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Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder

Eugene S Paykel¹, Rosemary Abbott, Richard Morriss

¹Department of Psychiatry, University of Cambridge, Douglas House, 18e Trumpington Road, Cambridge CB2 2AH, UK. esp10@cam.ac.uk

The British Journal of Psychiatry : the Journal of Mental Science

|August 2, 2006

Abstract

Background:

There have been few detailed longitudinal symptom studies of bipolar disorder.

Aims:

To describe the course of bipolar disorder over 18 months in 204 patients receiving mental healthcare.

Method:

Patients were interviewed every 8 weeks, with weekly ratings of depression, mania and overall severity.

Results:

Participants were symptomatic 53% of the time, with sub-syndromal symptoms present for twice as long as major disorder, and depressive symptoms three times more than manic symptoms. Individuals who were experiencing an episode at baseline spent 33% of the 18 months with substantial sub-syndromal symptoms, 17% with major disorder and 28% symptom free. Those not experiencing a baseline episode spent twice as long symptom free and half as long at disorder levels. Changes in symptom level were frequent. Predictors of sub-syndromal symptoms were similar to those of major disorder.

Conclusions:

Sub-syndromal residual symptoms are an important problem in recurrent bipolar disorder and require therapeutic intervention.

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