Initial symptoms of manic relapse in manic or mixed-manic bipolar disorder: Post hoc analysis of patients treated with olanzapine or lithium

A post hoc analysis of Young Mania Rating Scale (YMRS) item scores was conducted to identify symptoms that may predict impending relapse using prospectively collected data from a double-blind, randomized relapse prevention study of patients treated with olanzapine (N = 200, 5–20 mg/d) versus lithium (N = 201, 300–1800 mg/d). Methods: relapses (YMRS ⩾ 15, or hospitalization) included in this analysis occurred 3–52 weeks after randomization. Repeated measures logistic regression of increases (⩾1) in YMRS item scores prior to the visit that preceded relapse was used to estimate the odds of relapse. Results: a total of 31 patients relapsed during the first 3–16 weeks of the study (olanzapine, n = 12; lithium, n = 19). YMRS items that increased most frequently within a 2-week period preceding relapse were (olanzapine vs. lithium, respectively): increased motor activity/energy (58.3%, 21.1%), irritability (33.3%, 31.6%), decreased need for sleep (25.0%, 10.5%), increased speech (25.0%, 10.5%), and elevated mood (25.0%, 15.8%). YMRS items with significant odds ratios (OR) that predicted relapse in patients treated with olanzapine or lithium, respectively, were: increased motor activity/energy (OR, 35.7; OR, 7.8), irritability (OR, 9.5; OR, 7.8), elevated mood (OR, 8.1; OR, 4.2), and increased sexual interest (OR, 13.7; OR, 7.7). Conclusions: early recognition of symptom exacerbation in bipolar mania, particularly increased motor activity-energy may permit clinical interventions to help avert relapse.