Lifetime Psychotic Symptoms, Subthreshold Depression and Cognitive Impairment as Barriers to Functional Recovery in Patients with Bipolar Disorder

Abstract

(1) Background: bipolar disorder (BD) is a chronic disease that often leads to functional impairment. The objective of this study is to elucidate which variables are associated with better functional outcomes in a sample of euthymic patients with BD. (2) Methods: patients were recruited at the Hospital Clinic of Barcelona and they underwent a clinical interview, a functional assessment, and a comprehensive neuropsychological evaluation. After that, patients were divided into two groups according to the Functioning Assessment Short Test total score: functionally remitted vs. functionally impaired. Following this, a multivariate logistic regression was run in order to identify clinical, demographic and cognitive factors associated with functional remission. (3) Results: a total of 420 euthymic patients with BD were assessed for this study, distributed as follows: functionally remitted (n = 221) and functionally impaired (n = 199). Finally, the multivariate logistic regression revealed that only five variables significantly contributed to the model, including: lifetime history of psychotic symptoms (the variable that contributed the most to the model), followed by the Hamilton Depression total score, and cognitive performance (executive functions and verbal memory). (4) Conclusions: treatments to ensure a good functional outcome in BD should specially prevent psychosis, target subthreshold depressive symptoms and enhance cognition, more specifically executive functions and verbal memory.

Exploring Risk and Resilient Profiles for Functional Impairment and Baseline Predictors in a 2-Year Follow-Up First-Episode Psychosis Cohort Using Latent Class Growth Analysis

“…Less severe positive symptoms at baseline predicted a Moderate impairment-Stable trajectory vs. a Severe impairment-Stable trajectory. These results are in agreement with previous studies performed in FEP and chronic psychiatric samples, where parental SES [ 17 , 63 ], negative [ 14 , 64 , 65 ] and depressive symptoms [ 66 , 67 ], verbal memory [ 64 ], and premorbid adjustment [ 14 , 68 ] were predictors of functional outcomes. To our knowledge, however, this is the first study to simultaneously analyze such a large panel of potential predictors of mid-term psychosocial functioning trajectories identified using an LCGA approach, which included sociodemographic, clinical, and neurocognitive variables, and to further examine the interaction between the identified predictors.…”

Some characteristics of disorders of cognitive functions in the primary episode of bipolar affective disorder

“…Thus, in the study of Y. Zhu et al (2019) found an increase in the time of perform the TMT test in patients with BAD and major depressive disorder; in this case, the data on the quantitative characteristics of TMT-A are in general likely with the data received in our study for all patients with all clinical variants of PE of BAD [13], and are consistent with the data of Mar Bonnin et al (2019) regarding worse performance according to the TMT test in patients with BAR [14]. At the same time, the selection of the depressive, manic and mixed types of PE of BAD allowed us to show that the quantitative characteristics of TMT differ significantly depending on the clinical variant of PE, and it should be taken into account when assessing the cognitive functions of patients with PE of BAD.…”

Cognitive and clinical predictors of community functioning across the psychoses

“…Thus, while our findings regarding negative symptoms and outcomes are consistent with the SZ literature and extend these findings to a transdiagnostic sample, our findings regarding residual mania were unexpected. One possibility is that specific items from the YMRS may have driven this association; for instance, the above review also found that poor sleep was a strong predictor of outcomes (Bonnín et al, ), as was history of psychosis; both sleep and psychotic symptoms are assessed by the YMRS (although it should be noted that the psychosis item taps positive symptoms [e.g. delusions], and PANSS Positive scores were not associated with outcomes in our sample).…”

“…We also found that residual manic symptoms were predictive of community outcomes, which was unanticipated. A recent review of functioning in patients with BD found that history of psychosis and residual depressive symptoms were actually the most commonly reported clinical correlates of poor functioning (Bonnín et al, ). Thus, while our findings regarding negative symptoms and outcomes are consistent with the SZ literature and extend these findings to a transdiagnostic sample, our findings regarding residual mania were unexpected.…”