Functioning in euthymic patients with bipolar disorder: A systematic review and meta‐analysis using the Functioning Assessment Short Test

Abstract

Objectives Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. Methods Meta‐analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand‐searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two‐step meta‐analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed‐effects model for categorical variables. Results In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI. Conclusions This study reinforces the relevant functional impact of BD in this population and suggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.

Social support in patients with bipolar disorder and differing ages at onset

“…Bipolar disorder (BD) is a serious and recurrent mental disease marked by cyclic mood episodes of opposite polarity alternating with intervals of symptomatic remission. As a complex disorder, it is characterized by heterogeneous clinical manifestations and outcomes (Joslyn et al, 2016), which cause substantial damage to the patient's quality of life, social support and functionality (Léda-Rêgo et al, 2020;Studart et al, 2016Studart et al, , 2015. Furthermore, the risk of suicide is elevated in these patients (Dome et al, 2019).…”

Assessment of different domain impairments in Cognitive Functions and Functionalities found in Euthymic Patients with Bipolar Disorder I / II - during the early and late phases of the disease, using the FAB and FAST tests.

“…Our results also corroborate with the present literature, where the subtests (autonomy, occupational functioning, cognitive functioning, and interpersonal relationship), seem to present the greatest impacts. In a recent categorical meta-analysis that included 11 other studies, with a total sample of 1083 patients, the prevalence of global functional impairment was 58.6%.Regarding specific domains, the meta-analysis showed a prevalence of impairment in the following domains: 65.6% in occupational, 49.2% in cognitive, 42.6% in autonomy, 42.1% in interpersonal relationships, 29.2% in leisure, and 28.8% in the field of financial issues -all of them statistically significant [86]. Regarding the FAB test, and confirming one of our initial hypotheses, we observed a similar phenomenon.…”

Assessment of the Impairment in Domain functionalities and Executive Functions in Euthymic Patients, with Bipolar Disorder I/II - Utilizing the FAST and FAB tests

“…They observed that depressive symptomatology together with neurocognitive impairments related to verbal memory and EF are predictor variables of long-term functional outcome in BD.In a recent categorical meta-analysis which included 11 other studies, with a total sample of 1083 patients, the prevalence of global functional impairment was 58.6%. Regarding the specific domains, the meta-analysis presented an impairment prevalence in the following domains: 65.6% in the occupational, 49.2% in the cognitive, 42.6% in the autonomy, 42.1% in the interpersonal relationships, 29.2% in the leisure, and 28.8% in the financial issues domain -all of which were statistically significant [86]. In another study on the relationship between cognitive and occupational function in euthymic patients, it was reported that over six months, cognitive measures at the time of symptomatic recovery, particularly in the domains of working memory/attention and speed of processing, were strongly associated with…”