title: Influence of sub-syndromal symptoms after remission from manic or mixed episodes.
abstract: BACKGROUND
  Sub-syndromal symptoms in bipolar disorder impair functioning and diminish quality of life.
  
  
  OBJECTIVE
  To examine factors associated with time spent with sub-syndromal symptoms and to characterise how these symptoms influence outcomes.
  
  
  METHODS
  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.
authors.affiliation: Lilly Research Laboratories, Indianapolis, IN 46285, USA. m.tohen@lilly.com
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Daniel
authors.initials: D
authors.lastname: Lin
authors.forename: Tammy D
authors.initials: TD
authors.lastname: Forrester
authors.forename: Gary S
authors.initials: GS
authors.lastname: Sachs
authors.forename: Athanasios
authors.initials: A
authors.lastname: Koukopoulos
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Yatham
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D011379:Prognosis; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D018020:Lithium Compounds; D001569:Benzodiazepines; D000077152:Olanzapine