Influence of sub-syndromal symptoms after remission from manic or mixed episodes. Academic Article uri icon

start page

  • 515

end page

  • 519


  • Sub-syndromal symptoms in bipolar disorder impair functioning and diminish quality of life.To examine factors associated with time spent with sub-syndromal symptoms and to characterise how these symptoms influence outcomes.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.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).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.

date/time value

  • December 2006

Digital Object Identifier (DOI)

  • 10.1192/bjp.bp.105.020321

PubMed Identifier

  • 17139035


  • 189



  • Adult
  • Antipsychotic Agents
  • Benzodiazepines
  • Bipolar Disorder
  • Depressive Disorder
  • Double-Blind Method
  • Female
  • Humans
  • Lithium Compounds
  • Male
  • Middle Aged
  • Prognosis
  • Remission Induction
  • Treatment Outcome