Prompt intervention helps young bipolar patients at discharge

By Eleanor McDermid, Senior medwireNews Reporter

Young adults early in the course of bipolar disorder benefit at least as much as older patients from early intervention after hospital discharge, say researchers.

“There are a number of challenges related to young adulthood such as interference of illness with age-specific educational, social and psychological development, problems with insight into an illness that may interfere with identity, and possible comorbidity with alcohol and other substance use,” say Lars Vedel Kessing (Copenhagen University Hospital, Denmark) and co-workers.

“Despite these challenges we found indications that younger adults may potentially benefit more from early combined pharmacological and psychological treatment.”

However, the findings come from a post-hoc analysis of an early intervention trial, which was not powered to detect differences between age groups, so the team cautions that further research is needed.

The trial involved 158 patients discharged from their first, second, or third hospitalization, 18.4% of whom were aged between 18 and 25 years. The trial’s initial findings showed a significantly reduced risk for rehospitalization during an average 2.5 years of follow-up if patients received optimized pharmacologic treatment and group psychoeducation in a mood disorders clinic, rather than standard care.

In the post-hoc analysis, the effect seemed larger for the 18–25-year age group than for older patients, with respective risk reductions of 67% and 32%, although the researchers stress that these changes were not statistically significant and the confidence intervals were wide.

Among the younger patients, 28.6% of those in the intervention group were readmitted, compared with 71.4% of those in the control group, and the average time to readmission was 4.2 versus 2.5 years. The corresponding rehospitalization rates among the older patients were 37.9% and 52.1%, and the times to readmission were 4.1 and 3.4 years.

Treatment in the mood disorders clinic was associated with a more than fivefold increased use of mood stabilizers and antipsychotics among younger patients and a two- to threefold increase among older patients, although most associations were not significant.

“Findings from the present trial may suggest that also among young patients aged 18–25 years, the first episodes in bipolar disorder offer an important opportunity to provide psychological intervention and individual effective maintenance pharmacological treatment and improve outcome,” concludes the team in the Journal of Affective Disorders.

“Consequently, this should be tested in a larger randomised trial on early intervention in young patients with bipolar disorder.”

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