Residual subsyndromal symptoms influencing recovery in Bipolar Disorder

Recovery in Bipolar Didordes (BD) patients may be considered a bidimensional process in which we may distinguish “clinical” and “personal” recoveries. On one hand, the first type may be strictly considered as a syndromal recovery that is identified on the basis of clinical judgement and in presence of low scores on rating scales for depression and mania, and recovery of functioning. On the other hand, the second type involves a functional recovery, for which patients regain individual premorbid levels of residential, psychosocial and occupational status and in perception of their health. In BD some factors may facilitate or hinder functional recovery, particularly in patients on symptomatic recovery. The aim of this study was to improve our knowledge on the mechanisms that may influence the recovery process in BD patients, trying to identify those factors that may condition a failure to achieve a full recovery in patients with different age of onset. METHODS We enrolled 48 consecutive male or female BD outpatients from the outpatient facilities of the Departement of Neurology and Psychiatry of “La Sapienza” University of Rome (age range 21-59; diagnosis of BD1 or BD2 based on the SCID Interview for DSM-IV TR; IQ >70). All patients were euthymic (Hamilton Depression Scale<8 and Young Mania Rating Scale<6) and under stabilized pharmacological treatment and had not been hospitalized within the last six months. They had no history of drug/ alcohol abuse present or past and were not affected by neurological diseases or other medical major conditions. All patients completed questionnaires and interviews for the assessment of social functioning (LSP), perception of health (SF-36) and for the detection of subsyndromal syntoms (SCL-90R).RESULTS Forty-eight patients with BD were evaluated. On the basis of the age at onset the sample was stratified in 3 sub-groups: 19 patients early onset; 18 patients intermediate onset; 11 patients late onset. On the whole, assessments showed that these euthimic BD patients had impaired perfomances across several domains of psychosocial functioning. Subsyndromal symptoms were found associated with an increased loss of social functioning and different outcomes were found also within subgroups of BD patients with different age of onset. DISCUSSION These results may improve our knowledge of the mechanisms underlaying the recovery process in BD, supporting the existence of a strong association between symptomatic recovery and functional recovery in these patients. Since we reported that symptomatic recoveries do not always lead directly to functional recovery but may significantly influence it, this suggests to consider these variables in clinical practice to tailor interventions for these patients in order to favours the achievement of global recovery.