Open Access Research article

Treatment and outcomes of an Australian cohort of outpatients with bipolar I or schizoaffective disorder over twenty-four months: implications for clinical practice

Jayashri Kulkarni1*, Sacha Filia1, Lesley Berk268, Kate Filia1, Seetal Dodd28, Anthony de Castella1, Alan JM Brnabic3, Amanda J Lowry4, Katarina Kelin4, William Montgomery5, Paul B Fitzgerald1 and Michael Berk2678

Author Affiliations

1 Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, Central Clinical School, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia

2 Department of Psychiatry, The University of Melbourne, Parkville, VIC, 3010, Australia

3 Optum, Lilyfield, NSW, 2040, Australia

4 Eli Lilly Australia Pty Ltd, 112 Wharf Road, West Ryde, NSW, 2114, Australia

5 Global Health Outcomes, Intercontinental Region, Eli Lilly Australia Pty Ltd, 112 Wharf Road, West Ryde, NSW, 2114, Australia

6 Orygen Research Centre, Parkville, VIC, 3052, Australia

7 Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, 3010, Victoria, Australia

8 School of Medicine, Deakin University, Geelong, VIC, 3220, Australia

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BMC Psychiatry 2012, 12:228  doi:10.1186/1471-244X-12-228

Published: 17 December 2012



The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with ‘real-world’ treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication.


Participants prescribed either conventional mood stabilizers (CMS; n = 155) alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84) were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale – Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data.


On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine ± CMS (61%;) cohorts.


Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.