title: Do patients with bipolar disorder and subsyndromal symptoms benefit from functional remediation? A 12-month follow-up study.
abstract: We analyzed the efficacy of functional remediation, in a sample of patients with bipolar disorder who presented with subsyndromal symptoms. From a total sample of 239 patients with bipolar I and II disorder, according to DSM-IV-TR diagnostic criteria, entering a randomized clinical trial, those patients who presented with subsyndromal symptoms were selected based on a method already described by Berk and colleagues was applied. It consists of using the Clinical Global Impression-Bipolar version (CGI-BP) to establish the scores of the Hamilton Depression Rating Scale (HAM-D) and of the Young Mania Rating Scale (YMRS) that correspond with 1 in the CGI-BP. Functional outcome and mood symptoms were assessed at 6 and at 12-month follow-up. A total of 99 patients were selected for this post-hoc analysis, allocated as follows: functional remediation (n=33); psychoeducation (n=37) and treatment as usual (TAU,n=29). The repeated-measures analyses at 12-month follow-up revealed a significant group x time interaction in favour of the patients who received functional remediation when compared to psychoeducation and TAU (F=2.93; p=0.02) at improving psychosocial functioning. Finally, mood symptoms did not significantly change in any of the three groups at any time of follow-up, as shown by the non-significant group x time interaction effect in HAM-D scores (F=1.57; p=0.18) and YMRS scores (F=1.51; p=0.20). Bipolar patients with subsyndromal symptoms improve their functional outcome when exposed to functional remediation regardless of the persistence of mood symptomatology.
authors.affiliation: Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Sanchez-Moreno
authors.affiliation: Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Caterina
authors.initials: C
authors.lastname: Bonnín
authors.affiliation: Álava University Hospital, CIBERSAM, University of the Basque Country, BIOARABA, Vitoria, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: González-Pinto
authors.affiliation: FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona, Spain.
authors.forename: Benedikt L
authors.initials: BL
authors.lastname: Amann
authors.affiliation: Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Brisa
authors.initials: B
authors.lastname: Solé
authors.affiliation: Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia, Spain; Department of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Balanzá-Martínez
authors.affiliation: Child and Adolescent Psychiatry Department, Hospital Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
authors.forename: Celso
authors.initials: C
authors.lastname: Arango
authors.affiliation: Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Jimenez
authors.affiliation: Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Tabarés-Seisdedos
authors.affiliation: Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain.
authors.forename: M Paz
authors.initials: MP
authors.lastname: Garcia-Portilla
authors.affiliation: Department of Psychiatry, University Hospital Ramon y Cajal, University of Alcala, IRYCIS, CIBERSAM, Madrid, Spain.
authors.forename: Angela
authors.initials: A
authors.lastname: Ibáñez
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Crespo
authors.affiliation: Department of Psychiatry, Universidad Autónoma de Madrid, IIS-IP, CIBERSAM, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.affiliation: Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Electronic address: evieta@clinic.ub.es.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.affiliation: Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Electronic address: amartiar@clinic.ub.es.
authors.forename: Anabel
authors.initials: A
authors.lastname: Martinez-Aran
authors.affiliation: Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Torrent
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D000072466:Cognitive Remediation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D016896:Treatment Outcome
keywords: Bipolar disorder; Functional remediation; Subsyndromal symptoms; Treatment