Prevalence and predictors of new episodes in patients with bipolar disorder at Dr George Mukhari hospital over a one year period (June 2007-June 2008)

Abstract

Background: Bipolar disorder is a lifelong illness typically presenting with frequent relapses and/or recurrences. Bipolar disorder carries a high morbidity and mortality and can cause significant functional impairment. In understanding the relapsing course of the illness, chronicity may be reduced by preventing or delaying the occurrence of new episodes. Objectives: The objectives of this study were to establish the prevalence of new episodes in patients with bipolar I disorder and to determine predictors of new episodes. Methods: This was a retrospective, descriptive study based on the review of medical records of patients with bipolar I disorder seen at Dr. George Mukhari Hospital – psychiatry unit between the period of 1 June 2007 to 1 June 2008. Data concerning sociodemographic parameters of the patients and psychiatric information was collected using a data collection sheet. Results: Data was extracted and analysed from a total of 143 patient records. Ninety (63%) experienced new episodes and fifty-three patients (37%) did not have any new episodes. Seventy-nine patients (55%) had one or more manic episodes (mean=0.64) and nineteen (13.38 %) had one or more depressive episodes. (Mean=0.14). The maximum number of new episodes was 2 and the mean was 0.78. The most recent episode was manic in seventy-six patients (84%). The mean number of hospital admissions was 0.88. Of the patients that had new episodes, the age ranged from 18 to more than 55 years, the vast majority were black (94%) and of Christian faith (97%). More than half were female (58%) and single (49%), with 1-2 children (48%). The majority achieved high school education (60%), and were unemployed (70%). Only 47% were receiving a disability grant. New episodes were more prevalent in patients who experienced a younger age of onset of illness (41% in the 18-24 year age group) and who were ill for more than ten years (43%). Less than half had a positive family history of mental illness (43%), 39% had a history of substance use, the most common substance being alcohol (54%), and 39% suffered from one or more comorbid medical illnesses. 78% of the patients who had new episodes were on antipsychotics, 93% were on mood stabilisers, and 69% were on a xii combination of mood stabilisers and antipsychotics. The only factor that was significantly predictive of new episodes was poor compliance. Conclusion: There is a high prevalence of relapse in patients with bipolar I disorder, particularly to the manic pole. Compliance with medication remains a serious problem and is associated with the occurrence of new episodes. Improved treatments should include biopsychosocial strategies, identification of risk factors for relapse/recurrence and early and consistent intervention.