Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method

Robert M. Post, Kirk D. Denicoff, Gabriele S. Leverich, Lori L. Altshuler, Mark A Frye, Trisha M. Suppes, A. John Rush, Paul E. Keck, Susan L. McElroy, David A. Luckenbaugh, Chad Pollio, Ralph Kupka, Willem A. Nolen

Research output: Contribution to journalArticle

358 Citations (Scopus)

Abstract

Background: A number of recent longitudinal outcome studies have found substantial long-term morbidity in patients with bipolar disorder. The detailed course and pattern of illness emerging despite comprehensive treatment with mood stabilizers and adjunctive agents have previously not been well delineated. Method: 258 consecutive outpatients admitted from 1996 to 1999 to the Stanley Foundation Bipolar Network who had a full year of prospective daily clinician ratings on the National Institute of Mental Health-Life Chart Method were included in the analysis. Patients were diagnosed by the Structured Clinical Interview for DSM-IV, with the majority (76%) having bipolar I disorder. They completed a questionnaire on demographics and prior illness course, and variables associated with outcome were examined in a hierarchical multinomial logistic regression analysis. Patients were treated naturalistically with a mean of 4.1 psychotropic medications during the year. Results: Despite comprehensive pharmacologic treatment, mean time depressed (33.2% of the year) was 3-fold higher than time manic (10.8%); 62.8% of patients had 4 or more mood episodes per year. Two thirds of the patients were substantially impacted by their illness; 26.4% were ill for more than three fourths of the year, and 40.7% were intermittently ill with major affective episodes. After logistic regression analysis, those who were ill most of the year, compared with the largely well group, had a significantly greater family history of substance abuse, 10 or more depressive episodes, and limited occupational functioning prior to Network entry. Conclusion: A majority of outpatients with bipolar illness, even with intense monitoring and treatment in specialty clinics, have a considerable degree of residual illness-related morbidity, including a 3-fold greater amount of time spent depressed versus time spent manic. A personal or family history of substance abuse, 10 or more prior depressions, and limited occupational functioning predicted the poorest outcomes. Additional interventions, particularly those targeted at treating depressive phases of bipolar illness, are greatly needed.

Original languageEnglish (US)
Pages (from-to)680-690
Number of pages11
JournalJournal of Clinical Psychiatry
Volume64
Issue number6
StatePublished - Jun 1 2003
Externally publishedYes

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National Institute of Mental Health (U.S.)
Outpatients
Morbidity
Bipolar Disorder
Substance-Related Disorders
Logistic Models
Regression Analysis
Diagnostic and Statistical Manual of Mental Disorders
Longitudinal Studies
Therapeutics
Demography
Outcome Assessment (Health Care)
Interviews
Depression

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Post, R. M., Denicoff, K. D., Leverich, G. S., Altshuler, L. L., Frye, M. A., Suppes, T. M., ... Nolen, W. A. (2003). Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. Journal of Clinical Psychiatry, 64(6), 680-690.

Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. / Post, Robert M.; Denicoff, Kirk D.; Leverich, Gabriele S.; Altshuler, Lori L.; Frye, Mark A; Suppes, Trisha M.; Rush, A. John; Keck, Paul E.; McElroy, Susan L.; Luckenbaugh, David A.; Pollio, Chad; Kupka, Ralph; Nolen, Willem A.

In: Journal of Clinical Psychiatry, Vol. 64, No. 6, 01.06.2003, p. 680-690.

Research output: Contribution to journalArticle

Post, RM, Denicoff, KD, Leverich, GS, Altshuler, LL, Frye, MA, Suppes, TM, Rush, AJ, Keck, PE, McElroy, SL, Luckenbaugh, DA, Pollio, C, Kupka, R & Nolen, WA 2003, 'Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method', Journal of Clinical Psychiatry, vol. 64, no. 6, pp. 680-690.
Post, Robert M. ; Denicoff, Kirk D. ; Leverich, Gabriele S. ; Altshuler, Lori L. ; Frye, Mark A ; Suppes, Trisha M. ; Rush, A. John ; Keck, Paul E. ; McElroy, Susan L. ; Luckenbaugh, David A. ; Pollio, Chad ; Kupka, Ralph ; Nolen, Willem A. / Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. In: Journal of Clinical Psychiatry. 2003 ; Vol. 64, No. 6. pp. 680-690.
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abstract = "Background: A number of recent longitudinal outcome studies have found substantial long-term morbidity in patients with bipolar disorder. The detailed course and pattern of illness emerging despite comprehensive treatment with mood stabilizers and adjunctive agents have previously not been well delineated. Method: 258 consecutive outpatients admitted from 1996 to 1999 to the Stanley Foundation Bipolar Network who had a full year of prospective daily clinician ratings on the National Institute of Mental Health-Life Chart Method were included in the analysis. Patients were diagnosed by the Structured Clinical Interview for DSM-IV, with the majority (76{\%}) having bipolar I disorder. They completed a questionnaire on demographics and prior illness course, and variables associated with outcome were examined in a hierarchical multinomial logistic regression analysis. Patients were treated naturalistically with a mean of 4.1 psychotropic medications during the year. Results: Despite comprehensive pharmacologic treatment, mean time depressed (33.2{\%} of the year) was 3-fold higher than time manic (10.8{\%}); 62.8{\%} of patients had 4 or more mood episodes per year. Two thirds of the patients were substantially impacted by their illness; 26.4{\%} were ill for more than three fourths of the year, and 40.7{\%} were intermittently ill with major affective episodes. After logistic regression analysis, those who were ill most of the year, compared with the largely well group, had a significantly greater family history of substance abuse, 10 or more depressive episodes, and limited occupational functioning prior to Network entry. Conclusion: A majority of outpatients with bipolar illness, even with intense monitoring and treatment in specialty clinics, have a considerable degree of residual illness-related morbidity, including a 3-fold greater amount of time spent depressed versus time spent manic. A personal or family history of substance abuse, 10 or more prior depressions, and limited occupational functioning predicted the poorest outcomes. Additional interventions, particularly those targeted at treating depressive phases of bipolar illness, are greatly needed.",
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AU - Frye, Mark A

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AU - Rush, A. John

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N2 - Background: A number of recent longitudinal outcome studies have found substantial long-term morbidity in patients with bipolar disorder. The detailed course and pattern of illness emerging despite comprehensive treatment with mood stabilizers and adjunctive agents have previously not been well delineated. Method: 258 consecutive outpatients admitted from 1996 to 1999 to the Stanley Foundation Bipolar Network who had a full year of prospective daily clinician ratings on the National Institute of Mental Health-Life Chart Method were included in the analysis. Patients were diagnosed by the Structured Clinical Interview for DSM-IV, with the majority (76%) having bipolar I disorder. They completed a questionnaire on demographics and prior illness course, and variables associated with outcome were examined in a hierarchical multinomial logistic regression analysis. Patients were treated naturalistically with a mean of 4.1 psychotropic medications during the year. Results: Despite comprehensive pharmacologic treatment, mean time depressed (33.2% of the year) was 3-fold higher than time manic (10.8%); 62.8% of patients had 4 or more mood episodes per year. Two thirds of the patients were substantially impacted by their illness; 26.4% were ill for more than three fourths of the year, and 40.7% were intermittently ill with major affective episodes. After logistic regression analysis, those who were ill most of the year, compared with the largely well group, had a significantly greater family history of substance abuse, 10 or more depressive episodes, and limited occupational functioning prior to Network entry. Conclusion: A majority of outpatients with bipolar illness, even with intense monitoring and treatment in specialty clinics, have a considerable degree of residual illness-related morbidity, including a 3-fold greater amount of time spent depressed versus time spent manic. A personal or family history of substance abuse, 10 or more prior depressions, and limited occupational functioning predicted the poorest outcomes. Additional interventions, particularly those targeted at treating depressive phases of bipolar illness, are greatly needed.

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