Functional outcomes in first-episode patients with bipolar disorder: a prospective study from the Systematic Treatment Optimization Program for Early Mania project

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. (C) 2009 Elsevier Inc. All rights reserved.