Residual Symptom Recovery From Major Affective Episodes in Bipolar Disorders and Rapid Episode Relapse/Recurrence

Department of Psychiatry, University of California-San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0603, USA.
Archives of general psychiatry (Impact Factor: 14.48). 04/2008; 65(4):386-94. DOI: 10.1001/archpsyc.65.4.386
Source: PubMed


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.

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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. "
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    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.
    Full-text · Article · Oct 2015 · Cognitive Therapy and Research
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    • "Between full syndromal affective episodes, the majority of patients with bipolar disorder spend almost 50% of their time unwell due to subsyndromal symptoms that persist after the treatment and resolution of an acute episode (Altshuler et al., 2002; Joffe et al., 2004; Judd et al., 2002; Vieta et al., 2008). Subsyndromal residual symptoms are associated with diminished quality of life, functional impairment , and risk of early relapse and recurrence (Judd et al., 2008; Tohen et al., 2006). Although several pharmacotherapies from various drug classes are approved for the treatment of bipolar mania (Jann, 2014), all agents are not effective in all patients and the high incidence of residual symptoms and recurrence demonstrate the need for additional treatments with strong efficacy across the range of acute symptoms. "
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    ABSTRACT: Bipolar I disorder is a chronic disorder characterized by episodic recurrences of mania, depression, and mixed affective states interspersed with periods of full or partial remission; subsyndromal residual symptoms between episodes are common and disabling. Cariprazine, an atypical antipsychotic, is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors. Post-hoc analyses of pooled data from 3 positive trials were conducted to evaluate the effect of cariprazine 3-12mg/d on the symptoms of mania in inpatients (18-65 years) with bipolar I disorder and a current manic episode. Analyses were based on the pooled intent-to-treat (ITT) population (placebo=429; cariprazine=608). Mean change from baseline to the end of treatment on individual Young Mania Rating Scale (YMRS) items was analysed using a mixed-effects model for repeated measures (MMRM); categorical symptom severity shifts were analysed using logistic regression. Statistically significant improvement in mean change was seen for cariprazine versus placebo on all 11 YMRS items (p<0.0001); significantly more cariprazine- versus placebo-treated patients had mild/no symptoms at the end of treatment on 11 YMRS items (p<0.0001) and concurrently on the 4 YMRS core symptoms (irritability, speech, content, and disruptive-aggressive behaviour) (p<0.0001). Significantly more cariprazine- versus placebo-treated patients shifted from a Moderate/Worse or Marked/Worse Symptoms categories to Mild/No Symptoms on all 11 (p<0.0001) and 9 of 11 YMRS items (p<0.05), respectively. Results suggest that cariprazine treatment improved mania across YMRS symptoms; a significant percentage of cariprazine- versus placebo-treated patients had mild/no symptoms at the end of treatment.
    Full-text · Article · Sep 2015 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
    • "The aim of this pilot trial was to evaluate whether Eye Movement Desensitization and Reprocessing therapy can have mood stabilizing effects in bipolar patients with mild depressive and/or hypomanic symptoms, called subsyndromal symptoms (Tohen et al., 2009). We chose subsyndromal symptoms as they are clinically relevant by causing more affective relapses and poor functioning (Altshuler et al., 2006; Judd et al., 2008). Furthermore, bipolar patients would be also more likely to be able to tolerate and benefit from Eye Movement Desensitization and Reprocessing therapy than those who were currently experiencing a moderate to full-blown depressive or manic/mixed episode. "
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    No preview · Article · May 2014 · Psychiatry Research
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