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Regular Article

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Radua J.a,e-g · Grunze H.h · Amann B.L.a-d,e

Author affiliations

aFIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, bInstitute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, cDepartment of Psychiatry, Autonomous University of Barcelona, and dIMIM (Hospital del Mar Medical Research Institute), Barcelona, and eMental Health Research Networking Center (CIBERSAM), Madrid, Spain; fCentre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; gDivision of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; hParacelsus Medical University, Salzburg, Austria

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Psychother Psychosom 2017;86:90-98

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Article / Publication Details

First-Page Preview
Abstract of Regular Article

Received: January 07, 2016
Accepted: August 24, 2016
Published online: February 10, 2017
Issue release date: February 2017

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 0

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: http://www.karger.com/PPS

Abstract

Background: Reported relapse and recurrence rates in bipolar disorder (BD) differ significantly between studies. Most data originate from highly selective patients participating in sponsored randomized controlled trials with narrow inclusion criteria. To estimate the true risk of a subsequent mood episode (SME) under real-world conditions, we conducted a meta-analysis of rates of SME as reported in naturalistic BD studies. Methods: PubMed, ScienceDirect, Scopus, and Web of Knowledge were searched until July 2015. Studies reporting the time until the emergence of an SME, from which individual data or Kaplan-Meier plots with censors marked could be retrieved, were included. Results: Twelve studies comprising 5,837 patients met the inclusion criteria. The median time to an SME in adults after an index episode was 1.44 years. The risk of an SME was 44% during the first year. Not having a SME during this first year lowered this risk to 19% in the second year. The risk was higher in bipolar II disorder (BD-II) than in bipolar I disorder (BD-I; HR = 1.5). In BD-I, the risk of a subsequent manic, mixed, or depressive mood episode was higher after an index episode of the same polarity (HR = 1.89-5.14). The overall risk of an SME was higher in patients with persisting subsyndromal symptoms (HR = 2.17). Conclusions: The data from this study provide a more reliable estimate of the risk of an SME in BD in real-world settings. Further research into the longitudinal course of BD-II is warranted to confirm its role as a risk factor for SME.

© 2017 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Regular Article

Received: January 07, 2016
Accepted: August 24, 2016
Published online: February 10, 2017
Issue release date: February 2017

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 0

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: http://www.karger.com/PPS


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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