Muruga Loganathan, MD Allegheny General Hospital, Pittsburgh, Pa
Kavita Lohano, MD Jeanie R. Roberts, MD Yonglin Gao, MD Rif S. El-Mallakh, MD Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Ky Rselma01@louisville.edu
Drs. Loganathan, Lohano, Roberts, and Gao reported no potential conflict of interest relevant to this article. Dr. El-Mallakh reported that he is on the speakers bureau of AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Merck, Novartis, and Pfizer.
Predicting the course of disease, preventing relapse
FAST TRACK
Studies have found that patients who relapsed had an episode like their most recent one by a ratio of more than 2 to 1.
Generally, the polarity of the current episode predicts that of future episodes. Studies have found that, independent of whether patients were on effective mood-stabilizing agents or placebo, those who relapsed had an episode like their most recent one by a ratio of more than 2 to 1.28
Research suggests a link between age at onset of illness and cycling time and response to particular agents. In 1 trial, those with early-onset bipolar disorder (in adolescence) had briefer euthymic periods and responded better to carbamazepine compared with those who developed symptoms of bipolar disorder at a later age.29 Late-onset bipolar illness (in the 30s or older) was characterized by longer euthymic periods and manic episodes that responded well to lithium.29 The average age of onset is about 25 years.30
Regardless of patient age or age of onset of symptoms, however, prevention of relapse is the goal of ongoing treatment. You can help by assessing the patient’s mood, reviewing the medication regimen and level of compliance, and offering support at every visit—and by consulting with the patient’s psychiatrist, as needed.
CORRESPONDENCE Rif S. El-Mallakh, MD, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, MedCenter One, 501 East Broadway, Suite 340, Louisville, KY 40202; rselma01@louisville.edu
