Functional outcome in bipolar disorder: the role of clinical and cognitive factors

Abstract

Introduction: Few studies have examined the clinical, neuropsychological and pharmacological factors involved in the functional outcome of bipolar disorder despite the gap between clinical and functional recovery. Methods: A sample of 77 euthymic bipolar patients were included in the study. Using an a priori definition of low versus good functional outcome, based on the psychosocial items of the Global Assessment of Functioning (GAF, DSM‐IV), and taking also into account their occupational adaptation, the patients were divided into two groups: good or low occupational functioning. Patients with high (n = 46) and low (n = 31) functioning were compared on several clinical, neuropsychological and pharmacological variables and the two patient groups were contrasted with healthy controls (n = 35) on cognitive performance. Results: High‐ and low‐functioning groups did not differ with respect to clinical variables. However, bipolar patients in general showed poorer cognitive performance than healthy controls. This was most evident in low‐functioning patients and in particular on verbal memory and executive function measures. Conclusions: Low‐functioning patients were cognitively more impaired than highly functioning patients on verbal recall and executive functions. The variable that best predicted psychosocial functioning in bipolar patients was verbal memory.

Neurocognitive impairment in bipolar disorder patients: functional implications

“…Of the 13 remaining reports, one was excluded for not exploring correlations between cognitive and functional domains, yielding 12 studies suitable for further analysis (1,3,4,23,(28)(29)(30)(31)(32)(33)(34)(35). These 12 studies provided 13 sets of correlations between cognitive and functional status, including eight studies involving euthymic BPD patients (3,4,(29)(30)(31)(32)(33)(34) and five involving BPD patients in non-euthymic or uncertain mood states (1,3,23,28,35). The latter five studies included BPD patients either recently hospitalized (23,28) or still in major depression, mania, or hypomania (1, 3), or in unspecified mood states (35).…”

“…Euthymic BPD patients performed less well than matched healthy controls in these cognitive measures in 7 ⁄ 8 studies. Their impaired domains involved verbal learning and memory in four studies (4,29,32,34), executive functioning in three (4,33,34), and attention, concentration, mental tracking, and information processing speed in three (31)(32)(33).…”

“…Specifically, in studies of euthymic BPD patients (Table 2A), estimated premorbid IQ was assessed in 6 ⁄ 8 studies (3,4,(29)(30)(31)(32), executive function in six (3,4,30,(32)(33)(34), verbal learning and memory in six (3,4,29,(32)(33)(34), attention, concentration, mental tracking, information processing speed, and immediate memory in five (3,4,30,31,33), verbal fluency or language in four (4,30,31,33), visuospatial performance in three (29,31,33), and psychomotor speed in two studies (3,31). Euthymic BPD patients performed less well than matched healthy controls in these cognitive measures in 7 ⁄ 8 studies.…”

“…c Participants had cognitive testing when Ôsufficiently stableÕ after hospitalization; at one-year follow-up they were rated for functional status [Multidimensional Scale for Independent Living To assess functional status in euthymic BPD patients, 5 ⁄ 8 studies (3,4,30,32,34) used the Global Assessment of Functioning (GAF) Scale (38); three of these (4, 32, 34) reported explicitly that only social and occupational functioning, and not mood symptoms, were considered, two relied on patient self-assessment on psychosocial functioning rating scales (29,31), and only one used performance-based measures to assess the instrumental activities of daily living [IADL (33)]. Functional domains considered were vocational and educational activities, household maintenance, level of independent living, and quality of family and social relationships.…”

Neuropsychological Clustering in Bipolar and Major Depressive Disorder

“…Given the impact of these cognitive alterations on functional capacity (Martinez-Aran et al, 2007) and treatment outcomes (Dunkin et al, 2000), several studies have sought to identify the patterns of cognitive impairment associated with specific disorders such as BD and MDD. Unfortunately, few definite conclusions have emerged in this area of research.…”