Course and Outcome in Affective Disorders

Abstract

One hundred and two of 108 patients who were successive first lifetime admissions for affective disorders between 1961 and 1965, and whose charts fulfilled Feighner criteria for primary affective disorders, were followed up in 1978–1980. Such studies from the onset of illness or first admission are rare. Seventy-five patients had depressions only, and of these 41 were non-recurrent; 27 had manic episodes, but only 9 of these had manic and depressive episodes, and 17 had unipolar mania, which in 6 was non-recurrent (one patient had a single mixed episode). Sex ratios varied, with a large female excess in the single episode depressions, to a male excess in those with both manic and depressive episodes. Outcome after 15 years was examined on scales for economic productivity, social adjustment and psychiatric condition; summed for a combined outcome measure. Results from a previous study of schizophrenic patients were used for comparison. Patient groups were schizophrenic, single episode depression, recurrent depression, and mania ± depression. On all measures, schizophrenic patients had the worst outcome, single episode depression the best, with the recurrent depressives and manias ± depressions in an intermediate position and differing little from each other. Thus, in terms of the course of the illness over a period as long as 15 years, patients do not clearly fall into recurrent depressions (recurrent uhipolars) and manic depressives (bipolars), a large number being nonrecurrent depressions, which form a distinct group on the outcome measures. Although the affective disorders have a better long-term outcome than schizophrenia, they do produce definite morbidity, more so in the recurrent than non-recurrent disorders.