Baseline Characteristics and Outcomes in Patients With First Episode or Multiple Episodes of Acute Mania
J Clin Psychiatry 2010;71(3):255-261
© Copyright 2014 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Previous studies have reported differential responses to therapeutic interventions depending on the patient’s history with bipolar disorder, which highlights the importance of understanding the longitudinal nature of the disorder. The goal of the present analyses was to describe and compare the baseline characteristics, response to treatment, and medication patterns in adult patients experiencing a first episode versus multiple episodes of mania.
Method: The European Mania in Bipolar
Longitudinal Evaluation of Medication (EMBLEM) study was a 2-year prospective, observational study
to evaluate outcomes in patients experiencing a DSM-IV– or ICD-10–diagnosed manic or mixed
episode. The study was conducted from December 2002 to June 2004.
Results: Among 3,115 patients, 256 (8.2%) enrolled with a first manic or mixed episode. Relative to multiple-episode patients, first-episode patients were younger and had a lower body mass index (BMI), a higher incidence of past or current cannabis abuse, significantly higher baseline Young Mania Rating Scale total and Clinical Global Impressions-Bipolar Disorder (CGI-BP) mania scores, and lower CGI-BP depression and Hamilton Depression Rating Scale
(5-item version) total scores. At the 12-week endpoint, rates of recovery and remission were greater for first-episode patients, and times to recovery and remission were shorter.
Conclusions: Limitations of the study were that entry of patients into this study with an acute manic or mixed episode was determined by clinical interview but not confirmed with a structured diagnostic interview. That information on the course of illness prior to entry into the study was obtained retrospectively. First-episode patients presented with different baseline illness characteristics and achieved recovery and remission more rapidly than multiple-episode patients.
Submitted: July 30, 2008; accepted November 24, 2008.
Online ahead of print: August 25, 2009.
Corresponding author: Mauricio Tohen, MD, DrPH, MBA, Division of Mood and Anxiety Disorders, University of Texas Health Science Center at San Antonio, 7526 Louis Pasteur Drive, San Antonio, TX 78229-3900 (email@example.com).