A naturalistic observational study of patients with bipolar affective disorder from two tertiary care hospitals in Sri Lanka

Abstract

INTRODUCTION : Bipolar affective disorder (BAD) is a lifelong condition with a variable course. The objective of this study was to conduct a naturalistic observation of the course of this disorder among patients attending two general hospital psychiatric clinics in Sri Lanka. METHODS: Adult patients with a diagnosis of BAD for more than 12 months were included in this cross sectional descriptive study. Those who were suffering from acute exacerbations, had schizoaffective disorder or alcohol or drug misuse were excluded. Data was collected from the patients, caregivers and clinic records using a pre-tested interviewer administered questionnaire. Outcomes of interests were socio demographic characteristics, duration of the illness, number of relapses, treatment adherence, suicidality and level of functioning. RESULTS : Of the 350 patients studied, majority (55.7%) were females. Most (54.9%) had their first relapse within 2-5 years from onset of their illness. Of them 27.7% experienced their first relapse within one year. The first relapse occurred within 6-10 years of onset of illness in 8.9%, after 10 years in 6.3% and after 20 years in 2.3%. One third (33.4%) of patients had no second relapse. However, 38.3% relapsed for the second time within 2-5 years of diagnosing their illness. A minority (2.4%) had a second relapse within the first year and another minority (2.6%) after 20 years. The likelihood of a relapse for each patient per year was 0.644 in the first 5 years, 0.405 in the next 5-10 years, 0.38 in the next 10-15 years and 0.30 after 15 years. Conclusions : Despite the relapsing nature of BAD, predicting the course of the disorder in individual patients remains elusive. The trend was suggestive of fewer episodes over time, possibly mediated by better medication compliance and positive attitudes to treatment.