Objectives Functional impairment is an important driver of disability in patients with bipolar disorder (BD) and can persist even when symptomatic remission has been achieved. The objectives of this systematic literature review were to identify studies that assessed functioning in patients with BD and describe the functional scales used and their implementation. Methods A systematic literature review of English‐language articles published between 2000 and 2017 reporting peer‐reviewed, original research related to functional assessment in patients with BD was conducted. Results A total of 40 articles met inclusion criteria. Twenty‐four different functional scales were identified, including 13 clinician‐rated scales, 7 self‐reported scales, and 4 indices based on residential and vocational data. The Global Assessment of Functioning (GAF) and the Functional Assessment Short Test (FAST) were the most commonly used global and domain‐specific scales, respectively. All other scales were used in ≤2 studies. Most studies used ≥1 domain‐specific scale. The most common applications of functional scales in these studies were evaluations of the relationships between global or domain‐specific psychosocial functioning and cognitive functioning (eg, executive function, attention, language, learning, memory) or clinical variables (eg, symptoms, duration of illness, number of hospitalizations, number of episodes). Conclusions The results of this review show growing interest in the assessment of functioning in patients with BD, with an emphasis on specific domains such as work/educational, social, family, and cognitive functioning and high utilization of the GAF and FAST scales in published literature.

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BackgroundSchizophrenia and bipolar disorder (BD) are typically understood as separate and non-concurrent psychiatric disorders both in the clinical setting and in the DSM-V and ICD-10 classification systems. However, patients may experience both mood and schizophrenia symptoms simultaneously. Several studies have shown overlap between schizophrenia and BD symptoms, which may lead to diagnostic confusion. Additionally, molecular studies have confirmed that schizophrenia and BD share susceptibility genes. This study explored diagnosis patterns of patients with schizophrenia and/or type I bipolar disorder (BD-I) diagnoses in a real-world setting.MethodsThis was a retrospective cohort study using Truven MarketScan® Commercial, Medicaid, and Medicare Supplemental databases from the study period 01/01/2012 and 06/30/2016. Patients were considered to have a diagnosis of schizophrenia if 1 inpatient claim or 2 outpatient claims for schizophrenia were identified within a selected identification period (01/01/2013 and 06/30/2015). BD-I was defined in an analogous way, and the following five mutually exclusive cohorts were defined: 1) schizophrenia (SCZ) alone (cohort I): newly diagnosed with schizophrenia alone (e.g., met the claims-based diagnostic criteria for schizophrenia, but not for BD-I), 2) BD-SCZ (cohort II): met BD-I criteria only in the year prior to meeting the schizophrenia criteria, 3) SCZ-BD (cohort III): met schizophrenia criteria only in the year prior to, or on the same day as, meeting BD-I criteria, 4) BD-SCZ-BD (cohort IV) met BD-I criteria both in the year before and the year after meeting the schizophrenia criteria, and 5) BD alone (cohort V): newly diagnosed with BD-I alone (e.g., met the claims-based diagnostic criteria for BD-I, but not for schizophrenia). Descriptive statistics are reported for all cohorts.ResultsOf the 63,725 patients in the final analytic sample, 11.5% (n=7,336) had schizophrenia alone (cohort I), 7.7% (n=4,909) had a dual diagnosis (cohorts II-IV), and 80.8% (n=51,480) had BD-I alone (cohort V). The dual diagnosis patients included 1.0% (n=615) with BD-SCZ (cohort II), 2.8% (n=1,794) with SCZ-BD (cohort III), and 3.9% (n=2,500) with BD-SCZ-BD (cohort IV). Patients with different diagnosis patterns significantly differed in age, gender, and insurance type (p<.001). Considering the dual diagnosis cohorts, 927 received both diagnoses on the same day. Of those occurring on the same day, the majority (n=753) were on claims from the hospital/emergency department setting.DiscussionThis analysis of real-world data found a sizable number of patients with dual diagnoses of schizophrenia and BD-I. Among all patients with either BD-I, schizophrenia, or both, about 2/3 as many met the criteria for both disorders as for schizophrenia alone. Fifteen percent of patients who met criteria for both did so on the same day, likely reflecting patients presenting to acute care exhibiting mixed features. A review of medical records would be useful to determine if dual diagnosis is more common...

BackgroundPatient preferences in schizophrenia (SCZ), including identification of key goals and outcomes for treatment and relative importance of certain treatment goals to patients, have been assessed by several studies. However, there continues to be a lack of sufficient evidence on US patient attitudes and perceptions towards treatment goals and pharmacotherapy options in SCZ, especially taking into context long-acting injectable antipsychotics (LAIs) in this disease area. This lack of evidence is further pronounced in caregivers of individuals with SCZ. The objective of this analysis was to characterize patients with SCZ on LAIs vs patients on oral antipsychotics (OAPs) and evaluate the treatment goals of patients in each group.MethodsThis was a real-world, cross-sectional survey of US psychiatrists, patients =18 years old with a diagnosis of SCZ, and caregivers. Data was collected using the Disease Specific Programme (DSP) methodology, which has been previously published. Psychiatrists (n=120) completed detailed record forms for next 8 consecutive outpatients and 2 inpatients matching inclusion criteria, including non-interventional clinical and subjective assessments. The same patients and their caregivers, if present, were invited by their psychiatrist to voluntarily complete a separate survey.ResultsOf 1135 patients on treatment where the physician provided survey data; 251 were on an LAI, and 884 were on an OAP. Mean (SD) time to SCZ diagnosis for those on an LAI was 10.3 (12.0) years vs 7.8 (10.5) years for those on OAPs. More patients in the LAI vs OAP group were being treated as an inpatient (27.1% vs 15.7%, respectively; p<0.0001). Patients on an LAI reported being on their current medication regimen for less time (mean 1.7 years) vs those on OAPs (mean 2.5 years) (p=0.0093). More patients on LAIs were unemployed due to disability vs those on OAPs (56.1% vs 39.5%, respectively), and less patients on LAIs were able to work part-time or full-time (21.1% or 4.1%) vs those on OAPs (23.2% or 11.4%). More patients on an LAI had a caregiver vs those on OAPs (37.3% vs 26.1%, respectively; p=0.0011). Regarding the most important treatment goals reported by patients, both groups reported similar preferences for decrease in disease symptoms (62% on LAI vs 65% on OAPs) and thinking more clearly (53% on LAI vs 46% on OAPs); however, a numerically higher proportion of LAI patients reported that the current medication helped decrease hospitalizations due to relapse vs those on OAPs (38% vs 32%, respectively).DiscussionGiven the characteristics of patients participating in this real-world survey, those on LAIs exhibited qualities which indicate a higher severity of illness vs those on OAPs. Results suggest that treatment with LAIs is still mainly being provided to patients later in the disease course and/or who have adherence problems, despite a growing body of evidence of utility in younger patients earlier in the course of illness.FundingOtsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC

ObjectivesObjectives for this survey are to determine similarities or differences in treatment goals reported by psychiatrists, patients with schizophrenia (SCZ) and caregivers in the US, as well as whether goals differed by patients currently on an oral antipsychotic (OAP) or long-acting injectable (LAI), and whether goals differed by age.MethodsThis was a real-world, cross-sectional survey of US psychiatrists, patients =18 years old diagnosed with SCZ, and caregivers. Data was collected using the Disease Specific Programme (DSP) methodology. Psychiatrists (n=120) completed detailed record forms for next 8 outpatients and 2 inpatients matching inclusion criteria. The same patients and their caregivers, if present, were invited by their psychiatrist to voluntarily complete a separate survey.ResultsResponses on treatment goals were collected from psychiatrists for all patients included in the analysis (n=1161), patients (n= 542) and caregivers (n=130). Among 3 top goals, psychiatrists, patients and caregivers concurred that “decrease in disease symptoms” is most important (63%, 64%, 68% respectively). For psychiatrists and caregivers, second was “decrease in hospitalization for relapse” (41%, and 38% respectively), whereas for patients, it was “thinking clearly” (47%). Of the 3 least important goals, psychiatrists, patients and caregivers agreed with “sexual problems” (59%, 43%, 44%, respectively) and “weight gain” (38%, 44%, 38%, respectively).When asked which goals were met by current medication, patients responded “decrease in disease symptoms” (68%) and “thinking clearly” (39%). However, caregivers responded “thinking clearly” (30%) was not met by current medication. Caregivers most important goals, “decrease in disease symptom” (70%) and “decrease in hospitalization for relapse” (41%), were met. Additional analyses of patients on OAPs and LAIs, did not show differences in goals. However, “decrease in disease symptoms” was numerically more important for patients on LAIs vs OAPs according to psychiatrists (68% vs 62%) and caregivers (77% vs 70% respectively). Caregivers responded “decrease in hospitalization for relapse” was met for 63% patients currently on an LAI and 35% OAP. No major differences in treatment goals were observed by patient age (18–35 vs 36–65 vs >65 years).DiscussionThere is consensus among US psychiatrists, patients and caregivers on the most important treatment goal “decrease in disease symptoms”, regardless of patients’ current medication or age. For patients, “thinking more clearly” was second, compared with “decrease in hospitalization due to relapse”, for psychiatrists and caregivers. All agreed that least important treatment goals, related to AEs, were “weight gain” and “sexual problems”. More caregivers agreed “decrease in hospitalization for relapse” was met by patients on LAIs vs OAPs. These findings may help with discussions between psychiatrists, patients and caregivers.FundingLundbeck LLC and Otsuka Pharmaceutical Development & Commercialization, Inc.