Functioning and symptomatic outcomes in patients with bipolar I disorder in syndromal remission: a 1-year,...

Recent studies demonstrate that many Bipolar Disorder (BD) patients experience mild symptoms and/or suffer significant functional impairment during periods of syndromal remission, suggesting greater relapse risk and need for more intensive therapeutic strategies. However, most studies have cross-sectional designs and other methodological limitations. This study aimed to prospectively evaluate whether the presence of subsyndromal symptoms and level of functionality have long-term consequences in BD patients in syndromal remission.

A 1-year, prospective, observational cohort study of BD patients in syndromal remission assessed participants at study entry and 3, 6 and 12months after baseline on a range of clinical, social and functional outcomes.

A total of 473 BD patients were screened at 51 study sites across Spain. Finally, 398 patients with bipolar I disorder in syndromal remission were included. After the 12-month, follow-up period, 87.6% of patients remained in syndromal remission, 79.9% of patients were free of subsyndromal symptoms, but only 53.5% had normal levels of functionality. Patients without subsyndromal symptoms and with normal levels of functionality at baseline had longer time to relapse, lower relapse risk, fewer changes on medication and hospitalizations, better employment, less medical/psychiatric leaves and better functional household membership.

Limitations of this study are related with its naturalistic design.

In a prospectively assessed BD cohort with all patients in syndromal remission at baseline, syndromal remission was not always accompanied by normal functioning and/or the presence subsyndromal symptoms. Interventions, including medication and psychosocial approaches, should go beyond syndromal remission and target subsyndromal symptoms and functional recovery.