.
The researchers observed that the participants in the study had “a reasonably positive outcome at four years.” Almost three quarters of the participants were functioning at approximately the same level as they were before they entered the hospital. However, almost half of the participants were rehospitalized at least once and, on average, they experienced symptoms about a third of the time during the four year interval.
Drs. Roman Kotov and Evelyn Bromet from the Department of Psychiatry and Behavioral Science at Stony Brook collaborated with Dr. Carlson on the study along with Su-Wei Chang from the Academia Sinica, Nankang, Taipei, Taiwan and Camilo Ruggero from the University of North Texas. Their article is titled “Early determinants of four-year clinical outcomes in bipolar disorder with psychosis.” Bipolar Disorders is the official journal of the International Society for Bipolar Disorders.