Background: Bipolar disorder causes substantial psychosocial morbidity, as it frequently affects independent living, vocational, and social activities. However, there is a relative dearth of research on functional outcomes and their predictors in first-episode manic patients from prospective studies early in the course of bipolar disorder. Methods: The Systematic Treatment Optimization Program for Early Mania (STOP-EM) project recruited 53 patients who recently experienced their first episode of mania with or without psychosis. Multidimensional Scale of Independent Functioning (MSIF) was used as the main measure of functional outcome. Of the 53 patients recruited, 35 completed the 6-month follow-up assessment. Results: At entry, 62.3% of patients had met criteria for full remission of mood symptoms. Despite this, the mean baseline MSIF score was 4.5 points; 62.3% of the patients had at least moderate disability. A significant improvement in functioning was noted at 6 months relative to entry as indicated by the reduction in mean MSIF scores from 4.5 to 2.6 (t = 4.1, df = 34, P < .001). The proportion of patients with at least moderate disability was reduced from 62.3% to 25.7% at 6 months. Remission of depressive symptoms at 6 months was associated with better functioning (P < .01). In a regression model, only depressive symptoms were significantly correlated with the MSIF global functional scores at 6 months. Even subsyndromal depressive symptoms were significantly correlated with disability (r = 0.3, P < .05). Conclusion: The findings highlight the deleterious impact of depressive symptoms on functional recovery after a first manic episode even when they are subsyndromal. Considered together, these results emphasize the importance of an aggressive treatment of subsyndromal depressive symptoms for functional recovery.
Bibliographical noteFunding Information:
This work was supported by an unrestricted grant from AstraZeneca. The sponsor had no involvement in study design; in the collection, analysis, and interpretation of data; and in writing the report or in the decision of sending this to publication. Dr Kauer-Sant'Anna has been an investigator in clinical trials sponsored by Novartis, Servier, Canadian Institutes of Health Research, and Stanley Foundation and has received salary support from an APA/AstraZeneca unrestricted educational grant. Dr Bond has been an investigator in clinical trials sponsored by Sanofi-Aventis, GlaxoSmithKline, and Servier and has received speaking fees from AstraZeneca and Canadian Network for Mood and Anxiety Treatments. Dr Lam is on speaker/advisory boards for, or has received research grants from, the following: ANS Inc, AstraZeneca, Biovail, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Eli Lilly, GlaxoSmithKline, Great West Life, Janssen, Litebook Company Ltd, Lundbeck, Sanofi-Aventis, Servier, VGH and UBC Hospital Foundation, and Wyeth. Dr Yatham is on speaker/advisory boards for, or has received research grants from, the following: AstraZeneca, Bristol Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Eli Lilly, GlaxoSmithKline, Janssen, Michael Smith Foundation for Health Research, Pfizer, Servier, and Stanley Foundation.
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