The relationship between neurocognitive functioning and occupational functioning in bipolar disorder: A literature review

Abstract

Neurocognitive impairment in Bipolar Disorder (BD) has been widely reported, even during remission. Neurocognitive impairment has been identified as a contributing factor towards unfavourable psychosocial functioning within this population. The objective of this review was to investigate the association between neurocognitive impairment and occupational functioning in BD. A literature review of English-language journal articles from January 1990 to November 2013 was undertaken utilising the PsychINFO, Scopus and Web of Knowledge databases. Studies that made specific reference to occupational outcomes were included, and those that reported on global psychosocial measures were excluded. Majority of the papers reviewed (20 out of 23) identified an association between neurocognitive impairment (particularly in executive functioning, verbal learning and memory, processing speed and attention) and occupational functioning. Several methodological issues were identified. There was a discrepancy in the measures used to assess neurocognitive function across studies and also the definition and measurement of occupational functioning. The clinical features of the samples varied across studies, and confounding variables were intermittently controlled. The review focused on English-language papers only and hence there is a bias toward the Western labour market. These limitations therefore influence the generalizability of the interpreted findings and the reliability of comparisons across studies. Neurocognitive impairment in BD appears to play a role in occupational outcomes. The findings of this review highlight the challenges for future research in this area, particularly in the measurement of neurocognitive and occupational functioning. Incorporating neurocognitive interventions in the treatment of BD, which has traditionally focussed solely on symptomatic recovery, may advance the vocational rehabilitation of these patients.

Heterogeneity of functional outcomes in patients with bipolar disorder: a cluster‐analytic approach

“…Most jobs require a degree of memory and attention, so, targeting these functions may benefit occupational performance. Nevertheless, it does not seem to be a simple and direct relation and other factors would be mediating this relationship .…”

“…Therefore, these cognitive domains seem to be important for achieving a good functional outcome. Moreover, as a whole, cognitive variables could positively contribute more than other sociodemographic or clinical variables to occupational functioning . Most jobs require a degree of memory and attention, so, targeting these functions may benefit occupational performance.…”

“…MacQueen reported that around 30–60% of patients with BD failed to regain full functioning in occupational and social domains after remission of an acute episode . Difficulties in maintaining established relationships, occupational difficulties and, consequently, a reduced quality of life have been reported among individuals with BD . Indeed, BD is considered the fifth leading cause among psychiatric illnesses of lost years of work, therefore representing a major public health problem .…”

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

“…Within the occupational expression, studies have reported illness history as one of its predictors, pointing out that a better clinical course indicates better occupational functioning 56 . Another variable that can partially explain the work disability found in this population is neurocognition, as it is known for subserving complex, abstract, and everyday processing 57 . Consequently, individuals would benefit from targeted vocational rehabilitation programs with tailored cognitive remediation, helping them avert similar future dismissals and improve their outcomes 54 .…”

Genetic polymorphisms associated with circadian rhythm dysregulation provide new perspectives on bipolar disorder

“…Treatment has traditionally sought to reduce the effects of depression and mania. Moreover, even when symptomatic recovery is achieved, significant functional deficiencies often persist . Pharmacological treatment options to control symptoms and prevent relapse include lithium (Li), anticonvulsants, atypical antipsychotics, and antidepressants.…”