Subsyndromal Depressive Symptoms After Symptomatic Recovery From Mania Are Associated With Delayed Functional Recovery

Department of Psychiatry and Biobehavioral Sciences, The David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2011; 72(5):692-7. DOI: 10.4088/JCP.09m05291gre
Source: PubMed


This study examined whether the presence of subsyndromal depressive symptoms predicted functional recovery after an acute manic episode.
Subjects with bipolar I disorder (according to the Structured Clinical Interview for DSM-IV) who, at the time of symptomatic recovery from an acute manic or hypomanic episode, had a concomitant functional recovery (n = 52) were compared on demographic variables and mood symptoms to those who had symptomatically recovered but not functionally recovered (n = 33). Demographic and mood variables were examined in the nonfunctionally recovered group to assess predictors of time to functional recovery. The primary functional outcome measure used was the Life Functioning Questionnaire, a 5-minute, gender-neutral self-report scale to measure role function in 4 domains: workplace, duties at home, leisure time with family, and leisure time with friends. Participants in the study were recruited from July 2000 through February 2005.
Depressive symptoms, even at a subsyndromal level, were significantly associated with persisting functional impairment after symptomatic recovery from a manic episode (P < .02). Subsyndromal depressive symptoms also significantly predicted a slower time to functional recovery over the next 9 months (P = .006).
The presence of even mild subsyndromal depressive symptoms may interfere with functional recovery in patients with bipolar disorder after symptomatic recovery from a manic or hypomanic episode.

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    • "Future studies focused on elucidating which kind of depressive symptoms would be more functionally disabling are needed in order to proceed to treat them and to increase functional outcome. For instance,Gitlin et al. (2011) found that fatigability was the main depressive symptom that predicted slower functional recovery. Deckersbach et al. (2010) included a module focused on mood monitoring and treatment of residual depressive symptoms with standard techniques , such as activity management and problem solving, among others. "

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    • "For a comprehensive review, see Sanchez- Moreno et al. (2009). Among all the studied variables, the presence of depressive symptoms has been reported as the strongest predictor of poor outcome (Judd et al., 2005; Gitlin et al., 2011; Bonnin et al., 2010; Martino et al., 2009; Strejilevich et al., 2013; Gonzalez-Pinto et al., 2010). This symptomatology also affects neurocognitive performance, even at low levels of depressive symptoms (Bonnin et al., 2012; Torrent et al., 2012). "
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    ABSTRACT: Background Most studies on the factors involved in the functional outcome of patients with bipolar disorder have identified subsyndromal depressive symptoms and cognitive impairment as key players. However, most studies are cross-sectional and very few have analyzed the interaction between cognition and subclinical depression. The present study aimed to identify the role of cognition, and particularly verbal memory, and subthreshold depressive symptoms in the functional outcome of patients with bipolar I and II disorder at one year follow-up. Method A confirmatory analysis was performed using the path analysis. A total of 111 euthymic patients were included to test the role of verbal memory as a mediator in the relationship of subthreshold depressive symptoms and functional outcome at one year follow-up. Measures of verbal memory, subthreshold depressive symptoms and functioning (at baseline, at 6 months and at one year follow-up) were gathered through the use of a neuropsychological assessment and validated clinical scales. Results The hypothesized mediation model displayed a good fit to data (Chi=0.393, df=2, p=0.625; RMSEA<0.001 with CI: 0.001–0.125 and CFI=1.00). Functional outcome at one year follow-up was predicted by the functional outcome at baseline, which in turn, was related to subthreshold depressive symptoms at baseline and to the verbal composite memory scores as a mediator variable. Conclusion The results of this study prospectively confirm previous findings on the disabling role of subthreshold depressive symptoms and verbal memory impairment on psychosocial functioning. However, these results come from a sample with moderate to severe functional impairment; hence, as a limitation, this may hinder the generalization of these results.
    Full-text · Article · May 2014 · Journal of Affective Disorders
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    • "The influence of depressive symptoms in the functional outcome of patients has been reported in several studies, showing that it seems a strong predictor of functional outcome, together with cognitive variables such as verbal memory and executive functions [29, 30]. Recently, a study has found out that the presence of even mild depressive symptoms significantly interfere in the recovery of patients after an episode of bipolar mania [31]. Thus, it appears that depressive symptoms should be incorporated into an explicative model of the functional outcome of bipolar disorder, along with other clinical and cognitive variables [32]. "
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    ABSTRACT: A deficit of social cognition in bipolar disorder has been shown, even when patients are stable. This study compares the attribution of intentions (social-cognitive bias) in a group of 37 outpatients with bipolar disorder with 32 matched control subjects. Bipolar patients scored significantly higher in the Ambiguous Intentions Hostility Questionnaire, showing an angry and intentionality bias (P = .001, P = .02). Differences in blame scale and hostility bias did not reach statistical significance, but a trend was found (P = .06). Bipolar patients with depressive symptoms presented a higher score in the angry bias scale (P = .03) and aggressivity bias scale (P = .004). The global functioning (GAF) correlates significantly with intentionality (P = .005), angry (P = .027), and aggressivity (P = .020) biases. Bipolar patients show a social-cognitive bias that may play a role in their functional outcome.
    Full-text · Article · Jan 2012 · Depression research and treatment
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