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Influence of sub-syndromal symptoms after remission from manic or mixed episodes

  • Mauricio Tohen (a1), Charles L. Bowden (a2), Joseph R. Calabrese (a3), Daniel Lin (a4), Tammy D. Forrester (a4), Gary S. Sachs (a5), Athanasios Koukopoulos (a6), Lakshmi Yatham (a7) and Heinz Grunze (a8)...

Abstract

Background

Sub-syndromal symptoms in 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 risk of affective relapse and suggest that appropriate therapeutic interventions should be considered even when syndromal-level symptoms are absent.

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Copyright

Corresponding author

Dr Mauricio Tohen, Lilly Research Laboratories, Indianapolis, IN 46285, USA. Tel: + 1 (317)277 9585; fax: + 1(317) 276 7845; email: m.tohen@lilly.com

Footnotes

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Declaration of interest

Sponsorship from Lilly Research Laboratories.

Footnotes

References

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Influence of sub-syndromal symptoms after remission from manic or mixed episodes

  • Mauricio Tohen (a1), Charles L. Bowden (a2), Joseph R. Calabrese (a3), Daniel Lin (a4), Tammy D. Forrester (a4), Gary S. Sachs (a5), Athanasios Koukopoulos (a6), Lakshmi Yatham (a7) and Heinz Grunze (a8)...

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Influence of sub-syndromal symptoms after remission from manic or mixed episodes

  • Mauricio Tohen (a1), Charles L. Bowden (a2), Joseph R. Calabrese (a3), Daniel Lin (a4), Tammy D. Forrester (a4), Gary S. Sachs (a5), Athanasios Koukopoulos (a6), Lakshmi Yatham (a7) and Heinz Grunze (a8)...
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