Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder

Mood Disorders Program, McMaster University, Hamilton, ON, Canada.
Bipolar Disorders (Impact Factor: 4.97). 11/2003; 5(5):349-55. DOI: 10.1034/j.1399-5618.2003.00048.x
Source: PubMed


Many patients with bipolar disorder (BD) do not regain full function following an acute illness episode, but the extent to which this impairment is the result of persistent symptoms has not been well established. This study examined factors associated with persistent subsyndromal symptoms in a well characterized group of BD patients who were prospectively followed for an average of 3 years.
Detailed life charting data from 138 patients with BD were reviewed. Patients were categorized into euthymic, subsyndromal or syndromal groups according to the clinical state during their most recent year of follow-up. The three groups were then examined with respect to comorbidity, function and treatment received.
Patients with subsyndromal symptoms had high rates of comorbid anxiety disorders, and were more likely to have increased rates of eating disorders as well. Patients with subsyndromal symptoms had lower global assessment of function (GAF) scores than euthymic patients, and had as many clinic contacts and medication trials as patients with full episodes of illness.
Persistent subsyndromal symptoms in BD patients are associated with high rates of comorbidity that is important to recognize and treat in order to optimize mood and functioning.

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    • "Specifically, the frequent occurrence of subsyndromal symptoms has been noted in longitudinal studies.10–12 Subsyndromal symptoms have been associated with significant functional disability,13,14 and with an increased risk of relapse.15,16 Moreover, recurrence is not an exception rather than the rule. "
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    • "This hypothesis requires confirmation by additional studies. ADs occur most frequently during depressive and depressive manic episodes in BP patients (Dilsaver and Chen, 2003); AD also often presents during subsyndromal depressive states (MacQueen et al., 2003). One study (Boylan et al., 2004) reported that about 32% of their BP patients had 2 or more comorbid ADs. "
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    • "See figure 1 for a schematic of bipolar mood instability. The development of symptom-specific treatments [25,26], for example, to preserve inter-episodic mood stability [5,27] would promise a major effect on the quality of life. "
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