A prospective one-year follow-up study of patients with bipolar affective disorder.

BACKGROUND

Patients with affective disorder often have a poorer than expected prognosis for functional outcome between episodes. Previously, these patients were thought to have a better outcome between episodes, particularly Chinese patients. The aim of our study was to prospectively monitor symptoms, and vocational and residential functions of a group of patients with bipolar affective disorder one year after hospitalization. This study compare these data with index, admission data and discuss the relationship between patients' symptoms and functional outcome.

METHODS

The Brief Psychiatric Rating Scale (BPRS), Modified Manic State Rating Scale (MMS) and Hamilton Depression Rating Scale (HDRS-21 items) were used to measure the patients' general psychiatric condition, manic and depressive symptoms, respectively. A modified Vocational State Index and modified Location Code Index Scale were used to determine levels of functioning.

RESULTS

One-year follow-up measurements indicated that 75% of patients were free of symptoms or had mild psychiatric symptoms and 95% of patients were asymptomatic or mildly symptomatic for affective-manic condition. There was significant improvement in symptom outcome. However, only 46% of patients were employed at the one-year follow-up assessment, and as few as 12% worked at their expected level of employment, while 42% were rated as being unable to work and remained at an incapacitated occupational function. There was a significant tendency for increased independent living at one year of follow-up (74.6% vs 45.8%). More than 40% of patients were solely responsible for themselves, while over 50% required others to be responsible for them in terms of daily living. Additionally, 70% of first-admission subjects were employed at some level at one-year follow-up assessment, compared with only 31.8% of subjects with multiple admissions; 70% of first-admission patients were living independently compared with only 40% of subjects with multiple admissions.

CONCLUSIONS

The results showed that the symptom outcome was superior to the functional outcome. These findings indicate that variable factors other than psychotic symptoms are related to the functional outcome in Chinese patients with bipolar affective disorder. Although treatment reduced the symptom intensity of affective episodes, a long-range rehabilitative program and strategy for prevention relapse is required to help functional outcome catch up with symptomatic amelioration.