Burden of bipolar depression: impact of disorder and medications on quality of life.

Division of Mood Disorders, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
CNS Drugs (Impact Factor: 5.11). 02/2008; 22(5):389-406.
Source: PubMed


Bipolar disorder is a complex, chronic psychiatric condition characterized by recurring episodes of depressive illness and mania or hypomania. Although the manic or hypomanic episodes define the disorder, recent research has shown that depressive symptoms predominate over manic symptoms in the majority of patients, and that bipolar depression accounts for much of the significant morbidity and mortality associated with bipolar disorder. Given these findings, there has been a recent upsurge of interest in furthering our understanding of the burden of depression in bipolar disorder. At the same time, increasing scientific attention is now being paid to expanding the measurement of outcome in bipolar disorder to encompass broader indicators of response, one of which is the assessment of quality of life (QOL). In this review, we provide a summary of the current knowledge about QOL in the depressive phase of bipolar disorder, and the effects of pharmacological treatment interventions for bipolar disorder upon QOL. It appears that QOL is poorer in bipolar disorder than in other mood disorders and anxiety disorders, but that schizophrenia might compromise QOL more severely than bipolar disorder. Existing data also suggest that, for patients with bipolar disorder, QOL is negatively associated with depression, both as a cross-sectional mood state and perhaps also as a feature of the patient's course. Despite its clinical and public health importance, bipolar depression has only recently started to receive the attention it warrants in clinical trials, and many important questions about its optimal pharmacological management remain to be answered. There is also a paucity of information about the impact of pharmacological interventions on QOL in bipolar depression. To our knowledge, only two clinical trials to date have specifically examined the impact of medications on QOL in patients with bipolar depression. A small number of other studies have examined the effects of depressive symptoms on QOL in patients who are experiencing manic or mixed episodes. Nonetheless, QOL appears to be a meaningful and important indicator of outcome and recovery in this patient population, and one that warrants further scientific interest and energy.

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    • "Documenting the effects of in- and outpatient psychiatric care is not only important for benchmarking across care providers, but also for the patients themselves. This is also true for the care they receive in private practice, where it is hoped that evidence-based information about treatment is embedded in care provision and the interaction between patient and physician.58,59 "
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    ABSTRACT: Assessing quality of life (QoL) as a patient-reported outcome in adult psychiatry poses challenges in terms of concepts, methods, and applications in research and practice. This review will outline conceptually the construct of QoL, its dimensionality, and its representation across patient groups. Methodological challenges are examined, along with principles of QoL instrument development and testing, as well as across cultures. Application of instruments in epidemiological, clinical health economics, and health services research is reviewed based on pertinent literature. Validated measures for depression, psychosis, and anxiety disorders are available in adult psychiatry, and are increasingly used in research. Still, targeted measures are lacking for many mental health conditions and only rarely are tools applied in the practice context. Progress has been made in the development of instruments that are now ready for implementation. The information to be gained is valuable for identifying patient-reported needs for and benefits of treatment.
    Dialogues in clinical neuroscience 06/2014; 16(2):137-45.
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    • "The improved ability to control overt illness symptoms through psychopharmacological and psychosocial treatments, as highlighted in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study [1], has afforded new opportunities for people with mental illness. However, studies suggest that functional and psychological well-being of individuals with bipolar disorders is not consistently predicted by symptom severity [2,3]. As evidence for the management of BPD symptoms improves, it is important to broaden our understanding of factors that contribute to psychological well-being (subjective assessments of life quality, including emotional reactions and cognitive judgments), beyond overt symptoms and predictors of symptom exacerbation and remission. "
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    ABSTRACT: Bipolar disorder (BPD) is a common condition associated with significant morbidity and reduced quality of life. In addition to challenges caused by their mood symptoms, parents affected with BPD harbor concerns about the mental health of their children. Among adult parents who perceive themselves to have BPD, this study aims to examine participants' coping methods; identify predictors of adaptation; assess parental perceptions of risks for mood disorders among their children; and describe the relationships among illness appraisals, coping, adaptation to one's own illness, and perceived risk to one's children. Parents who self-identified as having BPD completed a web-based survey that assessed dispositional optimism, coping, perceived illness severity, perceived etiology of BPD, perceived risk to offspring, and adaptation to BPD. Participants had at least one unaffected child who was 30 years of age or below. 266 parents were included in the analysis. 87% of parents endorsed a "somewhat greater" or "much greater" risk for mood disorders in one's child(ren) than someone without a family history. Endorsing a genetic/familial etiology to BPD was positively correlated with perceived risk for mood disorders in children (rs = .3, p < 0.01) and active coping with BDP (r = .2, p < 0.01). Increased active coping (beta = 0.4, p < 0.001) and dispositional optimism (beta = 0.3, p < 0.001) were positively associated with better adaptation, while using denial coping was negatively associated with adaptation (beta = -0.3, p < 0.001). The variables explained 55.2% of the variance in adaptation (F = 73.2, p < 0.001). Coping mediated the effect of perceived illness severity on adaptation. These data inform studies of interventions that extend beyond symptom management and aim to improve the psychological wellbeing of parents with BPD. Interventions targeted at illness perceptions and those aimed at enhancing coping should be studied for positive effects on adaptation. Parents with BPD may benefit from genetic counseling to promote active coping with their condition, and manage worry about perceived risk to their children.
    BMC Psychiatry 12/2013; 13(1):327. DOI:10.1186/1471-244X-13-327 · 2.21 Impact Factor
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    • "Bipolar disorder (BD) is a common and often severe mood disorder, which affects multiple dimensions of the life of the patients (Colom et al., 2006). Functioning in BD is impaired in several domains, such as social, occupational and/or educational, and self-care (Michalak et al., 2008). One of the most robust determinants of level of functioning in BD is a history of multiple episodes, which impacts disability, chronicity and severity of subsyndromal symptoms and quality of life (Magalhaes et al., 2012). "
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    ABSTRACT: OBJECTIVE: Comprehensively review studies evaluating factors associated with adherence to treatment in bipolar disorder (BD), as well as the results of interventions developed to enhance adherence in this population. METHODS: The following search engines were consulted: PubMed, Scielo, LILACS and PsycINFO. The keywords used were "Bipolar Disorder", "Factor", "Adherence", "Nonadherence", "Compliance" and "Intervention". In addition, references list of selected studies were consulted searching for relevant articles. RESULTS: Adherence has been defined in various ways, with some considering adherence vs. nonadherence, and other including a "partial" adherence measure. In addition, methods to assess adherence differ for each study. Several factors were related to poor adherence, including patient-related factors (e.g. younger age, male gender, low level of education, alcohol and drugs comorbidity), disorder-related factors (e.g. younger age of onset, severity of BD, insight and lack of awareness of illness) and treatment-related factors (e.g. side effects of medications, effectiveness). To improve adherence, the main recommendations are to provide customized interventions focusing on the underlying causes of nonadherence, strong therapeutic alliance and different modalities based on psychoeducation. CONCLUSION: Our results indicate that nonadherence is a multicausal phenomenon and strategies to prevent and approaches them must include enhanced therapeutic alliance, flexible topics, early intervention, group setting, and psychoeducation. LIMITATIONS: Different definitions and measures of adherence in the literature currently moderate the generalization of the findings in this review. Further studies are necessary regarding factors of adherence in BD and interventions to improve it, especially on social factors like stigma and family.
    Journal of Affective Disorders 03/2013; 149(1-3). DOI:10.1016/j.jad.2013.01.036 · 3.38 Impact Factor
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