title: Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients.
abstract: BACKGROUND
  Researchers have previously found that persistent subthreshold symptoms increase the risk and shorten the time until an affective relapse in bipolar disorder (BD) patients. Research has mainly focused on patients from tertiary Care Centers in USA. We tested the hypothesis that even in a different setting, BD outpatients with subsyndromal affective symptoms would re.turn to a subsequent major affective episode significantly faster than completely asymptomatic at baseline. Secondarily, we analysed other variables related to time and risk to relapse.
  
  
  METHODS
  A community cohort of BD outpatients from Madrid (Spain) followed-up in a systematic prospective follow-up protocol for up to five years were evaluated. Patients in clinical euthymia at baseline were included and evaluated quarterly.
  
  
  RESULTS
  Initially, 225 patients were included in the survival analysis. Of them, according to predefined psychometric criteria, 163 were in euthymia (72.4%) and 62 (27.6%) suffered subsyndromal symptoms. Median follow-up was 157.6 weeks (95% CI, 78.14 to 111); 57.3% of patients experienced at least one affective episode during their follow-up. Median survival time to first affective episode was 109 weeks for patients in euthymia at baseline, versus 35 weeks for those with subsyndromal symptoms (p<0.0001). Psychosocial stress (p=0.003; HR 2.20; 95% CI 1.31-3.68) and the affective mood baseline state, subsyndromal vs. euthymic (p=0.046; HR 1.74; 95%CI 1.009-3.020), were related to time to first affective episode.
  
  
  CONCLUSIONS
  Naturalistic study, some of the data collected were necessarily retrospective.
  
  
  CONCLUSIONS
  In Spanish non-tertiary psychiatric outpatients, subsyndromal BD symptoms and psychosocial stress at baseline predict earlier episode relapse/recurrence.
authors.affiliation: University Hospital La Paz, IDIPAZ, Madrid, Spain. cdios.scsm@salud.madrid.org
authors.forename: C
authors.initials: C
authors.lastname: De Dios
authors.forename: E
authors.initials: E
authors.lastname: Ezquiaga
authors.forename: J L
authors.initials: JL
authors.lastname: Agud
authors.forename: E
authors.initials: E
authors.lastname: Vieta
authors.forename: B
authors.initials: B
authors.lastname: Soler
authors.forename: A
authors.initials: A
authors.lastname: García-López
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D002908:Chronic Disease; D003527:Cyclothymic Disorder / Q000523:psychology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D011594:Psychometrics; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors