The British Journal of Psychiatry (2006) 189: 515-519. doi: 10.1192/bjp.bp.105.020321
© 2006 The Royal College of Psychiatrists
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Influence of sub-syndromal symptoms after remission from manic or mixed episodes

MAURICIO TOHEN, MD, DrPH

Lilly Research Laboratories, Indianapolis, Indiana and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts

CHARLES L. BOWDEN, MD

Department of Psychiatry, University of Texas Health Sciences Center, San Antonio, Texas

JOSEPH R. CALABRESE, MD

Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio

DANIEL LIN, PhD and TAMMY D. FORRESTER

Lilly Research Laboratories, Indianapolis, Indiana

GARY S. SACHS, MD

Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA

ATHANASIOS KOUKOPOULOS, MD

Centro Lucio Bini, Rome, Italy

LAKSHMI YATHAM, MD

University of British Columbia, Vancouver, Canada

HEINZ GRUNZE, MD

Department of Psychiatry, University of Munich, Germany

Correspondence: Dr MauricioTohen, Lilly Research Laboratories, Indianapolis, IN 46285, USA. Tel: +1(317) 277 9585; fax: +1(317) 276 7845; email: m.tohen{at}lilly.com

Declaration of interest Sponsorship from Lilly Research Laboratories.

Background Sub-syndromal symptomsin bipolar disorder impair functioning and diminish quality of life.

Aims To examine factors associated with time spent with sub-syndromal symptoms and to characterise how these symptoms influence outcomes.

Method In a double-blind randomised maintenance trial, patients received either olanzapine or lithium monotherapy for 1 year. Stepwise logistic regression models were used to identify factors that were significant predictors of percentage time spent with sub-syndromal symptoms. The presence of sub-syndromal symptoms during the first 8 weeks was examined as a predictor of subsequent relapse.

Results Presence of sub-syndromal depressive symptoms during the first 8 weeks significantly increased the likelihood of depressive relapse (relative risk 4.67, P<0.001). Patients with psychotic features and those with a greater number of previous depressive episodes were more likely to experience sub-syndromal depressive symptoms (RR=2.51, P<0.001 and RR=2.35, P=0.03 respectively).

Conclusions These findings help to identify patients at increased riskof affective relapse and suggestthat appropriate therapeutic interventions should be considered even when syndromal-level symptoms are absent.




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