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Abstract
Objective. The objective of the study was to investigate affective symptoms and pharmacological treatment in bipolar I disorder patients, and to test whether self-rated symptoms could predict hospital admissions during a 12-month follow-up period. Methods. A total of 231 outpatients with clinical bipolar I disorder were recruited. The clinical diagnoses were reassessed by a semi-structured interview. Twenty-four patients (10%) was reclassified as bipolar disorder type II or schizoaffective disorder (bipolar type). Medication status was recorded and symptoms were assessed with the self-rating scale AS-18. Patients were prospectively followed for 12 months and hospitalizations during that time were recorded. Results. More than half (60%) rated themselves as normothymic. Mixed affective symptoms were more common than either depressive or manic/hypomanic symptoms. The admission rate during 1 year of follow-up was 13% (95% C.I. 8–17%). Patients which at baseline rated themselves high in either mania or in depression had a significantly increased risk for hospitalization (OR = 3.15; 95% C.I. 1.38–7.19). Conclusions. The findings should encourage clinicians to use patient self ratings in order to identify patients with a high risk for hospitalization for targeted interventions.
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Acknowledgements
The study was supported by the Stockholm County Council (ALF grants 20060306 and 20080247), and by grants from Söderström-Königska Foundation. A preliminary report was prepared in collaboration with Bristol-Myers Squibb, with the contribution of Karin Sennfält and Marc van Baardewijk, employees of Bristol-Myers Squibb. We thank Louise Frisén, MD, PhD, for important contributions in planning and setting up the study. We also thank Inger Röhmer-Ek, MSc, for excellent assistance in recruiting patients and in the retrieval of patient data.
Statement of interest
UÖ has been reimbursed by Bristol-Myers Squibb, Eli Lilly, and Pfizer for attending conferences; has received fees for speaking from Bristol-Myers Squibb, Organon, and Pfizer; has received funds for research from Bristol-Myers Squibb and Janssen-Cilag; and has received fees for consulting from AstraZeneca, Eli Lilly, and Pfizer. MA has received fees for speaking for Eli Lilly, Sanofi-Aventis and Bristol-Myers Squibb; MA has received fees from AstraZeneca for development of educational presentations; and has been reimbursed by Bristol Meyers Squibb for attending conferences. LB has received fees for consulting from Bristol-Myers Squibb; and has been reimbursed by Organon and Bristol-Myers Squibb for attending conferences. GE has been consultant for AstraZeneca and Janssen-Cilag, and his wife is a shareholder of AstraZeneca.
Appendix A. The Affective Self Rating Scale (AS-18)
Items of the Affective Self-Rating scale, translated from Swedish by the authors. Response categories are “none”, “a little”, “moderate”, “severe” and “very severe”, graded numerically from 0 to 4. Items labeled (M) = mania subscale and items labeled (D) = depression subscale.
During the last week, to which extent have you experienced the following problems…
(M) Talkativeness. “…having been so talkative that it has been hard for others to make themselves heard?”
(D) Increased sleep. “… sleeping more than usual”.
(M) Less need for sleep. “…having less need for sleep but still felt energetic and awake?”
(D) Hopelessness. “…feeling hopeless?”
D) Retardation. “…your movements have been slower?”
(M) Overactive. “…being wound up or overactive.”
(M) Agitation. ”…being so physically restless that you have had trouble keeping still?”
(M) Racing thoughts. “…that your thoughts race.”
(M) Irritability. “…that you have been easily irritated?”
(D) Depression. “…feeling low or depressed?”
(D) Anhedonia. “…inability to take an interest or pleasure in things that you normally enjoy?”
(D) Low energy. “…a lack of energy?”
(D) Guilt. “…feelings of guilt or worthlessness?”
Slow thinking. “…that your thoughts have been sluggish and slow?”
(M) Incerased self-esteem. “…that you have been over confident?”
(M) Euforia. “…that you have had an overly strong sense of happiness and increase in interest?”
(D) Sucidal ideation. “…that you have had thoughts of harming yourself or taking your own life?”
(M) Risk-taking. “…that you have been taking risks; for example with money, in traffic or in your social contacts?”