The Impact of Subsyndromal Bipolar Symptoms on Patient’s Functionality and Quality of Life

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 interepisodically 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-rhythmbased psychotherapies.

Associations of emotion recognition, loneliness, and social functioning in euthymic patients with bipolar disorder

“…Subsyndromal residual symptoms and cognitive impairments in the euthymic phase appear to be relevant to low functioning. 1,2 Mounting evidence suggests the existence of persistent neurocognitive deficits in euthymic BD patients. 3 The most affected domains are attention, verbal learning, and memory, in addition to executive functions.…”

“…Bipolar disorder (BD) is a chronic psychiatric illness characterized by recurrent manic and depressive symptoms and is associated with significant psychosocial disability in terms of work performance, family disturbance, and social dysfunction. Subsyndromal residual symptoms and cognitive impairments in the euthymic phase appear to be relevant to low functioning 1,2 …”

Psychological and behavioral response on the COVID-19 pandemic in individuals with bipolar disorder: A multicenter study

“…( Yocum et al, 2021 , Carta et al, 2021 ) The occurrence of sleep problems in BD is well-known ( Steardo et al, 2019 ) and has been shown to impact overall functioning. ( Grunze and Born, 2020 ) Sleep deprivation serves as a recognized trigger for manic episodes, ( Colombo et al, 1999 , Lewis et al, 2017 ) and a depressive state is associated with insomnia or hypersomnia. ( Steinan et al, 2016 ) Circadian rhythm disorders have been found to be associated with both manic and depressive episodes, ( Gershon et al, 2017 ) the latter of which may be favored by the circumstances of the COVID-19 pandemic.…”

Living With Bipolar Disorder in the Time of Covid-19: Biorhythms During the Severe Lockdown in Cagliari, Italy, and the Moderate Lockdown in Tunis, Tunisia

“…Although sleep dysregulation has been associated primarily with the onset of manic episodes in bipolar disorder, there is evidence that depression in bipolar disorder may also be caused by sleep dysregulation ( 35 , 39 ). While in sub-threshold bipolar disorders sleep disturbances are one of the most frequent symptoms and often associated with subthreshold depression ( 40 ); sleep abnormalities are in fact indicated as a good predictor of a mood swing in Bipolar Disorder; the maintaining of a stable sleep-wake cycle was indicated as a key to the maintenance of stability ( 36 ).…”