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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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References

APA practice guidelines for the treatment of patients with bipolar disorder 2002 American Psychiatric Association.Google Scholar
Black, D.W.Winokur, G.Hulbert, J.Nasrallah, A.Predictors of immediate response in the treatment of mania: the importance of comorbidity Biol Psychiatry 24 1988 191–198.Google Scholar
Brady, K.T.Sonne, S.C.The relationship between substance abuse and bipolar disorder J Clin Psychiatry 56 1995 19–24.Google Scholar
Cassidy, F.Ahearn, E.P.Carroll, B.J.Substance abuse in bipolar disorder Bipolar Disord 3 2001 181–188.CrossRefGoogle Scholar
Cassidy, F.Forest, K.Murry, E.Carroll, B.J.A factor analysis of the signs and symptoms of mania Arch Gen Psychiatry 55 1998 27–32.Google Scholar
Dilsaver, S.C.Chen, Y.R.Shoaib, A.M.Swann, A.C.Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations Am J Psychiatry 156 3 1999 426–430.Google Scholar
Feinman, J.A.Dunner, D.L.The effect of alcohol and substance abuse on the course of bipolar affective disorder J Affect Disord 37 1996 43–49.Google Scholar
Feske, U.Frank, E.Mallinger, A.G.Houck, P.R.Fagiolini, A.Shear, M.K. et al Anxiety as a correlate of response to the acute treatment of bipolar I disorder Am J Psychiatry 157 2000 956–962.Google Scholar
Fountoukalis, K.N.Vieta, E.Sanchez-Morena, J.Kaprinis, S.G.Goikolea, J.M.Kaprinis, G.S.Treatment guidelines for bipolar disorder: a critical review J Affect Disord 86 2005 1–10.Google Scholar
Goetz, I.Tohen, M.Reed, C.Lorenzo, M.Vieta, E.the EMBLEM Advisory Board Functional impairment in patients with mania: baseline results of the EMBLEM study Bipolar Disord 9 1–2 2007 45–52.Google Scholar
Goldberg, J.F.Garno, J.L.Leon, A.C.Kocsis, J.H.Portera, L.Association of recurrent suicidal ideation with nonremission from acute mixed mania Am J Psychiatry 155 1998 1753–1755.Google Scholar
Goldberg, J.F.Garno, J.L.Leon, A.C.Kocsis, J.H.Portera, L.A history of substance abuse complicates remission from acute mania in bipolar disorder J Clin Psychiatry 60 1999 733–740.Google Scholar
Goldstein, H.Multilevel models in educational and social research 1987 London: Griffin.Google Scholar
Gonzalez-Pinto, A.Ballesteros, J.Aldama, A.Pérez de Heredia, J.L.Gutierrez, M.Mosquera, F. et al Principal components of mania J Affect Disord 76 2003 95–102.CrossRefGoogle Scholar
Haro, J.M.van Os, J.Vieta, E.Reed, C.Lorenzo, M.Goetz, I. et al Evidence for three distinct classes of ‘typical’, ‘psychotic’ and ‘dual’ mania: results from the EMBLEM study Acta Psychiatr Scand 113 2006 112–120.Google Scholar
Kessing, L.V.Subtypes of manic episodes according to ICD-10: prediction of time to remission and risk of relapse J Affect Disord 81 2004 279–285.Google Scholar
Kraepelin, E.Manic-depressive insanity and paranoia [Barclay RM, Trans.] Robertson, G.M. 1976 New York: Arno Press.Google Scholar
Licht, R.W.Gouliaev, G.Vestergard, P.Frydenberg, M.Generalisability of results from randomised drug trials: a trial on antimanic treatment Br J Psychiatry 170 1997 264–267.Google Scholar
Mant, J.Dawes, M.Graham-Jones, S.Internal validity of trials is more important than generalisibility Br J Med 312 1996 779.Google Scholar
van Os, J.van Rossum, I.Boomsma, M.Vieta, E.Goetz, I.Reed, C. et al The social, psychopathological and consumer context of rate of symptom improvement in acute mania Soc Psychiatry Psychiatr Epidemiol 42 8 2007 631–638.Google Scholar
Sato, T.Bottlender, R.Kleindienst, N.Moller, H.J.Syndromes and phenomenological subtypes underlying acute mania: a factor analytic study of 576 manic patients Am J Psychiatry 159 2002 968–974.Google Scholar
Spearing, M.K.Post, R.M.Leverich, G.S.Modification of the clinical global impressions (CGI) scale for use in bipolar illness (BP): the CGI-BP Psychiatry Res 73 1997 159–171.Google Scholar
STATACORP Stata statistical software: release 9.1 2005 College Station, TX: Stata Corporation.Google Scholar
Vieta, E.Carne, X.The use of placebo in clinical trials on bipolar disorder: a new approach for an old debate Psychother Psychosom 74 2005 10–16.Google Scholar
Welge, J.A.Keck, P.E.Meinhold, J.M.Predictors of response to treatment of acute bipolar manic episodes with divalproex sodium or placebo in 2 randomized, controlled, parallel-group trials J Clin Psychopharmacol 24 2004 607–612.Google ScholarPubMed
Wells, K.B.Treatment research at the crossroads: the scientific interface of clinical trials and effectiveness research Am J Psychiatry 156 1999 5–10.Google Scholar
Wilkins, J.N.Shaner, A.L.Patterson, C.M.Setoda, D.Gorelick, D.Discrepancies between patient report, clinical assessment and urine analysis in psychiatric patients during inpatient admission Psychopharmacol Bull 27 1991 149–154.Google Scholar
Young, R.C.Biggs, J.T.Ziegler, V.E.Meyer, D.A.A rating scale for mania: reliability, validity and sensitivity Br J Psychiatry 133 1978 429–435.Google Scholar
Zarate, C.A.Narendran, R.Tohen, M.Greaney, J.J.Berman, A.Pike, S. et al Clinical predictors of acute response with olanzapine in psychotic mood disorders J Clin Psychiatry 59 1998 24–28.Google Scholar
Zarate, C.A.Rothschild, A.Fletcher, K.E.Madrid, A.Zapatel, J.Clinical predictors of acute response with quetiapine in psychotic mood disorders J Clin Psychiatry 61 2000 185–189.Google Scholar
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