Trajectories of functioning in bipolar disorders: A longitudinal study in the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort

Abstract

Objective: We aimed at identifying distinct trajectories of functioning and at describing their respective clinical characteristics in a cohort of individuals with bipolar disorders. Methods: We included a sample of 2351 individuals with bipolar disorders who have been followed-up to 3 years as part as the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Global functioning was measured using the Functioning Assessment Short Test. We used latent class mixed models to identify distinct longitudinal trajectories of functioning over 3 years. Multivariable logistic regression models were used to identify the baseline factors that were associated with the membership to each trajectory of functioning. Results: Three distinct trajectories of functioning were identified: (1) a majority of individuals (72%) had a stable trajectory of mild functional impairment, (2) 20% of individuals had a stable trajectory of severe functional impairment and (3) 8% of individuals had a trajectory of moderate functional impairment that improved over time. The membership to a trajectory of stable severe versus stable mild functional impairment was associated with unemployment, a higher number of previous hospitalizations, childhood maltreatment, a higher level of residual depressive symptoms, higher sleep disturbances, a higher body mass index and a higher number of psychotropic medications being prescribed at baseline. The model that included these seven factors led to an area under the curve of 0.85. Conclusion: This study enabled to stratify individuals with bipolar disorders according to three distinct trajectories of functioning. The results regarding the potential determinants of the trajectory of severe functional impairment needs to be replicated in independent samples. Nevertheless, these potential determinants may represent possible therapeutic targets to improve the prognosis of those patients at risk of persistent poor functioning.

Influence of childhood maltreatment on prevalence, onset, and persistence of psychiatric comorbidities and suicide attempts in bipolar disorders

“…Hence, childhood maltreatment should be systematically assessed in individuals with BD, in particular when the course of BD is characterized by multiple and/or persistent psychiatric comorbidities or by suicide attempts. Since both childhood maltreatment and psychiatric comorbidities may increase the risk of subsequent relapses, but also may condition trajectories of poor functioning [24,49] in BD, they are key components that should be systematically screened during the clinical assessment to better prescribe personalized therapeutic strategies and psychosocial interventions.…”

Strategies and foundations for scientific discovery in longitudinal studies of bipolar disorder

“…BD is a complex, dynamic, and heterogeneous condition with varied psychopathology 21‐24 . It is commonly associated with multiple psychiatric and somatic comorbidities, and poorly understood pathophysiology 25,26 .…”

“…BD is a complex, dynamic, and heterogeneous condition with varied psychopathology. [21][22][23][24] It is commonly associated with multiple psychiatric and somatic comorbidities, and poorly understood pathophysiology. 25,26 There are many unconfirmed biochemical studies have been based on small nonrepresentative clinical samples with crosssectional designs.…”

Pharmacological treatment profiles in the FACE-BD cohort: An unsupervised machine learning study, applied to a nationwide bipolar cohort✰

“…This multicentre longitudinal study was based on the patient database from FondaMental Advanced Centres of Expertise for Bipolar Disorders (FACE-BD) cohort. This cohort has been fully described elsewhere (Godin et al, 2020;Henry et al, 2015;Henry et al, 2011;Henry et al, 2017). We searched for clusters of individuals based on their treatments during the first year following inclusion.…”