Abstract

Introduction: Bipolar disorder is a recurrent and long term mental illness that can seriously affect the lives of patients and their families. Globally the lifetime prevalence of all forms of the illness, often referred to as bipolar spectrum disorders, has been estimated to be 5% in the general population. Objective: To assess the Outcome of Bipolar mood disorder treatment in elderly patients in tertiary care hospital. Methods: A prospective cohort study was conducted between July 2022 to October 2023 in a tertiary care teaching hospital BSMMU located in Shahbag, Dhaka Bangladesh. The Institutional Ethics Committee approval was obtained before the study. All newly diagnosed bipolar disorder patients as per diagnostic and statistical manual-IV criteria or previously diagnosed bipolar disorder patients but not on treatment and who are willing to participate in the study were enrolled. Results: During the study period, 100 bipolar disorder patients were enrolled in the study based inclusion criteria. Patient demography, age at onset, treatment outcome, and other details are summarized in Table 1. The average age of the study population was 37.6 ± 14.1 years (mean ± SD), and 65.0% (n = 65) of the patients were female. Early-onset bipolar disorder was seen in 17.0%, (n = 17) and the mean age at early-onset bipolar disease was 15.7 ± 2.4 (mean ± SD) years. Treatment delay was observed in 24.0% (n = 24) of patients. At the end of the follow-up period, 38.0% (n = 38) had remission and 76% (n = 76) had non remission. There was a statistically significant (at P < 0.01), 67.5% reduction in YMRS and 70.0% reduction HAM-D score compared to baseline whereas in nonremission group, reduction in YMRS and HAM-D score was not significant. However, remission (45.7%, n = 16) was more in patient who were treated with mood stabilizers (lithium salts) compared to anticonvulsants (31.2%, n = 19) and antipsychotics (30.0%, n = 21). Twelve variables were analyzed to identify the possible association with nonremission in the study population. Early onset (OR: 9.77; confidence intervals [CI]: 1.11–86.01), treatment delay (OR: 6.48; CI: 1.27–32.92) treatment noncompliance (OR: 4.64; CI: 1.37–15.64), and single living (OR: 4.26; CI: 1.56–11.66) were independently associated with nonremission in bipolar disorder patients. Other variables, namely low income, depression, male sex, hypothyroidism, hypertension, and obesity also had OR >1; however, they were not statistically significant. Smoking and alcoholism shown to favour remission but again results were statistically no significant.

Conclusion: It is known that the outcome of bipolar disorder treatment is highly variable and several patients and environmental-related factors may affect the outcome. The identified factors may be used as a clinical decision supporting tool and addressing these factors in the early phase of treatment may reduce the chances of nonremission in bipolar disorder patients and improve their quality of life.