A 12-month prospective study on the time to hospitalization and clinical management of a cohort of bipolar type I and schizoaffective bipolar patients.

Abstract

BACKGROUND\nSchizoaffective disorder, bipolar type (SAD) and bipolar disorder I (BD) present a large clinical overlap. In a 1-year follow-up, we aimed to evaluate days to hospitalization (DTH) and predictors of relapse in a SAD-BD cohort of patients.\n\n\nMETHODS\nA 1-year, prospective, naturalistic cohort study considering DTH as primary outcome and incidence of direct and indirect measures of psychopathological compensation as secondary outcomes. Kaplan-Meyer survival analysis with Log-rank Mantel-Cox test compared BD/SAD subgroups as to DTH. After bivariate analyses, Cox regression was performed to assess covariates possibly associated with DTH in diagnostic subgroups.\n\n\nRESULTS\nOf 836 screened patients, 437 were finally included (SAD\u2009=\u2009105; BD\u2009=\u2009332). Relapse rates in the SAD sample was n\u2009=\u200926 (24.8%) vs. n\u2009=\u200941 (12.3%) in the BD sample (p\u2009=\u20090.002). Mean\u2009±\u2009SD DTH were 312.16\u2009±\u200910.6 (SAD) vs. 337.62\u2009±\u20094.4 (BD) days (p\u2009=\u20090.002). Patients with relapses showed more frequent suicide acts, violent behaviors, and changes in pharmacological treatments (all p\u2009<\u20090.0005) in comparison to patients without relapse. Patients without relapses had significantly higher mean number of treatments at T0 (p\u2009=\u20090.010). Cox regression model relating the association between diagnosis and DTH revealed that BD had higher rates of suicide attempts (HR\u2009=\u200913.0, 95%CI\u2009=\u20094.0-42.0, p\u2009<\u20090.0005), whereas SAD had higher rates of violent behavior during psychotic episodes (HR\u2009=\u200912.0, 95%CI\u2009=\u2009.3.3-43.5, p\u2009>\u20090.0005).\n\n\nCONCLUSIONS\nSAD patients relapse earlier with higher hospitalization rates and violent behavior during psychotic episodes whereas bipolar patients have more suicide attempts. Psychiatric/psychological follow-up visits may delay hospitalizations by closely monitoring symptoms of self- and hetero-aggression.