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Table 1 Characteristics and results of included primary studies and meta-analyses

From: Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review

Author Sampling N Main outcomes measured Main results
Berk et al. (2011) Meta-analysis of 12 Lilly funded RCTs 4346 Symptomatic response and relapse using manic symptoms, depression, and global impression Increased response comparing 1–5 episodes with >10 episode groups in treatment of depression, mania, and maintenance studies
Scott et al. (2007) Meta-analysis of RCTs 716 Relapse rates Psychological adjuncts were more effective in patients who had experienced less episodes
Colom et al. (2010) Patients from the Bipolar Disorders Program at the Hospital Clinic of Barcelona 120 Time to recurrence Increased response to treatment in people with fewer previous episodes, particularly if less than seven
Dion et al. (1988) Patients from the clinical evaluation unit of McLean hospital, USA 67 Functioning via the modified vocational status index and modified location code index scales At follow-up, the first admission had increased rates of employment vs the previous admissions (64 vs 33 %)
Admission number not significant in explaining employment in multiple regression
Franchini et al. (1999) Outpatient Lithium Clinic for Mood Disorders, Milan 270 in total
171 with bipolar disorder
Recurrence rates Initiating lithium therapy during the first 10 years of bipolar onset results in less recurrence
Jiang (1999) Acute psychiatric service Taiwan 63 Vocational and residential functioning The first admission (70.2 %) vs multiple admission (31.8 %) employed and able to live independently at follow-up
Effect not significant in multiple regression explaining outcome
Keck et al. (1995) Patients from the University of Cincinnati Hospital psychiatric units 71 Symptomatic and syndromal outcomes in manic symptoms, depression, global assessment of functioning, and comorbidity The first episode (using the first admission as proxy) mania associated with shorter hospital stays compared with multiple episode patients
Rosa et al. (2012) Patients at Santiago Apostol Hospital and in the Bipolar Disorders Program at Hospital Clinic of Barcelona 119 Psychosocial functioning Treatment of patients in the first episode (using the first admission as proxy) resulted in improved symptomatic and psychosocial outcomes in comparison to patients treated in later episodes, even after controlling for the effects of age and affective symptoms
Tohen et al. (2010) Inpatients and outpatients initiating or changing oral medication for treatment of acute mania 3115 Recovery, response and remission using clinical global impression, mania symptoms, and depression Patients treated in their first episode of bipolar reached recovery or remission more often and faster at 12 weeks compared with patients experiencing a later episode
Swann et al. (1999) Inpatients 154 Response to anti-manic medication Increased response to treatment for patients who had experienced fewer episodes, particularly if less than ten