title: Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder.
abstract: OBJECTIVE
  Dysregulated affect is a hallmark feature of acute episodes of bipolar disorder (BD) and persists during inter-episode periods. Its contribution to course of illness is not yet known. The present report examines the prospective influence of inter-episode affect dysregulation on symptoms and functional impairment in BD.
  
  
  METHODS
  Twenty-seven participants diagnosed with inter-episode bipolar I disorder completed daily measures of negative and positive affect for 49 days (±8 days) while they remained inter-episode. One month following this daily assessment period, symptom severity interviews and a measure of functional impairment were administered by telephone.
  
  
  RESULTS
  More intense negative affect and positive affect during the inter-episode period were associated with higher depressive, but not manic, symptoms at the one-month follow-up assessment. More intense and unstable negative affect, and more unstable positive affect, during the inter-episode period were associated with greater impairment in home and work functioning at the follow-up assessment. All associations remained significant after controlling for concurrent symptom levels.
  
  
  CONCLUSIONS
  The findings need to be confirmed in larger samples with longer follow-up periods. A more comprehensive assessment of functional impairment is also warranted.
  
  
  CONCLUSIONS
  The findings suggest that a persistent affective dysregulation between episodes of BD may be an important predictor of depression and functional impairment. Monitoring daily affect during inter-episode periods could allow for a more timely application of interventions that aim to prevent or reduce depressive symptoms and improve functioning for individuals with BD.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA. Electronic address: gershon@stanford.edu.
authors.forename: Anda
authors.initials: A
authors.lastname: Gershon
authors.affiliation: Cognitive Behavior Therapy & Science Center, 5435 College Ave., Suite 100-1, USA.
authors.forename: Polina
authors.initials: P
authors.lastname: Eidelman
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000339:Affect; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology*; D003863:Depression / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012917:Social Adjustment; D016526:Workload / Q000523:psychology; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Affect; Bipolar disorder; Depressive symptoms; Illness course; Longitudinal study