Functional outcomes in first-episode patients with bipolar disorder: a prospective study from the Systematic Treatment Optimization Program for Early Mania project.
BACKGROUND
Bipolar disorder causes substantial psychosocial morbidity, as it frequently affects independent living, vocational, and social activities. However, there is a relative dearth of research on functional outcomes and their predictors in first-episode manic patients from prospective studies early in the course of bipolar disorder.


METHODS
The Systematic Treatment Optimization Program for Early Mania (STOP-EM) project recruited 53 patients who recently experienced their first episode of mania with or without psychosis. Multidimensional Scale of Independent Functioning (MSIF) was used as the main measure of functional outcome. Of the 53 patients recruited, 35 completed the 6-month follow-up assessment.


RESULTS
At entry, 62.3% of patients had met criteria for full remission of mood symptoms. Despite this, the mean baseline MSIF score was 4.5 points; 62.3% of the patients had at least moderate disability. A significant improvement in functioning was noted at 6 months relative to entry as indicated by the reduction in mean MSIF scores from 4.5 to 2.6 (t = 4.1, df = 34, P < .001). The proportion of patients with at least moderate disability was reduced from 62.3% to 25.7% at 6 months. Remission of depressive symptoms at 6 months was associated with better functioning (P < .01). In a regression model, only depressive symptoms were significantly correlated with the MSIF global functional scores at 6 months. Even subsyndromal depressive symptoms were significantly correlated with disability (r = 0.3, P < .05).


CONCLUSIONS
The findings highlight the deleterious impact of depressive symptoms on functional recovery after a first manic episode even when they are subsyndromal. Considered together, these results emphasize the importance of an aggressive treatment of subsyndromal depressive symptoms for functional recovery.
Kauer-Sant'Anna
Marcia
M
Department of Psychiatry, Mood Disorders Centre, University of British Columbia, Vancouver, Canada.
Bond
David J
DJ
Lam
Raymond W
RW
Yatham
Lakshmi N
LN
D000293:Adolescent; D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use*; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D016730:Program Development; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000175:diagnosis / Q000209:etiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*; D055815:Young Adult
D018692:Antimanic Agents; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid