Residual Symptom Recovery From Major Affective Episodes in Bipolar Disorders and Rapid Episode Relapse/Recurrence
ABSTRACT Both bipolar disorder type I and type II are characterized by frequent affective episode relapse and/or recurrence. An increasingly important goal of therapy is reducing chronicity by preventing or delaying additional episodes.
To determine whether the continued presence of subsyndromal residual symptoms during recovery from major affective episodes in bipolar disorder is associated with significantly faster episode recurrence than asymptomatic recovery and whether this is the strongest correlate of early episode recurrence among 13 variables examined.
An ongoing prospective, naturalistic, and systematic 20-year follow-up investigation of mood disorders: the National Institute of Mental Health Collaborative Depression Study.
Five academic tertiary care centers.
Two hundred twenty-three participants with bipolar disorder (type I or II) were followed up prospectively for a median of 17 years (mean, 14.1 [SD, 6.2] years).
Participants defined as recovered by Research Diagnostic Criteria from their index major depressive episode and/or mania were divided into residual vs asymptomatic recovery groups and were compared according to the time to their next major affective episodes.
Participants recovering with residual affective symptoms experienced subsequent major affective episodes more than 3 times faster than asymptomatic recoverers (hazard ratio, 3.36; 95% confidence interval, 2.25-4.98; P < .001). Recovery status was the strongest correlate of time to episode recurrence (P < .001), followed by a history of 3 or more affective episodes before intake (P = .007). No other variable examined was significantly associated with time to recurrence.
In bipolar disorder, residual symptoms after resolution of a major affective episode indicate that the individual is at significant risk for a rapid relapse and/or recurrence, suggesting that the illness is still active. Stable recovery in bipolar disorder is achieved only when asymptomatic status is achieved.
- SourceAvailable from: Randye J. Semple
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- "The secondary objective was to examine whether MBCT is associated with decreases in subthreshold depressive symptoms during the 8 weeks treatment and a 1- and 6-month post-treatment follow-up. Subthreshold depressive symptoms are strong correlates of functional impairment in patients with depression and bipolar disorder and are prospectively associated with time to recurrence (e.g., Rush 2007; Judd et al. 2008). Thus, interventions that reduce residual symptoms are likely to have preventative effects on time to recurrence and degree of disability in both disorders. "
ABSTRACT: The perinatal period is a high-risk time for mood deterioration among women vulnerable to depression. This study examined feasibility, acceptability, and improvement associated with mindfulness-based cognitive therapy (MBCT) in perinatal women with major depressive disorder (MDD) or bipolar spectrum disorder (BSD). Following a diagnostic evaluation, 39 perinatal women with a lifetime history of MDD (n = 27) or BSD (n = 12) enrolled in an 8-week program of MBCT classes (2 h each) that incorporated meditation, yoga, and mood regulation strategies. Participants were pregnant (n = 12), planning pregnancy (n = 11), or up to 1-year postpartum (n = 16). Participants were self-referred and most had subthreshold mood symptoms. Assessments of depression, (hypo)mania, and anxiety were obtained by interview and self-report at baseline, post-treatment and at 1- and 6-month post-treatment. Women with a history of MDD were more likely to complete the classes than women with BSD. Of 32 women who completed the classes, 7 (21.9 %) had a major depressive episode during the 6-month post-treatment follow-up. On average, participants with MDD reported improvements in depression from pre- to post-treatment. Mood improvement was not observed in the BSD group. In the full sample, improvements in depression symptoms across time points were associated with increasing mindful tendency scores. This study was limited by its uncontrolled design, heterogeneous sample, and questionnaire-based assessment of mindfulness skills. MBCT may be an important component of care for perinatal women with histories of major depression. Its applicability to perinatal women with BSD is unclear.Cognitive Therapy and Research 10/2015; 39(5). DOI:10.1007/s10608-015-9681-9 · 1.70 Impact Factor
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- "The primary outcome measure, of an improvement in subsyndromal mood symptoms in the Eye Movement Desensitization and Reprocessing group, was met: we found a statistically significant mood stabilizing effect for both depressive and (hypo)manic symptoms in instable bipolar patients at the end of the Eye Movement Desensitization and Reprocessing intervention. Documenting improvement in subsyndromal mood symptoms is of clinical relevance, since these are frequent in bipolar disorder and have been found to be associated with a higher risk of poor outcome on a variety of measures and are difficult to control with medication (Altshuler et al., 2006; Paykel et al., 2006; Judd et al., 2008; Marangell et al., 2009). Also, the study provides a 'proof-ofprinciple' that bipolar disorder is susceptible to treatment with a form of trauma-directed therapy. "
ABSTRACT: Traumatic events are frequent in bipolar patients and can worsen the course of the disease. Psychotherapeutic interventions for these events have not been studied so far. Twenty DSM-IV bipolar I and II patients with subsyndromal mood symptoms and a history of traumatic events were randomly assigned to Eye Movement Desensitization and Reprocessing therapy (n = 10) or treatment as usual (n =10). The treatment group received between 14 and 18 Eye Movement Desensitization and Reprocessing sessions during 12 weeks. Evaluations of affective symptoms, symptoms of trauma and trauma impact were carried out by a blind rater at baseline, 2 weeks, 5 weeks, 8 weeks, 12 weeks and at 24 weeks follow-up. Patients in the treatment group showed a statistically significant improvement in depressive and hypomanic symptoms, symptoms of trauma and trauma impact compared to the treatment as usual group after intervention. This effect was only partly maintained in trauma impact at the 24 weeks follow-up visit. One patient dropped from Eye Movement Desensitization and Reprocessing group whereas four from the treatment as usual group. This pilot study suggests that Eye Movement Desensitization and Reprocessing therapy may be an effective and safe intervention to treat subsyndromal mood and trauma symptoms in traumatized bipolar patients. Do you want to check a brief presentation about this manuscrit? Please follow the link below. http://audioslides.elsevier.com//ViewerLarge.aspx?source=1&doi=10.1016/j.psychres.2014.05.012Psychiatry Research 05/2014; DOI:10.1016/j.psychres.2014.05.012i · 2.47 Impact Factor
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- "Many patients with bipolar disorder experience significant dayto-day or week-to-week mood swings below the criteria of a fullblown episode, but above those experienced by non-affected individuals (Bonsall et al., 2012). This mood instability impairs daily functioning over time (Akiskal et al., 1995) and increases the risk for relapse and/or recurrence, thus indicating that the illness is still active (Judd et al., 2008). However, the longitudinal pattern of mood instability is poorly understood as it is difficult to assess validly (Bonsall et al., 2012). "
ABSTRACT: The daily electronic self-monitoring Smartphone software "MONARCA" was used by 17 patients with bipolar disorder for 3 consecutive months. Patients were rated fortnightly using Hamilton Depression rating Scale 17 items (HDRS-17) and Young Mania rating Scale (YMRS) (102 ratings) with blinding for Smartphone data. Objective Smartphone measures such as physical and social activity correlated with clinically rated depressive symptoms. Self-monitored depressive symptoms correlated significantly with HDRS-17 items score.03/2014; 217(1-2). DOI:10.1016/j.psychres.2014.03.009