Changes in morbidity among bipolar I patients during the pandemic: comparison between two seven-month periods

Abstract

Introduction: Converging evidence supports the involvement of circadian rhythm disturbances in the course and morbidity of bipolar disorder (BD). 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 BD patients living under strict lockdown.Method: Thirty-seven type I BD outpatients under naturalistic treatment conditions were followed from March to September 2020 using a mood chart technique. Different variables of illness severity, including mood instability, were assessed and compared with the clinical outcomes obtained during the same seven-month period in 2019.Results: No significant between-period differences were observed in patients’ clinical course, intensity of pharmacological treatment, or number of outpatient visits. During the pandemic, most patients (54%) did not exhibit any increase in mood instability or in the time spent with mood symptoms.Conclusion: In line with previous longitudinal studies of BD patients, the results of this study show no worsening in clinical morbidity during the pandemic. Such a conspicuous contrast between our initial predictions and the observed findings highlights the fact that we are still far from being able to accurately predict the evolution of the disorder and the impact that specific stressors have on illness variables.