Treatment outcome of patients with bipolar 1 disorder following hospitalisation at Moi Teaching and Referral Hospital.

Abstract

Background. Bipolar 1 disorder is the third leading cause of death in persons aged 15-24 years and if untreated it carries a 15% risk of suicide. The worldwide prevalence is 3-5%. The life time prevalence is 1.3 -1.6%. Drugs used are antipsychotics, mood stabilizers and benzodiazepines in specific cases. Despite the treatment only about 60% of these patients have good recovery after a single episode. Some of the factors that influence outcomes include age of onset, severity of first episode, psychosocial support, drug compliance and co morbid substance use or abuse. Objective: To assess the 12 month treatment outcomes and levels of recovery in patients admitted for bipolar 1 mania or mania with mixed features and to identify the possible clinical predictors associated with such recovery levels at Moi Teaching and Referral Hospital. Methods This longitudinal study was carried out at Moi Teaching and Referral Hospital psychiatric wards and outpatient clinics. The study population included all patients aged 18 years and above, admitted to the psychiatric ward at Moi Teaching and Referral hospital with first episode mania and mania with mixed features. Data was collected between November 2013 and December 2014. The patients were interviewed using a structured questionnaire, the Young Mania rating scale, the Hamilton Depression scale and the Global assessment of Functioning scale. Data was obtained within 72 hours of admission. Thereafter assessment was done at 3, 6 and 12 month follow up visits. Analysis was done using STATA version 13 SE. Descriptive statistics such as frequency listings and measures of central tendency were used. Chi square test was used test for association between two categorical variables. In all analysis a p-value less than 0.05 was considered significant. Data was then presented in tables, graphs and p values. Consent was obtained from all study participants. The study was approved by Institutional Research and Ethics Committee and Moi Teaching and referral hospital. Confidentiality of patient record was maintained. Results. A total of 77 patients were recruited into the study. The median age was 25years (IQR=22, 28). There were 39 females and 38 males. Forty seven (61.0%) were employed and majority (50.6%) were single. Slightly more than half of the participants (51.9%) had co-morbid substance use. Majority of the patients (61.84%) had mania with mixed features while the remaining had a manic episode at presentation. The mean length of stay was 2.29 weeks (IQR 2, 2.89). At 12 month follow-up all the participants had syndromic recovery, 25.6% had symptomatic recovery and 28.3% had functional recovery. The 12 month rates of remission were 2.6% (YMRS) and 10.5% (HMDS). Longer duration of hospital stay was associated with poorer functional recovery (p<0.001). Conclusion. Despite treatment, majority of the patients with bipolar 1 disorder continue to experience persistent, residual, social and occupational dysfunction 12 months after acute manic episode and longer admission duration predict poorer functional recovery. Recommendations. Longer follow-up and larger studies need to done.