Mood instability and functional recovery in bipolar disorders

Objective: The aim of this study was to identify psychopathological factors associated with long-term functional outcome in euthymic bipolar disorder patients and to test new measures of mood instability and symptoms intensity. Method: Fifty-five patients with more than 12 months of follow-up were included. In addition to traditional clinical variables, the time spent ill was documented using a modified life-charting technique based on NIHM life-charting method. New measures, Mood Instability Factor, and Mood Intensity Factor were defined and assessed. Functioning Assessment Short Test (FAST) was used to assess disability. Results: The follow-up period was 3.00 +/- 1.51 years. Weeks with subsyndromal depressive symptoms (beta = 0.133, t = 2.556, P = 0.014), weeks with mild manic symptoms (beta = 1.441, t = 3.10, P = 0.003), and the Mood Instability Factor (beta = 0.105, t = 3.593, P = 0.001) contributed to approximately 46% of the FAST total score variance. Conclusion: New methodologies including subsyndromal symptoms and mood instability parameters might contribute to understand the worse long-term functional outcome that affects a considerable percentage of BD patients even after episode remission. Concerns about therapeutic approaches are discussed.