Course of illness and predictors of relapse following a first episode of psychotic mania

Melissa Hasty1, Sue Cotton2,3, Craig Macneil1, Philippe Conus4; 1Orygen Youth Health Clinical Program, 2Orygen, The National Centre of Excellence in Youth Mental, 3Centre for Youth Mental Health, University of Melbourne, 4Centre Hospitalier Universitaire Vaudois

Purpose: Bipolar disorder can be highly recurrent and many young people experience one or more relapses in the years following their initial episode. Understanding of the early course of the disorder and predictors of relapse may help to inform prognosis and improve treatment following recovery from a first episode of mania. Therefore, the aim of this study was to examine the course of the disorder in young people following treatment for first episode psychotic mania and identify factors associated with relapse in this population. Method: Seventy-four patients with first episode mania who were treated at the Early Psychosis Prevention and Intervention Centre in Melbourne, Australia enrolled in a RCT comparing acute treatment using either olanzapine or chlorpromazine in combination with lithium. This cohort was prospectively followed up for 18 months and their course was mapped through regular outpatient appointments and research interviews. The design of the RCT allowed us to closely monitor the timing of symptom recurrences, changes to treatment, and to examine the association of clinical variables and medication status with relapse. Results: Sixty-two percent of participants had one or more affective and/or psychotic relapses. Logistic regression and survival analyses evaluating the above aims will be presented. Conclusions: Our study showed high rates of relapse early in the course of bipolar disorder despite high quality biopsychosocial treatment. Identification of risk factors for recurrence is relevant for psychological interventions aimed at relapse prevention. Further research is required to explore best treatment options to prevent relapse and its deleterious effects.

Topic Area: Mood Disorders

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