OUTCOME

MDI causes disability during symptomatic and during symptom-free periods. In the past it was assumed that once the symptoms were controlled, the person would return to a premorbid or baseline level of functioning without much delay. Longitudinal studies of interepisodic functioning among patients with MDI revealed a very different reality.

In order to clarify the effect of MDI on various aspects of life, a distinction has been made between symptomatic versus functional recovery.

One of the best studies focused on patients recovering from Mania (Tsuang). One hundred patients were evaluated 35 years after they were hospitalized. Marital, occupational, residential and symptomatic (psychiatric) status were evaluated and combined. In 64%, the outcome was good, fair in 14%, and poor in 22%. When compared to two control groups, MDI patients did better than schizophrenic patients but not as well as a group admitted for minor surgical procedures.

The tendency of mixed episodes and depressive episodes to last longer and to recover slowly has been well documented, especially among those who cycle continuously. (Keller)

Chronicity or the tendency of the illness to remain symptomatic for periods of 2 years or more without remission has been evaluated in several studies and appears to occur in about 20% of the patients.

Kraepelin wrote: “…when the disease has lasted for some time, and the attacks have been frequently repeated, the psychic changes usually become more distinct during the intervals also.”
This is confirmed by more recent studies of outcome, such as a study by Dion. Manic patients at a six month follow-up had reached symptomatic recovery in 80% of cases, but only 43% were employed, and only 21% working at their perceived level of employment. Tohen and colleagues have studied the outcome of patients admitted with a psychotic first episode of MDI and found the functional recovery to lag behind symptomatic recovery.