Course and Outcome in Bipolar Affective Disorder

A Longitudinal Follow-Up Study

Goldberg, Joseph F.
Harrow, Martin
Grossman, Linda S.

Received March 3, 1993; revision received Aug. 1, 1994; accepted Sept. 26, 1994. From the Department of Psychiatry, University of Illinois College of Medicine, Chicago, and the Department of Psychiatry, Michael Reese Hospital and Medical Center, Chicago. Address reprint requests to Dr. Goldberg, Department of Psychiatry, Payne Whitney Clinic, The New York Hospital-Cornell University Medical Center, 525 East 68th St., New York, NY 10021.
Supported in part by NIMH grants MH-26341 and MH-41684 and by a research grant from Michael Reese Hospital.
The authors thank Jennifer A. Campbell, B.A., for her assistance with statistical analyses and manuscript preparation.

American Journal of Psychiatry 152(3):p 379-384, March 1995.

Objective

A number of recent studies have questioned whether, despite modern treatment, the natural course of bipolar illness today still involves multiple relapses and impaired psychosocial functioning. This prospective follow-up study examined longitudinal outcome in a large group of inpatients with affective disorders. Method: Fifty-one bipolar manic patients and 49 unipolar depressed patients were interviewed three times: 1) during hospitalization, 2) approximately 2 years after discharge, and 3) approximately 4.5 years after discharge. Subjects were treated under routine conditions and assessed for global adjustment, rehospitalization, and work and social functioning. Results: Only 41% of the bipolar group had a good overall outcome by the time of the 4.5-year follow-up. The bipolar patients had more severe work impairment than the unipolar group. More than one-half of the bipolar patients were rehospitalized at least once during the 4.5-year follow-up period. Outcome for both diagnostic groups improved significantly over time. Conclusions: Many contemporary bipolar patients demonstrate gradual improvement in the first several years after hospitalization. However, a subgroup approaching 60% still experience poor posthospital adjustment in one or more areas of functioning. (Am J Psychiatry 1995; 152:379-384)