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Stability and treatment outcome of distinct classes of mania

Published online by Cambridge University Press:  16 April 2020

Inge van Rossum ,
Josep Maria Haro ,
Diederik Tenback ,
Maarten Boomsma ,
Iris Goetz ,
Eduard Vieta ,
Jim van Os  and
for the EMBLEM Advisory Board
Inge van Rossum
Affiliation:
Medical Department, Eli Lilly Nederland, Grootslag 1-5, Houten, The Netherlands
Josep Maria Haro
Affiliation:
Sant Joan de Deu-SSM, Fundació Sant Joan de Déu, Sant Boide Llobregat, Barcelona, Spain
Diederik Tenback
Affiliation:
Symfora Group Psychiatric Center, Utrechtseweg 266, 3818 EW Amersfoort, The Netherlands Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 GX Utrecht, The Netherlands
Maarten Boomsma
Affiliation:
GlaxoSmithKlein, Zeist, The Netherlands
Iris Goetz
Affiliation:
Eli Lilly, Windlesham, UK
Eduard Vieta
Affiliation:
Department of Psychiatry, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
Jim van Os*
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands Division of Psychological Medicine, Institute of Psychiatry, London SE5 8AF, UK
*
*Corresponding author. Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 43 38 75 443; fax: +31 43 38 75 444. E-mail address: [email protected] (J. van Os).
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Abstract

Background

Psychopathological heterogeneity in manic syndromes may in part reflect underlying latent classes with characteristic outcome patterns. Differential treatment course and outcome after 12 weeks of treatment were examined for three distinct classes of patients with acute mania in bipolar disorder.

Subjects and methods

Three thousand four hundred and twenty-five patients with acute mania were divided into three distinct mania classes: ‘Typical’, ‘Psychotic’ and ‘Dual’ (i.e. comorbid substance use) mania. Persistence of class differences and social outcomes were examined, using multilevel regression analyses and odds ratios.

Results

The three classes showed substantial stability post-baseline in the pattern of associations with class-characteristic variables. Psychotic and Dual mania predicted poorer outcome in terms of psychosis comorbidity and overall bipolar and mania severity, while Dual mania additionally predicted poorer outcome of alcohol and substance abuse. Worse social outcomes were observed for both Dual and Psychotic mania.

Conclusion

The identified distinct classes are stable and associated with differential treatment outcome. Overall, Dual and Psychotic mania show less favourable outcomes compared to Typical mania. These findings additionally give rise to concern on the generalisability of randomized clinical trials RCTs.

Keywords

Mania and bipolar disorderPsychiatry in EuropeEpidemiology
Type
Original article
Information
European Psychiatry , Volume 23 , Issue 5 , August 2008 , pp. 360 - 367
Copyright
Copyright © Elsevier Masson SAS 2008

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