Research report Time spent with symptoms in a cohort of bipolar disorder outpatients in Spain: A prospective, 18-month follow-up study Consuelo De Dios a,b, ⁎, Elena Ezquiaga b,c,1 , Aurelio Garcia d,2 , Begoña Soler e,3 , Eduard Vieta f,4 a University Hospital La Paz, Madrid, Spain b Autónoma University, Madrid, Spain c University Hospital La Princesa, Madrid, Spain d Mental Health Center San Blas, Madrid, Spain e EC-Bio, Madrid, Spain f Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain article info abstract Article history: Received 14 November 2009 Received in revised form 4 December 2009 Accepted 6 December 2009 Available online xxxx Objective: Most research on the symptomatic burden in bipolar disorder has included patients enrolled exclusively from tertiary centers, and only a few studies have analyzed factors related to it. We investigated the proportion of time and the proportion of visits with symptoms in a cohort of bipolar outpatients followed-up for 18 months, as well as the associated variables. Methods: 296 DSM-IV-TR bipolar outpatients were included in a naturalistic longitudinal follow-up study, with quarterly assessment. Euthymia was defined by a Hamilton Depression Rating Scale score b 7 and Young Mania Rating Scale score b 5. Depressive episode, by a HDRS score of N 17, hypomanic episode by a YMRS score of 10–20, and manic episode by a YMRS score N 20. Sub-syndromal symptoms required scores of 7–17 in HDRS and 5–10 in YMRS. Based on a detailed recall of affective symptoms in the time between interviews, time in episode was also determined. Results: Patients were symptomatic for one third of the follow-up, and also one third of the visits. They spent three times more days depressed than manic or hypomanic. More prior affective episodes were related both to more time symptomatic and more visits with symptoms. Limitations: Some of the data were collected retrospectively. Treatment was naturalistic. Conclusions: In a bipolar outpatient cohort from Spain, time with symptoms was shorter than previously found in tertiary care settings. In accordance with other longitudinal studies, those patients spent much more time depressed than manic. © 2009 Elsevier B.V. All rights reserved. Keywords: Bipolar disorders Disorder, bipolar Symptoms, affective Sub-syndromal symptoms Time with symptoms Depression, bipolar 1. Introduction Several follow-up studies of patients with bipolar disorder describe it as a chronic disorder with well-defined episodes, but in many cases with persistent affective symptoms of variable severity. The National Institute of Mental Health-Collaborative Depression Study (CDS) (Coryell et al., 1989; Judd et al., 2005a, 2003a,b, 2002) established that depressive and manic symptoms show a high degree of variability in patients and that they persist for a long time, both in type I and type II bipolar disorder patients. In that cohort, type I patients Journal of Affective Disorders xxx (2009) xxx–xxx ⁎ Corresponding author. Servicio de Psiquiatría, Hospital Universitario La Paz, Paseo de la Castellana 264, 28046 Madrid, Spain. Tel.: +34 727 72 76. E-mail addresses: cdios.scsm@salud.madrid.org (C. De Dios), eezquiaga@yahoo.es (E. Ezquiaga), eleaur@yahoo.com (A. Garcia), bsoler@ecbio.net (B. Soler), evieta@clinic.ub.es (E. Vieta). 1 Servicio de Psiquiatría, Hospital Universitario La Princesa, C/ Diego De León 62, 28006 Madrid, Spain. Tel.: +34 91 520 22 00. 2 C/ Julia García Boutan, 8, 28022 Madrid, Spain. Tel.: +34 91 313 55. 3 C/ Rosa de Lima, 1, Edificio ALBA, Oficina 016, 28230, LAS ROZAS, Madrid, Spain. Tel.: +34 916300480; fax: +34 916303668. 4 Unidad de Trastornos Bipolares, Hospital Clínic, C/ Villarroel 170, 08036 Barcelona, Spain. Tel.: + 34 932275400. JAD-04448; No of Pages 8 0165-0327/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2009.12.006 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad ARTICLE IN PRESS Please cite this article as: De Dios, C., et al., Time spent with symptoms in a cohort of bipolar disorder outpatients in Spain: A prospective, 18-month follow-up study, J. Affect. Disord. (2009), doi:10.1016/j.jad.2009.12.006