Bipolar affective disorder and associated factors in a university clinic, 30-year retrospective follow-up study

The files of patients who had been treated with Bipolar Affective Disorder in Atatürk University Medical Faculty inpatient psychiatry clinic between 1985 and 2015 were investigated retrospectively to analyze the sociodemographic and clinical characteristics of the disorder, the factors that might be related to the long-term course of the disorder, and the effects of changes in the treatment strategies on the clinical features. For this purpose, 1267 files of patients who were hospitalized with Bipolar Affective Disorder in Atatürk University Medical Faculty Psychiatry Clinic between 1985 and 2015 were investigated retrospectively. Of the files examined, 528 (41%) were female and 739 (58%) were male patients. The mean age at onset was 24.1 ± 8.9 years. It was found that 89.4% of the patients had no comorbid psychiatric disorder, the most common comorbid psychiatric disorders (3.4%) were personality disorders, 86% of the patients had no additional medical illnesses, and the most common medical illness was hypothyroidism (4.6%), 46.2% of the patients had mental illness in the family and the most common disorder was bipolar disorder (17,7%). Mania was the diagnosis for the first episode in69.1% of the patients (N = 876), whereas depression was the diagnosis for the first episode in 23.4% (N = 296) of the patients. Psychotic manifestations were present in 62.4% of the episodes. It was found that nonadherence to treatment (44.8%) triggered a new episode, and lack of treatment efficiency (42.9%) was the most important factor in triggering a new depressive episode. Given the change in medication trends between 1985 and 2015; It was concluded that the usage of mood stabilizers (MS) generally did not change significantly, the usage of lithium decreased significantly, the useage of valproate increased significantly, the usage of carbamazepine increased significantly in the second decade but decreased in the third decade, and the usage of lamotrigine increased, but this increase was not found to be statistically significant. It was found that the combined use of MS showed an increase, however not at a significant level. When the change in antipsychotic use over the years was observed, it was found that the use of typical AP decreased significantly, the use of atypical AP and depot AP increased significantly, and the use of combined AP decreased significantly. When antidepressant use was considered, antidepressant use decreased significantly from 13.8% in the first decade to 5.0% in the last decade. Whereas NASSA (30,8%), tricyclic antidepressants (23,1%) and MAO inhibitor were used in the first decade SSGİ (56.7%) and SNGİ (13.3) were preferred in the last decade. Compulsory intramuscular sedation was found to be significantly lower in patients using atypical AP. Compulsory intramuscular sedation showed an increase in the second decade but decreased in the third decade. Suicide attempts have been found to be more frequent in manic (45,2%) and depressive episodes (31,5%). The most commonly used suicide methods were drug overdose (2.8%) and jumping from height(1.9%). Suicide attempt was found to be significantly lower in patients using atypical AP and lithium. Investigating possible changes in factors affecting the course of the disorder over a period of 30 years can be useful in understanding Bipolar Affective Disorder, a heterogeneous disorder in many ways.