Chronic mania revisited: Factors associated with treatment non-response during prospective follow-up of a large European cohort (EMBLEM)

Abstract

Objective. To describe the course and outcome of patients with prospectively defined chronic mania and to identify predictors of treatment non-response. Method. EMBLEM is a 2-year prospective, observational study of bipolar disorder treatment outcomes conducted in 14 European countries. Patients with a manic/mixed episode were assessed and prospectively followed for 1 year. Clinical scales (Clinical Global Impressions–Bipolar Disorder (CGI-BP) overall, mania, and depression; Young Mania Rating Scale (YMRS); and five-item Hamilton Depression Rating Scale (HAM-D-5)) and medication taken were systemically recorded. Treatment adherence and outcome measures were also captured. Chronic mania (non-response) was defined as not achieving more than one point improvement on CGI-BP mania scale during up to 12-month follow-up. The analysis was conducted with 3373 patients who had at least two CGI-BP mania ratings available. Results. A total of 15% of patients fulfilled criteria for chronic mania. Compared to those who responded to treatment, chronic mania was associated with lower severity of mania symptoms at baseline (OR = 0.44, 95% CI 0.37–0.52), shorter duration of current episode before treatment start (OR = 0.71, 95% CI 0.52–0.96), more delusions/hallucinations at baseline (OR = 1.12, 95% CI 1.03–1.22), less socially active (OR = 0.52, 95% CI 0.39–0.70) and greater occupational impairment (OR = 1.54, 95% CI 1.01–2.35) by multivariate statistical analysis. Conclusions. Rather than severity or duration of manic symptoms, factors associated with chronicity in mania are the presence of psychotic symptoms and issues related to social and occupational functioning.