Identifying patterns in treatment response profiles in acute bipolar mania: a cluster analysis approach

Lipkovich, Ilya A.; Houston, John P.; Ahl, Jonna
January 2008
BMC Psychiatry;2008, Vol. 8, Special section p1
Academic Journal
Background: Patients with acute mania respond differentially to treatment and, in many cases, fail to obtain or sustain symptom remission. The objective of this exploratory analysis was to characterize response in bipolar disorder by identifying groups of patients with similar manic symptom response profiles. Methods: Patients (n = 222) were selected from a randomized, double-blind study of treatment with olanzapine or divalproex in bipolar I disorder, manic or mixed episode, with or without psychotic features. Hierarchical clustering based on Ward's distance was used to identify groups of patients based on Young-Mania Rating Scale (YMRS) total scores at each of 5 assessments over 7 weeks. Logistic regression was used to identify baseline predictors for clusters of interest. Results: Four distinct clusters of patients were identified: Cluster 1 (n = 64): patients did not maintain a response (YMRS total scores ≤ 12); Cluster 2 (n = 92): patients responded rapidly (within less than a week) and response was maintained; Cluster 3 (n = 36): patients responded rapidly but relapsed soon afterwards (YMRS ≥ 15); Cluster 4 (n = 30): patients responded slowly (≥ 2 weeks) and response was maintained. Predictive models using baseline variables found YMRS Item 10 (Appearance), and psychosis to be significant predictors for Clusters 1 and 4 vs. Clusters 2 and 3, but none of the baseline characteristics allowed discriminating between Clusters 1 vs. 4. Experiencing a mixed episode at baseline predicted membership in Clusters 2 and 3 vs. Clusters 1 and 4. Treatment with divalproex, larger number of previous manic episodes, lack of disruptive-aggressive behavior, and more prominent depressive symptoms at baseline were predictors for Cluster 3 vs. 2. Conclusion: Distinct treatment response profiles can be predicted by clinical features at baseline. The presence of these features as potential risk factors for relapse in patients who have responded to treatment should be considered prior to discharge. Trial registration: The clinical trial cited in this report has not been registered because it was conducted and completed prior to the inception of clinical trial registries.


Related Articles

  • Comparably high retention and low relapse rates in different subpopulations of bipolar patients in a German non-interventional study. Kraemer, Susanne; Minarzyk, Anette; Eppendorfer, Steffen; Henneges, Carsten; Hundemer, Hans-Peter; Wilhelm, Stefan; Grunze, Heinz // BMC Psychiatry;2013, Vol. 13 Issue 1, p1 

    Background: Although a range of pharmacotherapeutical options are available for the treatment of bipolar disorder, patient non-adherence to prescribed treatment regimens and early treatment discontinuation remain among the primary obstacles to effective treatment. Therefore, this observational...

  • Olanzapine is superior to lamotrigine in the prevention of bipolar depression: a naturalistic observational study. Pei-Yin Pan; Meei-Shyuan Lee; Miao-Chi Lo; En-Lin Yang; Chin-Bin Yeh // BMC Psychiatry;2014, Vol. 14 Issue 1, p117 

    Background Bipolar disorder is a highly recurrent disease and has great impact on the function of patients. Depressive symptoms consist of more than 50% of life time during the illness and may lead to self harm or suicidal behaviors. Little is known about the antidepressant effects of...

  • Treatment of bipolar disorder: a systematic review of available data. Fountoulakis, Konstantinos; Vieta, Eduard; Kaprinis, George // Annals of General Psychiatry;2008 Supplement 1, Vol. 7, Special section p1 

    Background The current article is a systematic review of the data available concerning the treatment of bipolar disorder. Materials and methods A systematic MEDLINE search concerning treatment guidelines and clinical trials. Results The search for treatment guidelines returned 370 articles and...

  • The need for inclusion of concepts of recovery in clinical trials. Shepherd, Andrew; Tohen, Mauricio // British Journal of Psychiatry;Feb2013, Vol. 202 Issue 2, p153 

    A letter to the editor and a reply by the author to the article "Randomised, Double-Blind, Placebo-Controlled Study of Olanzapine in Patients With Bipolar I Depression," that was published in a 2011 issue is presented.

  • Olanzapine.  // Reactions Weekly;10/22/2011, Issue 1374, p28 

    The article cites a case of delirium experienced by an elderly patient following olanzapine therapy for bipolar affective disorder.

  • Metabolic impact a key factor in antipsychotics' cost effectiveness.  // Reactions Weekly;7/23/2011, Issue 1361, p3 

    The article discusses the findings of research which compared the metabolic effects and cost-effectiveness of aripiprazole and olanzapine in patients with schizophrenia and bipolar disorders, published in the May 24, 2011 issue of "Acta Psychiatrica Scandinavica."

  • Patrones de tratamiento farmacológico para el episodio maníaco en la práctica clínica. Resultados de la muestra española en el estudio EMBLEM. Montoya, A.; Sánchez-Toledo, J. Pérez; Gilaberte, I.; González-Pinto, A.; Haro, J. M.; Vieta, E.; Tohen, M. // Actas Espanolas de Psiquiatria;sep2007, Vol. 35 Issue 5, p315 

    Introduction. Although treatment for mania has been studied extensively in randomized clinical trials, there are few data that address how these patients are truly managed in clinical, functional, and economic terms in the psychiatric practice in Spain. Objective. To determine prescribing...


    The present work tries to summarize the discursive rules of the psychiatric classification and the analysis of the social and historical determinations of our epoch. Then we try to approach analytically the transformations that made possible that the pathology historically named...

  • Olanzapine.  // Reactions Weekly;12/1/2007, Issue 1180, p31 

    The article presents medical cases of two women aged 32 and 34 who developed bilateral pedal oedema after starting olanzapine for manic episodes of bipolar disorder. Both women were diagnosed with bipolar disorder, manic episode with psychotic features and started treatment with olanzapine,...


Other Topics