Influence of sub-syndromal symptoms after remission from manic or mixed episodes

Mauricio Tohen, Charles L. Bowden, Joseph R. Calabrese, Daniel Lin, Tammy D. Forrester, Gary S. Sachs, Athanasios Koukopoulos, Lakshmi Yatham, Heinz Grunze

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Background: Sub-syndromal symptoms in bipolar disorder impair functioning and diminish quality of life. Aims: To examine factors associated with time spent with sub-syndromal symptoms and to characterise how these symptoms influence outcomes. Method: In a double-blind randomised maintenance trial, patients received either olanzapine or lithium monotherapy for 1 year. Stepwise logistic regression models were used to identify factors that were significant predictors of percentage time spent with sub-syndromal symptoms. The presence of sub-syndromal symptoms during the first 8 weeks was examined as a predictor of subsequent relapse. Results: Presence of sub-syndromal depressive symptoms during the first 8 weeks significantly increased the likelihood of depressive relapse (relative risk 4.67, P < 0.001). Patients with psychotic features and those with a greater number of previous depressive episodes were more likely to experience sub-syndromal depressive symptoms (RR=2.51, P < 0.001 and RR=2.35, P=0.03 respectively). Conclusions: These findings help to identify patients at increased risk of affective relapse and suggest that appropriate therapeutic interventions should be considered even when syndromal-level symptoms are absent.

Original languageEnglish (US)
Pages (from-to)515-519
Number of pages5
JournalBritish Journal of Psychiatry
Issue numberDEC.
StatePublished - Dec 2006

ASJC Scopus subject areas

  • Psychiatry and Mental health


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