Longterm outcome

The long-term outcome of mood disorders is usually unfavourable. Five comparable long-term follow-up studies (10 years or more) are listed in Table 1... All re-examined depressive patients, most if not all of whom had originally been admitted to psychiatric hospitals. After 10 years, roughly one-third had been readmitted, and this figure rose to about two-thirds after 20 years. A poor outcome, as operationally defined by Lee and Murray, (25) was observed in 11 to 25 per cent of patients. The outcome was in no way more favourable in the two studies that included psychiatric outpatients.

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Table 1 Long-term follow-up studies of depression

Bipolar disorder has a poorer outcome than depression. After a follow-up of 22 to 26 years, definitive recovery (at least 5 years with good social adaptation) was found in 25 per cent of 186 depressive subjects, whereas the figure was 16 per cent of the 220 bipolar patients; a chronic course lasting at least 2 years without remission was present in 11.8 per cent of the depressive subjects compared with 14.1 per cent of the bipolars.(29)

Modern treatment may have changed the outcome of mood disorders by reducing chronicity and rehospitalization. A recent 10-year prospective study of 131 hospitalized bipolar patients (39 found that only 4 per cent had developed chronicity, although most patients still had recurrences. The frequency of episodes did not increase with time, so no further kindling effect was observed. Comorbidity with alcoholism, a factor known to correlate with poorer outcome, was found in 30 per cent of the patients. Coryell et al.(7) found that, over 5 years, bipolar II disorder had a better outcome than bipolar I disorder in terms of rehospitalizations; furthermore, the two groups tended to remain diagnostically stable. Episode frequency was comparable in the two groups.

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