Relapse and impairment in bipolar disorder

Am J Psychiatry. 1995 Nov;152(11):1635-40. doi: 10.1176/ajp.152.11.1635.


Objective: The purpose of this study was to evaluate the outcome of bipolar disorder in the context of maintenance pharmacotherapy.

Method: Eighty-two bipolar outpatients were followed prospectively for a mean of 4.3 years (minimum of 2 years); symptom rating and psychosocial outcome scales were used, and pharmacotherapy was rated on a 5-point scale.

Results: Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. Of those who relapsed, two-thirds had multiple relapses. Relapse could not be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure of cumulative affective morbidity appeared to be a more sensitive correlate of psychosocial functioning than was the number of relapses. Poor psychosocial outcome paralleled poor syndromal course. Poor psychosocial functioning, especially occupational disruption, predicted a shorter time to relapse. Depressions were most strongly related to social and family dysfunction.

Conclusions: Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients.

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Ambulatory Care
  • Bipolar Disorder / drug therapy
  • Bipolar Disorder / prevention & control*
  • Bipolar Disorder / psychology
  • Carbamazepine / therapeutic use
  • Drug Therapy, Combination
  • Family Health
  • Female
  • Follow-Up Studies
  • Humans
  • Lithium Carbonate / therapeutic use
  • Male
  • Middle Aged
  • Recurrence
  • Social Adjustment
  • Survival Analysis
  • Treatment Outcome
  • Valproic Acid / therapeutic use


  • Lithium Carbonate
  • Carbamazepine
  • Valproic Acid