Real-world clinical predictors of manic/hypomanic episodes among outpatients with bipolar disorder

Keita Tokumitsu, Yasui Furukori Norio, Naoto Adachi, Yukihisa Kubota, Yoichiro Watanabe, Kazuhira Miki, Takaharu Azekawa, Koji Edagawa, Eiichi Katsumoto, Seiji Hongo, Eiichiro Goto, Hitoshi Ueda, Masaki Kato, Atsuo Nakagawa, Toshiaki Kikuchi, Takashi Tsuboi, Koichiro Watanabe, Kazutaka Shimoda, Reiji Yoshimura

Research output: Contribution to journalArticlepeer-review

Abstract

Background Bipolar disorder is a mental illness in which manic and depressive states are repeated, causing psychosocial dysfunction. Manic/hypomanic episodes cause problems with interpersonal, social and financial activities, but there is limited evidence regarding the predictors of manic/hypomanic episodes in real-world clinical practice. Methods The multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was administered in an observational study that was conducted to accumulate evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked to complete a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics by conducting a retrospective medical record survey. Our study extracted baseline patient characteristics from September to October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. We investigated the presence or absence of manic/hypomanic episodes over the course of one year from baseline to September-October 2017. Results In total, 2231 participants were included in our study, 29.1% of whom had manic/hypomanic episodes over the course of one year from baseline. Binomial logistic regression analysis revealed that the presence of manic/hypomanic episodes was correlated with lower baseline GAF scores, rapid cycling, personality disorder, bipolar I disorder, and a mood state with manic or mixed features. Substance abuse was also a risk factor for manic episodes. There was no significant association between a baseline antidepressant prescription and manic/hypomanic episodes. Conclusions In Japan, 29.1% of outpatients with bipolar disorder had manic/hypomanic episodes over the course of one year. Our study suggested that a low GAF score, rapid cycling, personality disorder, bipolar I disorder, substance abuse, and baseline mood state could be predictors of manic/hypomanic episodes. Based on our findings, an antidepressant prescription is not a predictor of manic/hypomanic episodes.

Original languageEnglish
Article numbere0262129
JournalPloS one
Volume16
Issue number12 December
DOIs
Publication statusPublished - 2021 Dec

ASJC Scopus subject areas

  • General

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