Kessing LV, et al. - This meta-analysis was performed to evaluate the risk of recurrence among patients with a single manic/mixed episode by systematically reviewing prior studies on cohorts of adults, and cohorts of children and adolescents, respectively. The high rate of recurrence was observed among adults as well as children and adolescents. When deciding to start maintenance treatment or not following the onset of a single manic or mixed episode, it was important that clinicians and patients, as well as relatives, were well informed about these high risks.

Methods

• Up to August 2017, the researchers conducted a systematic literature search.
• They selected studies in which< 25% of the participants were estimated to have had a mood episode that required pharmacological treatment prior to the index manic or mixed episode at inclusion.

Results

• The researchers identified 3 studies which included 293 adult patients with a single manic or mixed episode and 3 studies consisting of children and adolescents (126 patients).
• After recovery, 31%, 40% and 42% experienced recurrence within 1 year, 59% after 2 years, and 58% after 4 years, respectively, in the adult studies.
• Forty percent and 52% experienced recurrence after recovery within 1 year, 30% and 60% after 2 years and 64% and 67% after 4 to 5 years, respectively, in the studies on children and adolescents.
• The following results were demonstrated: A 1-year rate of recurrence of 35% (95% confidence interval [CI]: 30-41%) in adults, and in adolescents/children, a 1-year rate of recurrence of 48% (95% CI: 38-58%), a 2-year rate of 46% (95% CI: 33-60%) and a 4-5-year rate of recurrence of 65% (95% CI: 52-77%; as data from different studies were included at 1, 2 and 5 years, rates of recurrence did not increase steadily with time).