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.
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.
Authors: Paola Salvatore; Ross J Baldessarini; Mauricio Tohen; Hari-Mandir K Khalsa; Jesus Perez Sanchez-Toledo; Carlos A Zarate; Eduard Vieta; Carlo Maggini Journal: J Clin Psychiatry Date: 2010-07-13 Impact factor: 4.384
Authors: Jean-Michel Azorin; Charles L Bowden; Ricardo P Garay; Giulio Perugi; Eduard Vieta; Allan H Young Journal: Neuropsychiatr Dis Treat Date: 2010-03-24 Impact factor: 2.570
Authors: Paola Salvatore; Ross J Baldessarini; Mauricio Tohen; Hari-Mandir K Khalsa; Jesus Perez Sanchez-Toledo; Carlos A Zarate; Eduard Vieta; Carlo Maggini Journal: J Clin Psychiatry Date: 2008-12-30 Impact factor: 4.384
Authors: Trine V Lagerberg; Ole A Andreassen; Petter A Ringen; Akiah O Berg; Sara Larsson; Ingrid Agartz; Kjetil Sundet; Ingrid Melle Journal: BMC Psychiatry Date: 2010-01-27 Impact factor: 3.630