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Clinical, sociodemographic and environmental predicting factors for relapse in bipolar disorder: A systematic review

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Introduction: Bipolar disorder (BD) is a chronic and recurrent illness characterized by
manic, mixed or depressive episodes, alternated with periods of euthymia. Several
prognostic factors are associated with higher rates of relapse, which is crucial for the
identification of high-risk individuals. This study aimed at systematically reviewing the
existing literature regarding the impact of sociodemographic, clinical and environmental
factors, in clinical relapses, recurrences and hospitalizations due to mood episodes in
BD.
Methods: A systematic search of electronic databases (PubMed, Cochrane library and
Web of Science) was conducted to integrate current evidence about the impact of
specific risk factors in these outcomes.
Results: Fifty-eight articles met the inclusion criteria. Studies were grouped by the type
of factors assessed. Family and personal psychiatric history, more severe previous
episodes, earlier age of onset, and history of rapid cycling are associated with clinical
relapses, along with lower global functioning and cognitive impairments.
Unemployment, low educational status, poorer social adjustment and life events are
also associated with higher frequency of episodes, and cannabis with a higher
likelihood for rehospitalization.
Limitations: small sample sizes, absence of randomized clinical trials, diverse follow-up
periods, lack of control for some confounding factors, heterogeneous study designs
and diverse clinical outcomes.
Conclusions: Although current evidence remains controversial, several factors have
been associated with an impaired prognosis, which might allow clinicians to identify
patients at higher risk for adverse clinical outcomes and find modifiable factors. Further
research is needed to elucidate the impact of each risk factor in the mentioned
outcomes.

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Journal of Affective Disorders, 2024, vol. 360, p. 276-296

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Articles publicats en revistes (Medicina)

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Clinical, sociodemographic and environmental predicting factors for relapse in bipolar disorder: A systematic review