Changes in morbidity among bipolar I patients during pandemic-related strict lockdown: comparison

between two seven-month periods

Cecilia Samamé¹ ², Eliana Marengo², Antonella Godoy², José Smith², Sebastián Camino², Melany Oppel², María Florencia Tagni², Martina Sobrero², Lautaro López Escalona², Sergio Strejilevich²*
¹Universidad Católica del Uruguay, Montevideo, Uruguay; ²AREA, Asistencia e Investigación en Trastornos del Ánimo, Buenos Aires, Argentina; *sstreji@gmail.com

Introduction
Converging evidence supports the involvement of circadian rhythm disturbances in the course and morbidity of bipolar disorder (BD) (1-3). During 2020, lockdown measures were introduced worldwide to contain the health
crisis caused by the COVID-19 pandemic. As a result, chronobiological rhythms were critically disrupted, leading to sleep disturbances and psychological symptoms in the general population. Within this context, a mental
health crisis was thought to be approaching and it was reasonable to expect that BD-related outcomes would worsen because of these circumstances. The current study aimed to explore changes in illness severity among
type I BD patients living in Argentina under strict lockdown.

Methods Table 2. Morbidity variables across each mirror period; mean ± standard deviation (min - max).
Methods
Pre-pandemic Pandemic Wilcoxon signed-rank test
 Thirty-seven adult type I BD outpatients under naturalistic treatment conditions were followed from March to
September 2020 using a mood chart technique based on the NIMH life-charting method. Nº of episodes
0.89 ± 1.70 0.70 ± 1.27
Z = -1.19, p = 0.23
(0 - 10) (0 - 7)
 Sociodemographic and clinical data were obtained as well as pharmacological exposure information. Different 0.38 ± 0.92 0.24 ± 0.72
variables of illness course and severity, including mood instability, were assessed and compared with the clinical Nº of depressive episodes Z = -1.89, p = 0.06
(0 - 5) (0 - 4)
outcomes obtained during the same seven-month period in 2019. 0.35 ± 0.92 0.30 ± 0.66
Nº of manic episodes Z = -0.54, p = 0.59
(0 - 5) (0 - 3)
 Between-period differences in morbidity and pharmacological measures were analyzed using non-parametric 0.16 ± 0.44 0.16 ± 0.44
Wilcoxon signed-rank test for paired data. Nº of mixed episodes Z = 0.00, p = 1.00
(0 - 2) (0 - 2)
7.08 ± 8.96 6.97 ± 9.10
Time (weeks) spent with symptoms Z = -0.03, p = 0.98
Results (0 - 28) (0 - 28)
Time (weeks) spent with depressive 3.03 ± 5.81 4.11 ± 7.18
Z = -1.27, p = 0.21
Demographic and clinical variables at baseline are shown in Table 1. No significant between-period differences symptoms (0 - 20) (0 - 28)
Time (weeks) spent with manic 2.32 ± 4.22 2.05 ± 5.28
were observed in patients’ clinical course, intensity of pharmacological treatment, or number of outpatient visits symptoms (0 - 16) (0 - 28)
Z = -0.13, p = 0.90
(Table 2). During lockdown, most patients (54%) did not exhibit any increase in mood instability or in the time Time (weeks) spent with mixed 1.73 ± 6.39 1.35 ± 4.74
spent with mood symptoms. No differences were observed between periods as regards exposure to Z = -0.05, p = 0.96
symptoms (0 - 28) (0 - 27)
pharmacological treatment (all p values > 0.05) Mood instability (nº of mood changes)
2.00 ± 2.38 1.89 ± 2.14
Z = -0.28, p = 0.78
(0 - 9) (0 - 8)
Table 1. Baseline demographic and illness characteristics of patients (n = 37). 0.00 ± 0.00 0.03 ± 0.16
No of suicide attempts Z = -1.00, p = 0.32
(0 - 0) (0 - 1)
No of previous hospital admissions, 1.27 ± 1.24 0.05 ± 0.33 0.00 ± 0.00
Females, n (%) 22 (59.5) No of hospital admissions Z = -1.00, p = 0.32
mean ± SD (min - max). (0 - 5) (0 - 2) (0 - 0)
51.92 ± 15.48 Patients with previous suicide attempts, 4.41 ± 3.39 4.16 ± 3.17
Age, years, mean ± SD (min - max). 9 (24.3) No of planned outpatient visits Z = -0.34, p = 0.74
(26 - 89) n (%) (1 - 18) (1 - 12)

25.53 ± 10.91 No of previous suicide attempts, mean ± 0.35 ± 0.68

Age at 1st episode, mean ± SD (min - max).
(12 - 55) SD (min - max). (0 – 2) Conclusions
Years of previous follow-up, mean ± SD 5.81 ± 4.24
IFD Scale - Lithium, median (IQR) 2 (1 - 2)
 In line with previous longitudinal studies of BD patients (4-6), the results of this study show no worsening
(min - max). (2 - 16) in clinical morbidity or increase in the exposure to pharmacological treatment during lockdown.
No of previous depressive episodes, mean ± 4.31 ± 4.32 IFD Scale - Anticonvulsants, median
1 (0 - 2)  Such a conspicuous contrast between our initial predictions and the observed findings highlights the fact
SD (min - max). (0 - 23) (IQR) that we are still far from being able to accurately predict the evolution of the disorder and the impact
No of previous manic episodes, mean ± SD 3.37 ± 1.94 that specific stressors have on illness variables.
IFD Scale - Antipsychotics, median (IQR) 2 (1 - 2)
(min - max). (0 - 8)
 These results should be interpreted cautiously as the BD sample was small, and actigraphy or other
Patients with previous hospital admissions, IFD Scale - Antidepressants, median methods able to ensure significant changes in patients' physical activity were not used. Further, the
26 (70.3) 0 (0 - 0)
n (%) (IQR)
observation period was limited to a 7-month lockdown and it is possible than changes occur later in
IFD Scale: Clinical Scale of Intensity, Frequency, and Duration of Pharmacological Treatment.
time.

References
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