Article

Psychosocial predictors of major affective recurrences in bipolar disorder: A 4-year longitudinal study of patients on prophylactic treatment

Department of Psychiatry, University Clinics of Brussels. Erasme Hospital, Free University of Brussels, Belgium.
Acta Psychiatrica Scandinavica (Impact Factor: 5.55). 07/1996; 93(6):420-6. DOI: 10.1111/j.1600-0447.1996.tb10672.x
Source: PubMed

ABSTRACT A total of 21 recovered bipolar patients on prophylactic treatment were prospectively followed up for a period of 1 year. Data for major recurrences were retrospectively collected for an additional 3-year period. During the entire 4-year period, over half of the patients (52%) had no major affective recurrences. Eight patients experienced a major depressive episode, while only two experienced a manic one. Psychosocial and clinical variables were assessed at entry to the study. The effect of these variables on the subsequent 4-year illness course was analysed using survivorship curves. The results show that the following psychosocial variables significantly predicted the occurrence of a major affective episode: low level of social support, maladjustment in social and leisure activities, and poor quality of relationships with extended family. In contrast, clinical variables which characterize illness history were not significantly associated with major recurrences.

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    • "In addition to these cross-sectional findings, there is evidence that impaired family functioning predicts increased rates of depressive (Yan et al., 2004) and manic (Kim and Miklowitz, 2004) episode relapse over time, even up to 6 years after an index episode (Keitner et al., 1997). Notably, previous studies have often combined patient and family member reports to create a composite of family functioning (e.g., Friedmann et al., 1997; Miller et al., 1986), whereas others have focused exclusively on patient-reported (Stefos et al., 1996) or family-reported (Kim and Miklowitz, 2004; Yan et al., 2004) functioning and their associations with mood disorder outcomes. However, in the absence of existing data on the degree of concordance between patients and their family members on measures of family functioning, it is unclear whether reports from patients and their family members necessarily reflect the same overall level of family functioning or whether combined reports somehow obscure important differences in perceptions of family functioning , should they exist. "
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    • "Previous studies report that social support is a good prognosis variable (O'Connell et al., 1985; Johnson et al., 1999; Gutiérrez-Rojas et al., 2008). In this case, we were not able to confirm the association of low level of social support with relapses (Cohen et al., 2004) or number of episodes (Stefos et al., 1996). "
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    • "This finding fits well with other findings on the importance of social support in bipolar disorder. The availability of social support has been associated with better adherence and response to lithium therapy (Kulhara et al., 1999; O'Connell et al., 1985), more rapid recovery from bipolar mood episodes and lowered vulnerability to depression over time (Johnson et al., 1999), and lower risk of major affective reoccurrence (Johnson et al., 2003; Stefos et al., 1996). In addition, social support may be understood as an index of general psychosocial functioning including, as our results indicate, one's ability to align with a treatment provider. "
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