title: Bipolar patients referred to specialized services of care: Not resistant but impaired by sub-syndromal symptoms. Results from the FACE-BD cohort.
abstract: OBJECTIVE
  A national network of expert centers for bipolar disorders was set up in France to provide support, mainly for psychiatrists, who need help for managing bipolar disorder patients. The aims of this article are to present the main characteristics of the patients referred to an expert center in order to highlight the major disturbances affecting these patients and to understand the most significant difficulties encountered by practitioners dealing with bipolar disorder patients.
  
  
  METHODS
  Patients were evaluated by trained psychiatrists and psychologists, with standardized and systematic assessment using interviews and self-report questionnaires.
  
  
  RESULTS
  All patients (n = 839) met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for bipolar disorder I (48.4%), bipolar disorder II (38.1%) or bipolar disorder-not otherwise specified (13.5%). Mean illness duration was 17 years (±11.3), with 41.9% of patients having a history of suicide attempts. Lifetime comorbidities were 43.8% for anxiety disorders and 32.8% for substance abuse. At the point of inclusion, most patients (76.2%) were not in an acute phase, being considered to have a syndromal remission, but which still required referral to a tertiary system of care. Among these patients, 37.5% had mild to moderate residual depressive symptoms (Montgomery and Asberg Depression Rating Scale ranging from 7 to 19) despite 39% receiving an antidepressant. However, 47.8% were considered to be poorly adherent to medication; 55% showed evidence of sleep disturbances, with half being overweight; 68.1% of patients showed poor functioning (Functioning Assessment Short Test ⩾ 12) with this being linked to residual depressive symptoms, sleep disturbances and increased body mass index.
  
  
  CONCLUSIONS
  It appears that bipolar disorder patients referred to an expert center in most cases do not suffer from a severe or resistant illness but they rather have residual symptoms, including subtle but chronic perturbations that have a major impact on levels of functioning. The longitudinal follow-up of these patients will enable a better understanding of the evolution of such residual symptoms.
authors.affiliation: Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France chantal.henry@inserm.fr.
authors.forename: Chantal
authors.initials: C
authors.lastname: Henry
authors.affiliation: Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Etain
authors.affiliation: Fondation FondaMental, fondation de cooperation scientifique, Créteil, France UPMC Université Paris 06, UMRS 943, Paris, France.
authors.forename: Ophelia
authors.initials: O
authors.lastname: Godin
authors.affiliation: Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Instituto Nacional de Ciência e Tecnologia-Translacional em Medicina (INCT) e Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: Aroldo Ayub
authors.initials: AA
authors.lastname: Dargel
authors.affiliation: Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, Marseille, France Aix-Marseille Université, CNRS, CRN2M UMR 7286, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.affiliation: Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Service de psychiatrie adulte, Bordeaux, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gard
authors.affiliation: Fondation FondaMental, fondation de cooperation scientifique, Créteil, France AP-HP, GH Saint-Louis-Lariboisière-Fernand Widal, Pôle Neurosciences, Paris, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
authors.affiliation: Université Paris-Est, UMR_S955, UPEC, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Université Joseph Fourier, Grenoble, France CHU de Grenoble, Grenoble, France Grenoble Institut des Neurosciences (GIN) Inserm U836, La Tronche, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bougerol
authors.affiliation: Université Paris-Est, UMR_S955, UPEC, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Université de Lorraine, Nancy, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Kahn
authors.affiliation: Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Centre Hospitalier de Versailles, Le Chesnay, France Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Passerieux
authors.affiliation: Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Centre Hospitalier Princesse Grace, Monaco.
authors.forename: Valerie
authors.initials: V
authors.lastname: Aubin
authors.affiliation: Fondation FondaMental, fondation de cooperation scientifique, Créteil, France Psychiatric Emergency Department, CHRU Montpellier, Montpellier, France Inserm U1061, Université Montpellier, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Courtet
authors.affiliation: Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France Fondation FondaMental, fondation de cooperation scientifique, Créteil, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Leboyer
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology*; D012074:Remission Induction; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D013577:Syndrome; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: Bipolar disorders; expert center; functioning; remitted phase; residual depressive symptoms