Original Article

Recurrence in Patients with Bipolar Disorder and its Risk Factors


Objective: The aim of this study was to identify prognosis factors associated with recurrence in patients ‎with bipolar disorder.‎‎
Method: This retrospective cohort study was conducted in Hamadan Province, the west of Iran. All ‎patients (n = 400) with bipolar disorder who were hospitalized for the second time or more ‎during April 2008 to September 2014 were included in this study. Ordinal logistic regression ‎analysis was employed to determine the effective factors in each recurrence, and odds ratio (OR) and 95% confidence intervals (CI) were obtained.‎
Results: The mean (SD) age of the participants at the entrance to the study was 34.62 (11.68) years. ‎There was an association between recurrence and type of bipolar disorder (P = 0.033). The ‎OR of recurrence was 0.28 (95% CI: 0.09, 0.90) for bipolar disorder II; 0.35 (95% CI: 0.13, ‎‎0.92) for the patients‎‏ ‏with college education; 0.39 (95% CI: 0.25, 0.60) for employed ‎patients; 0.55 (95% CI: 0.35, 0.87) for patients who received both drugs and ‎electroconvulsive therapy, and 1.89 (95% CI: 1.23, 2.92) for patients who stopped using ‎drugs. In addition, a non-significant association was found between recurrence and age, sex, ‎marital status, place of residence, season, mood classification and family history of mood ‎disorder.‎
Conclusion: Type of bipolar disorder and cessation of medication were the leading causes of an increase in ‎the relapse of the disease. Furthermore, patients who received both drugs and ‎electroconvulsive therapy had a fewer risk of recurrence.‎

Salvatore P, Tohen M, Khalsa HM, Baethge C, Tondo L , Baldessarini RJ. Longitudinal research on bipolar disorders. Epidemiologia e psichiatria sociale 2007; 16: 109-117.

Kleinman L, Lowin A, Flood E, Gandhi G, Edgell E , Revicki D. Costs of bipolar disorder. PharmacoEconomics 2003; 21: 601-622.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM). Washington, DC: American psychiatric association 1994: 143-147.

Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of general psychiatry 2011; 68: 241-251.

Sadock BJ, Sadock VA. Kaplan & Sadock's Synopsis of Psychiatry,10th eds. New York: Lippincott Williams & Wilkins; 2007.

Gelenberg AJ, Kane JM, Keller MB, Lavori P, Rosenbaum JF, Cole K, et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. The New England journal of medicine 1989; 321: 1489-1493.

Gitlin MJ, Swendsen J, Heller TL , Hammen C. Relapse and impairment in bipolar disorder. The American journal of psychiatry 1995; 152: 1635-1640.

Murray CJ, Lopez AD. Global Health Statistics: A compendium of incidence, prevalence and mortality estimates for over 200 conditions. Boston: Harvard School of Public Health on behalf of the World Health Organization and the World Bank, 1996.

Fialko L, Garety PA, Kuipers E, Dunn G, Bebbington PE, Fowler D, et al. A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophrenia research 2008; 100: 53-59.

Milne BJ, Caspi A, Harrington H, Poulton R, Rutter M , Moffitt TE. Predictive value of family history on severity of illness: the case for depression, anxiety, alcohol dependence, and drug dependence. Archives of general psychiatry 2009; 66: 738-747.

Gaudiano BA, Weinstock LM , Miller IW. Improving treatment adherence in bipolar disorder: a review of current psychosocial treatment efficacy and recommendations for future treatment development. Behavior modification 2008; 32: 267-301.

Albuquerque J, Deshauer D, Fergusson D, Doucette S, MacWilliam C , Kaufmann IM. Recurrence rates in Ontario physicians monitored for major depression and bipolar disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie 2009; 54: 777-782.

Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR, et al. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). The American journal of psychiatry 2006; 163: 217-224.

Mohammadi M-R, Ghanizadeh A, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, et al. Prevalence of mood disorders in Iran. Iranian Journal of Psychiatry. 2006; 1:59-64.

de Dios C, Gonzalez-Pinto A, Montes JM, Goikolea JM, Saiz-Ruiz J, Prieto E, et al. Predictors of recurrence in bipolar disorders in Spain (PREBIS study data). Journal of affective disorders 2012; 141: 406-414.

Kupka RW, Luckenbaugh DA, Post RM, Leverich GS , Nolen WA. Rapid and non-rapid cycling bipolar disorder: a meta-analysis of clinical studies. The Journal of clinical psychiatry 2003; 64: 1483-1494.

Peen J, Schoevers RA, Beekman AT , Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta psychiatrica Scandinavica 2010; 121: 84-93.

Dickerson FB, Boronow JJ, Stallings CR, Origoni AE, Cole S , Yolken RH. Association between cognitive functioning and employment status of persons with bipolar disorder. Psychiatric services (Washington, D.C.) 2004; 55: 54-58.

Altman S, Haeri S, Cohen LJ, Ten A, Barron E, Galynker, II, et al. Predictors of relapse in bipolar disorder: A review. Journal of psychiatric practice 2006; 12: 269-282.

Coryell W, Endicott J , Keller M. Rapidly cycling affective disorder. Demographics, diagnosis, family history, and course. Archives of general psychiatry 1992; 49: 126-131.

Serretti A, Chiesa A, Calati R, Linotte S, Sentissi O, Papageorgiou K, et al. Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder. European archives of psychiatry and clinical neuroscience 2013; 263: 93-103.

Kessing LV, Hansen MG, Andersen PK , Angst J. The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders - a life-long perspective. Acta psychiatrica Scandinavica 2004; 109: 339-344.

Degenhardt EK, Gatz JL, Jacob J , Tohen M. Predictors of relapse or recurrence in bipolar I disorder. Journal of affective disorders 2012; 136: 733-739.

Jindal RD , Thase ME. Integrating psychotherapy and pharmacotherapy to improve outcomes among patients with mood disorders. Focus 2005; 3: 114.

Versiani M, Cheniaux E , Landeira-Fernandez J. Efficacy and safety of electroconvulsive therapy in the treatment of bipolar disorder: a systematic review. The journal of ECT 2011; 27: 153-164.

IssueVol 11 No 3 (2016) QRcode
SectionOriginal Article(s)
Bipolar Disorder Ordinal Logistic Regression Prognosis Factors Recurrence

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Najafi-Vosough R, Ghaleiha A, Faradmal J, Mahjub H. Recurrence in Patients with Bipolar Disorder and its Risk Factors. Iran J Psychiatry. 2016;11(3):173-177.