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Functional Impairment and Disability across Mood States in Bipolar Disorder

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      Abstract

      Background

      Bipolar disorder (BD) represents a chronic and recurrent illness that can lead to severe disruptions in family, social, and occupational functioning. The severity of mood symptomatology has been associated with functional impairment in this population. However, the majority of studies have assessed global functioning without considering specific domains. The main objective of the current study was to assess specific life domains of functioning as well as the overall functioning in patients with BD across different mood states ([hypo] mania, depression, or euthymia) compared with healthy controls by the means of a standardized scale validated for BD.

      Methods

      The sample included 131 subjects with BD (68 in remission, 31 hypo [manic], and 32 depressed) and 61 healthy controls. The Functioning Assessment Short Test was used to assess overall and multiple areas of functional impairment (autonomy, occupational functioning, cognitive functioning, interpersonal relationships, financial issues, and leisure time).

      Results

      The results showed significant intergroup differences; depressed patients had the lowest functioning (48.03 ± 12.38) followed by (hypo) manic patients (39.81 ± 13.99). The euthymic group showed least impairment in functioning compared with the depression and (hypo) mania groups (11.76 ± 12.73) but still displayed significant impairment when compared with the healthy control group (5.93 ± 4.43).

      Conclusions

      This study indicates that depressive symptoms are associated with greater negative impact on psychosocial functioning than (hypo) manic symptoms. Further deficits in functioning seem to persist during remission. The results highlight the importance of aggressively treating depression and mania and the need to develop psychosocial interventions targeting to improve functional outcomes.

      Keywords

      References

        • Murray CJ
        • Lopez AD
        Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.
        Lancet. 1997; 349: 1436-1442
        • Gardner HH
        • Kleinman NL
        • Brook RA
        • et al.
        The economic impact of bipolar disorder in an employed population from an employer perspective.
        J Clin Psychiatry. 2006; 67: 1209-1218
        • Sánchez-Moreno J
        • Martínez-Arán A
        • Tabarés-Seisdedos R
        • et al.
        Functioning and disability in bipolar disorder: an extensive review.
        Psychother Psychosom. 2009; 78: 285-297
        • Michalak EE
        • Yatham LN
        • Lam RW
        Quality of life in bipolar disorder: a review of the literature.
        Health Qual Life Outcomes. 2005; 3: 72
        • Michalak EE
        • Murray G
        • Young AH
        • Lam RW
        Burden of bipolar depression: impact of disorder and medications on quality of life.
        CNS Drugs. 2008; 22: 389-406
        • Keck PE
        Defining and improving response to treatment in patients with bipolar disorder.
        J Clin Psychiatry. 2004; 65: 25-29
        • Mintz J
        • Mintz LI
        • Arruda MJ
        • Hwang SS
        Treatments of depression and the functional capacity to work.
        Arch Gen Psychiatry. 1992; 49: 761-768
        • Ustun B
        • Kennedy C
        What is “functional impairment”? Disentangling disability from clinical significance.
        World Psychiatry. 2009; 8: 82-85
        • Tohen M
        • Hennen J
        • Zarate Jr, CM
        • et al.
        Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features.
        Am J Psychiatry. 2000; 157: 220-228
        • MacQueen GM
        • Young LT
        • Joffe RT
        A review of psychosocial outcome in patients with bipolar disorder.
        Acta Psychiatr Scand. 2001; 103: 163-170
        • Simon GE
        • Bauer MS
        • Ludman EJ
        • et al.
        Mood symptoms, functional impairment, and disability in people with bipolar disorder: specific effects of mania and depression.
        J Clin Psychiatry. 2007; 68: 1237-1245
        • Judd LL
        • Akiskal HS
        • Schettler PJ
        • et al.
        Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study.
        Arch Gen Psychiatry. 2005; 62: 1322-1330
        • Calabrese JR
        • Hirschfeld RM
        • Frye MA
        • Reed ML
        Impact of depressive symptoms compared with manic symptoms in bipolar disorder: results of a U.S. community-based sample.
        J Clin Psychiatry. 2004; 65: 1499-1504
        • Altshuler LL
        • Post RM
        • Black DO
        • et al.
        Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: results of a large, multisite study.
        J Clin Psychiatry. 2006; 67: 1551-1560
        • Martínez-Arán A
        • Vieta E
        • Torrent C
        • et al.
        Functional outcome in bipolar disorder: the role of clinical and cognitive factors.
        Bipolar Disord. 2007; 9: 103-113
        • Bonnín CM
        • Martínez-Arán A
        • Torrent C
        • et al.
        Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: a long-term, follow-up study.
        J Affect Disord. 2009; 6: 156-160
        • Sartori N
        Disability and mental illness are different entities and should be assessed separately.
        World Psychiatry. 2009; 8: 86
        • First MB
        • Spitzer R
        • Gibbon M
        Structured Clinical Interview for DSM-IV Axis I Disorders. American Psychiatric Press Inc, Washington, DC1997
        • First MB
        • Spitzer R
        • Gibbon M
        Structured Clinical Interview for DSM-IV Axis II Personality Disorders. American Psychiatric Press Inc, Washington, DC1997
        • Bobes J
        • Bulbena A
        • Luque A
        • et al.
        A comparative psychometric study of the Spanish versions with 6, 17, and 21 items of the Hamilton depression rating scale.
        Med Clin (Barc). 2003; 120: 693-700
        • Colom F
        • Vieta E
        • Martinez-Aran A
        • et al.
        Spanish version of a scale for the assessment of mania: validity and reliability of the Young Mania rating scale.
        Med Clin (Barc). 2002; 119: 366-371
        • Rosa AR
        • Sanchez-Moreno J
        • Martinez-Aran A
        • et al.
        Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder.
        Clin Pract Epidemol Ment Health. 2007; 7: 5
        • Coryell W
        • Turvey C
        • Endicott J
        • et al.
        Bipolar I affective disorder: predictors of outcome after 15 years.
        J Affect Disord. 1998; 50: 109-116
        • Michalak EE
        • Yatham LN
        • Maxwell V
        • et al.
        The impact of bipolar disorder upon work functioning: a qualitative analysis.
        Bipolar Disord. 2007; 9: 126-143
        • Bauer MS
        An evidence-based review of psychosocial treatments for bipolar disorder.
        Psychopharmacol Bull. 2001; 35: 109-134
        • Simon GE
        • Ludman EJ
        • Unützer J
        • et al.
        Severity of mood symptoms and work productivity in people treated for bipolar disorder.
        Bipolar Disord. 2008; 10: 718-725
        • Hlastala SA
        • Frank E
        • Mallinger AG
        • et al.
        Bipolar depression: an underestimated treatment challenge.
        Depress Anxiety. 1997; 5: 73-83
        • Rosa AR
        • Franco C
        • Martínez-Aran A
        • et al.
        Functional impairment in patients with remitted bipolar disorder.
        Psychother Psychosom. 2008; 77: 390-392
        • Calabrese JR
        • Hirschfeld RM
        • Reed M
        • et al.
        Impact of bipolar disorder on a U.S. community sample.
        J Clin Psychiatry. 2003; 64: 425-432
        • Strakowski SM
        • Williams JR
        • Fleck DE
        • Delbello MP
        Eight-month functional outcome from mania following a first psychiatric hospitalization.
        J Psychiatr Res. 2000; 34: 193-200
        • Kennedy N
        • Foy K
        • Sherazi R
        • et al.
        Long-term social functioning after depression treated by psychiatrists: a review.
        Bipolar Disord. 2007; 9: 25-37
        • Kennedy N
        • Paykel ES
        Residual symptoms at remission from depression: impact on long-term outcome.
        J Affect Disord. 2004; 80: 135-144
        • Weinstock LM
        • Miller IW
        Functional impairment as a predictor of short-term symptom course in bipolar I disorder.
        Bipolar Disord. 2008; 10: 437-442
        • Rosa AR
        • Reinares M
        • Franco C
        • et al.
        Clinical predictors of functional outcome of bipolar patients in remission.
        Bipolar Disord. 2009; 11: 401-409
        • Dickerson F
        • Boronow JJ
        • Stallings C
        • et al.
        Cognitive functioning in schizophrenia and bipolar disorder: comparison of performance on the Repeatable Battery for the Assessment of Neuropsychological Status.
        Psychiatry Res. 2004; 30: 45-53
        • MacQueen GM
        • Young LT
        • Robb JC
        • et al.
        Effect of number of episodes on wellbeing and functioning of patients with bipolar disorder.
        Acta Psychiatr Scand. 2000; 101: 374-381
        • Kapczinski F
        • Vieta E
        • Andreazza AC
        • et al.
        Allostatic load in bipolar disorder: implications for pathophysiology and treatment.
        Neurosci Biobehav Rev. 2008; 32: 675-692
        • Post M
        Transduction of psychosocial stress into the neurobiology of recurrent affective disorder.
        Am J Psychiatry. 1992; 149: 999-1010