Abstract
Subsyndromal symptoms have rarely been in the focus of bipolar research. This may be, in part, due to the fact that there is neither a uniform definition nor do they constitute an indication of regulatory and commercial interest. Nevertheless, they do have a decisive impact on the long-term course of bipolar disorder (BD), and the degree of functionality and quality of life (QoL) is more likely determined by their presence or absence than by acute episodes. Summarizing the literature an estimated 20–50% of patients suffer inter-episodically or chronically from subsyndromal BD. The most prominent symptoms that interfere with functionality are subsyndromal depression, disturbances of sleep, and perceived cognitive impairment, whereas anxiety negatively impacts on QoL. In the absence of evidence-based pharmacological treatments for subsyndromal BD, clinical practice adopts guidelines designed for treatment-resistant full-blown episodes of BD, supplemented by cognitive-behavioral, family focused or social-rhythm–based psychotherapies.
Highlights
Reality has taught us that Kraepelin’s assumption of full recovery as a decisive distinction between manic-depressive illness and dementia praecox does not hold true in a fair proportion of bipolar patients
This review focuses on three topics: Definition and frequency of symptoms of BD (SSBD), Impact of SSBD on functionality and quality of life (QoL), and pharmacological and psychological therapies applied in SSBD
In a cross-sectional Mexican study using the QoL.bipolar disorder (BD) scale and a score of 170 as cut-off for poor QoL, anxious symptoms affected the perceived QoL more than subthreshold symptoms of mania and depression and more than other variables related to the course of BD, such as number of hospitalizations, and even a comorbid diagnosis of full-criteria generalized anxiety disorder (GAD)
Summary
Reality has taught us that Kraepelin’s assumption of full recovery as a decisive distinction between manic-depressive illness and dementia praecox does not hold true in a fair proportion of bipolar patients. Little is known about the effects of persisting psychotic symptoms in bipolar patients, the bulk of data points toward subthreshold depression, impaired cognition and disturbed circadian rhythm as the most relevant SSBD (Figure 1) [5,6,7,8]. Both subsyndromal depression and impaired cognition appear to act directly and independently on functionality [5, 8], whereas there is only a moderate indirect effect of sleep disturbances on functioning mediated via residual depressive symptoms and perceived cognitive impairments [5].
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