Recurrent affective syndromes in bipolar and unipolar mood disorders at follow-up

Background. It is in dispute whether affective relapse disrupts psychosocial functioning to the same extent in depressed and manic patients. Method. A prospective, naturalistic, longitudinal follow-up of 84 unipolar and bipolar affectively disordered in-patients was conducted to examine the extent of recurrent affective syndromes and their relationship to overall outcome. Global adjustment relative to relapse was assessed at 2- and 4.5-year follow-ups. Results. Nearly half of the bipolar patients had subsequent syndromes, which were often associated with uniformly poor psychosocial functioning. Fewer than one-quarter of those with recurrences had steady work performance. Bipolar patients taking lithium alone had fewer recurrences than those taking lithium as well as neuroleptics (P < 0.05). Bipolar and unipolar patients relapsed with equal frequency, but unipolar relapse was less often associated with readmission to hospital, work impairment, or uniformly poor functioning. Conclusion. Affective relapse in bipolar disorders was more detrimental to overall functioning than was recurrence in unipolar depression.