Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2012-0048
Trends in Psychiatry and Psychotherapy
Original Article

The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up

A evolução de 102 pacientes brasileiros com transtorno bipolar: os primeiros 12 meses de acompanhamento prospectivo

Fernanda Novis; Patricia Cirillo; Rafael Assis da Silva; Ana Letícia Santos; Luciana Angélica Silva Silveira; Adriana Cardoso; Pedro Coscarelli; Antônio Egidio Nardi; Elie Cheniaux

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Abstract

INTRODUCTION: Prospective studies have shown that the course of bipolar disorder (BD) is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. OBJECTIVES: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. METHODS: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D17). Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. RESULTS: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. CONCLUSION: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.

Keywords

Clinical progression, outcome assessment, depression, bipolar disorder

Resumo

INTRODUÇÃO: Estudos prospectivos vêm demonstrando que o curso do transtorno bipolar (TB) é marcado por uma persistência de sintomas em grande parte do tempo, sendo estes predominantemente depressivos. Porém, até onde sabemos, não há estudos na América Latina sobre o assunto. OBJETIVO: Replicar pesquisas internacionais com uma amostra brasileira, para estudar prospectivamente a evolução no primeiro ano de tratamento e possíveis fatores relacionados a cronicidade. MÉTODO: Acompanhamos 102 pacientes com TB mensalmente por 12 meses, avaliando o número de meses em episódios afetivos e a intensidade dos sintomas maníacos e depressivos com a Young Mania Rating Scale (YMRS) e a Hamilton Depression Scale (HAM-D17), respectivamente. A partir de dados sociodemográficos e clínicos retrospectivos, buscamos definir fatores preditivos de evolução. RESULTADOS: Quase metade dos pacientes ficou cerca de metade do tempo sintomática, com predominância de episódios depressivos. Fatores preditivos de cronicidade encontrados foram a duração da doença e o número prévio de episódios depressivos. Encontramos, ainda, como fatores que predizem a ocorrência de novos episódios depressivos, a polaridade depressiva do primeiro episódio e um número maior de episódios depressivos. CONCLUSÕES: Em geral, a evolução do TB é bastante insatisfatória no primeiro ano de acompanhamento, apesar de tratamento adequado, com a predominância de sintomas depressivos. Episódios depressivos prévios são um fator preditivo de novos episódios depressivos e de uma pior evolução.

Palavras-chave

Evolução clínica, avaliação de resultados, depressão, transtorno bipolar

References

Kraepelin E. Dementia praecox and manic-depressive insanity. .

Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. ;59:530-37.

Post RM, Denicoff KD, Leverich GS, Altshuler LL, Frye MA, Suppes TM. Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry. ;64:680-90.

Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR. Predictors of recurrence in bipolar disorder: primary outcomes from the systematic treatment enhancement program for bipolar disorder (STEP-BD). Am J Psychiatry. ;163:217-24.

Diagnostic and Statistical Manual of Mental Disorders - 4th edition (DSM-IV): Primary Care Version. .

Altshuler LL, Post RM, Black DO, Keck PE, Nolen WA, Frye MA. Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: results of a large, multisite study. J Clin Psychiatry. ;67:1551-560.

Marangell LB, Dennehy EB, Miyahara S, Wisniewski SR, Bauer MS, Rapaport MH. The functional impact of subsyndromal depressive symptoms in bipolar disorder: data from STEP-BD. J Affect Disord. ;114:58-67.

Joffe RT, MacQueen GM, Marriott M, Trevor Young L. A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders. Bipolar Disord. ;6:62-6.

Miller IW, Uebelacker LA, Keitner GI, Ryan CE, Solomon DA. Longitudinal course of bipolar I disorder. Compr Psychiatry. ;45:431-40.

First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV Axis I Disorders: Clinician Version. .

Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. ;133:429-35.

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. ;23:56-62.

Keck PE Jr, McElroy SL, Havens JR, Altshuler LL, Nolen WA, Frye MA. Psychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness. Compr Psychiatry. ;44:263-69.

Nolen WA, Luckenbaugh DA, Altshuler LL, Suppes T, McElroy SL, Frye MA. Correlates of 1-year prospective outcome in bipolar disorder: results from the Stanley foundation bipolar network. Am J Psychiatry. ;161:1447-454.

Turvey CL, Coryell WH, Solomon DA, Leon AC, Endicott J, Keller MR. Long-term prognosis of bipolar I disorder. Acta Psychiatr Scand. ;99:110-19.

Frangou S. Predictors of outcome in a representative population of bipolar disorder. Bipolar Disord. ;4(Suppl 1):41-2.

Daban C, Colom F, Sanchez-Moreno J, García-Amador M, Vieta E. Clinical correlates of first-episode polarity in bipolar disorder. Compr Psychiatry. ;47:433-37.

Altshuler LL, Kupka RW, Hellemann G, Frye MA, Sugar CA, McElroy SL. Gender and depressive symptoms in 711 patients with bipolar disorder evaluated prospectively in the Stanley Foundation bipolar treatment outcome network. Am J Psychiatry. ;167:708-15.

Robb JC, Young LT, Cooke RG, Joffe RT. Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores. J Affect Disord. ;49:189-93.

Mander AJ. Clinical prediction of outcome and lithium response in bipolar affective disorder. J Affect Disord. ;11:35-41.

Yatham LN, Kauer-Sant'Anna M, Bond DJ, Lam RW, Torres I. Course and outcome after the first manic episode in patients with bipolar disorder: prospective 12-month data from the Systematic Treatment Optimization Program For Early Mania project. Can J Psychiatry. ;54:105-12.

Benazzi F. Classifying mood disorders by age-at-onset instead polarity. Prog Neuropsychopharmacol Biol Psychiatry. ;33:86-93.

Angst J. The course of affective disorders. II. Typology of bipolar manic depressive illness. Arch Psychiatr Nervenkr. ;226:65-73.

Colom F, Vieta E, Daban C, Pacchiarotti I, Sánchez-Moreno J. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord. ;93:13-7.

Rosa AR, Andreazza AC, Kunz M, Gomes F, Santin A, Sanchez-Moreno J. Predominant polarity in bipolar disorder: diagnostic implications. J Affect Disord. ;107:45-51.

Vieta E, Berk M, Wang W, Colom F, Tohen M, Baldessarini RJ. Predominant previous polarity as an outcome predictor in a controlled treatment trial for depression in bipolar I disorder patients. J Affect Disord. ;119:22-7.

Tohen M, Waternaux CM, Tsuang MT. Outcome in mania. A 4-year prospective follow-up of 75 patients utilizing survival analysis. Arch Gen Psychiatry. ;47:1106-111.

Winokur G, Scharfetter C, Angst J. A family study of psychotic symptomatology in schizophrenia, schizoaffective disorder, unipolar depression, and bipolar disorder. Eur Arch Psychiatry Neurol Sci. ;234:295-98.

Rosen LN, Rosenthal NE, Dunner DL, Fieve RR. Social outcome compared in psychotic and nonpsychotic bipolar I patients. J Nerv Ment Dis. ;171:272-75.

Rosenthal NE, Rosenthal LN, Stallone F, Fleiss J, Dunner DL, Fieve RR. Psychosis as a predictor of response to lithium maintenance treatment in bipolar affective-disorder. J Affect Disord. ;1:237-45.

González-Isasi A, Echeburúa E, Limiñana JM, González-Pinto A. Predictors of good outcome in patients with refractory bipolar disorder after a drug or a drug and cognitive-behavioral treatment. Compr Psychiatry. ;53:224-29.

Rosa AR, Reinares M, Franco C, Comes M, Torrent C, Sánchez-Moreno J. Clinical predictors of functional outcome of bipolar patients in remission. Bipolar Disord. ;11:401-09.

MacQueen GM, Young LT, Joffe RT. A review of psychosocial outcome in patients with bipolar disorder. Acta Psychiatr Scand. ;103:163-70.

Keck PE Jr, McElroy SL, Strakowski SM, West SA, Sax KW, Hawkins JM. 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. Am J Psychiatry. ;155:646-52.

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