While many patients with bipolar disorder respond well to treatment, an increasingly large group have not only continuing difficulty, but also a course of illness characterized by increasing frequency or severity of manic or depressive episodes or what could be considered a pattern of illness deterioration or progression. We assessed the relationship of a host of factors that have previously been associated with a poor outcome in bipolar disorder to several patient-rated measures of illness progression that occurred prior to entry in our network in outpatients from the United States.
In the United States, the prevalence of bipolar disorder is in the range of 3%–5%,1and, in primary care, 9.8% of patients screened positive for bipolar disorder, but few were taking mood stabilizers or had a bipolar diagnosis entered into the record.2 Even in patients who were given a new diagnosis of bipolar disorder in another study,3 50% were treated with antidepressants, mostly in monotherapy (which is not recommended), and much fewer numbers of patients were treated with approved classes of medications such as lithium, mood stabilizers, or atypical antipsychotics.