Detection of subclinical depression in bipolar disorder: a cross-sectional, 4-month prospective follow-up study at community mental health services (SIN-DEPRES).

OBJECTIVE: The aim of this study was to assess the prevalence and the impact of depressive symptoms on the functional outcome of bipolar disorder outpatients in remission. METHOD: A cross-sectional, prospective 16-week study of a cohort of 739 euthymic bipolar disorder patients (DSM-IV-TR criteria) recruited by 94 investigators was conducted. Clinical stability was assessed at baseline and at week 16 with the modified Clinical Global Impressions Scale-Bipolar Version, and depressive symptoms were assessed at baseline with the 17-item Hamilton Depression Rating Scale (HDRS-17 [primary endpoint measure]), the Montgomery-Asberg Depression Rating Scale (MADRS), and the self-applied Center for Epidemiologic Studies-Depression Scale (CES-D). Functional status was evaluated with the Social and Occupational Functioning Assessment Scale (SOFAS) and Social Adaptation Self-evaluation Scale (SASS). The study was conducted from April 2006 to March 2007. RESULTS: Subclinical depressive symptoms (SDS) were detected on the HDRS-17 in 16.9% of the sample. In symptom-free patients, the incidence of new SDS after 16 weeks was 20% (MADRS score > 7). At baseline, SDS patients compared to non-SDS patients presented with poorer social-occupational performance (SOFAS score mean difference, -11.9; 95% CI, -14.2 to -9.6) and poorer social adjustment (SASS score mean difference, -5.6; 95% CI, -7.1 to -4.1). Depressive symptoms were inversely related to functional status and social adjustment: MADRS-SOFAS correlation coefficients, r = -0.54 (P < .0001), and MADRS-SASS correlation coefficients, r = -0.42 (P < .0001). The self-applied survey identified additional cases with depressive symptoms, showing an SDS total prevalence of 44.9%. CONCLUSIONS: Depressive symptoms in apparently remitted bipolar disorder outpatients are not rare and result in a decline in occupational outcome and social maladjustment.

Psychometric performance of the Oviedo Sleep Questionnaire in patients with severe mental disorder.

INTRODUCTION: The prevalence of sleep disturbances among patients with severe mental disorder ranges from 30 to 80%. Since the impact of these disturbances on patients' lives is substantial, there is a need for their evaluation and management. The aim of this study was to examine the reliability and validity of the Oviedo Sleep Questionnaire (OSQ) in patients with severe mental disorder. MATERIAL AND METHODS: We performed an observational, prospective (3-month), multicenter study. A total of 259 individuals (184 patients with severe mental disorder and 75 controls) were included. EVALUATION: the OSQ, the sleep items of the Bech- Rafaelsen's Scales for Depression (MES item 3) and Mania (MAS item 5), and the Clinical Global Impression Scales for Severity of Mental Disorder (CGI-SMD) and Sleep Disorder (CGI-SSD). RESULTS: a) Factorial structure: two factors accounted for 57.65% of the variance; factor 1 (insomnia) accounted for 44.65% and factor 2 (hypersomnia) for 13%; b) internal consistency: total OSQ=0.90, insomnia scale=0.91, hypersomnia scale=0.88; c) testretest reliability=0.87; d) convergent validity: Pearson's correlation coefficients were 0.632 with item 3 of the MES, 0.619 with item 5 of the MAS, and 0.630 with the CGI-SS (p<0.001); e) discriminant validity: the OSQ was able to differentiate between patients and controls (p=0.018), and among distinct degrees of mental disorder severity (CGISMD) (p<0.001) and sleep disorder severity (CGI-SSD) (p<0.001); f) responsiveness: the OSQ, like the CGI-SSD (p=0.004), identified a significant decrease in the insomnia severity score after 3 months (p=0.005). CONCLUSIONS: The OSQ is a valid and reliable method for measuring the sleep/wake cycle in patients with severe mental disorder.