Bipolar Recurrence After First Mania — MRCPsych Paper B MCQ

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ModerateMood DisordersBipolar Recurrence After First ManiaMRCPsych Paper B

A 30-year-old woman has recovered from her first manic episode, which established a diagnosis of bipolar I disorder. She asks about her risk of becoming unwell again. According to systematic evidence from adult cohorts following recovery from a single manic or mixed episode, approximately what proportion experience recurrence of any mood episode within 4 years?

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Correct answer: B — 60%

The correct answer is B. A systematic review of adult cohorts following recovery from a single manic or mixed episode found that approximately 58% experienced a further mood episode by 4 years, best represented by 60%. About 35% recurred within 1 year, making C a plausible but incorrectly timed estimate. Rates around 75% have been reported in some individual cohorts and broader bipolar populations, but they are not the best pooled estimate for adults after a single episode. A 90% lifetime figure is sometimes quoted clinically, but it is not established by the directly applicable evidence and should not be presented as an untreated rate. NICE recommends an individualised discussion of longer-term treatment after mania rather than asserting that one episode automatically requires lifelong medication.

Reference: Kessing LV, Andersen PK, Vinberg M. Risk of recurrence after a single manic or mixed episode: a systematic review and meta-analysis. Bipolar Disorders. 2018;20(1):9–17. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations