Psychosocial Disability in the Course of Bipolar I and II Disorders

Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 01/2006; 62(12):1322-30. DOI: 10.1001/archpsyc.62.12.1322
Source: PubMed


Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder (BP-I) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder (BP-II).
To provide detailed data on psychosocial disability in relation to symptom status during the long-term course of BP-I and BP-II.
A naturalistic study with 20 years of prospective, systematic follow-up.
Inpatient and outpatient treatment facilities at 5 US academic centers. Patients One hundred fifty-eight patients with BP-I and 133 patients with BP-II who were followed up for a mean (SD) of 15 (4.8) years in the National Institute of Mental Health Collaborative Depression Study.
The relationship, by random regression, between Range of Impaired Functioning Tool psychosocial impairment scores and affective symptom status in 1-month periods during the long-term course of illness from 6-month and yearly Longitudinal Interval Follow-up Evaluation interviews.
Psychosocial impairment increases significantly with each increment in depressive symptom severity for BP-I and BP-II and with most increments in manic symptom severity for BP-I. Subsyndromal hypomanic symptoms are not disabling in BP-II, and they may even enhance functioning. Depressive symptoms are at least as disabling as manic or hypomanic symptoms at corresponding severity levels and, in some cases, significantly more so. At each level of depressive symptom severity, BP-I and BP-II are equally impairing. When asymptomatic, patients with bipolar disorder have good psychosocial functioning, although it is not as good as that of well controls.
Psychosocial disability fluctuates in parallel with changes in affective symptom severity in BP-I and BP-II. Important findings for clinical management are the following: (1) depressive episodes and symptoms, which dominate the course of BP-I and BP-II, are equal to or more disabling than corresponding levels of manic or hypomanic symptoms; (2) subsyndromal depressive symptoms, but not subsyndromal manic or hypomanic symptoms, are associated with significant impairment; and (3) subsyndromal hypomanic symptoms appear to enhance functioning in BP-II.

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Available from: Pamela J Schettler, Dec 18, 2013
    • "The most robust clinical predictor of long-term functional impairment is subsyndromal depressive symptoms (Altshuler et al., 2002; Fagiolini et al., 2005; Judd et al., 2005; Bonnin et al., 2010), although studies also have shown associations between older age, presence of mixed episodes, and increased number of previous hospitalizations and poor functioning (Rosa et al., 2009). Comparatively understudied are the contributions of cognitive functioning and sleep to sustained work disability, as both are often found to be impaired despite remission of mood symptoms and may in fact be inter-related (see Boland and Alloy, 2013 for a review of the theoretical relationship between sleep and neurocognition in BD). "
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    ABSTRACT: Bipolar Disorder (BD) is associated with impairment in a number of areas including poor work functioning, often despite the remission of mood symptoms. The present study aimed to examine the role of sleep disturbance and cognitive functioning in occupational impairment in BD. Twenty-four euthymic BD participants and 24 healthy control participants completed a week of prospective assessment of sleep disruption via self-report and actigraphy, a battery of neuropsychological tests of executive functioning, working memory, and verbal learning, and assessments of work functioning. BD participants experienced significantly poorer cognitive functioning as well as greater months of unemployment and greater incidence of being fired than controls. Moderation analyses revealed that both poor sleep and cognitive functioning were associated with poor work performance in BD participants, but not control participants. Sleep and cognitive functioning may be impaired in euthymic BD and are associated with poor work functioning in this population. More research should be conducted to better understand how sleep and cognitive functioning may interact in BD.
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    • "Bipolar disorder (BD) is a highly prevalent (Catalá-López et al., 2013; Merikangas et al., 2011) and disabling disease (Huxley and Baldessarini, 2007; Judd et al., 2005; Rosa et al., 2008, 2009). "
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    ABSTRACT: The identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode. We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable. Number of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode. The main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness. Psychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Aug 2015 · Journal of Affective Disorders
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    • "Though BD is an episodic illness, individuals with BD suffer from depressive symptoms up to 32% of the time, and manic symptoms about 9% of the time (Judd et al., 2002). Subsyndromal and mixed symptoms are prevalent, and contribute to restricting the effort of individuals with BD to achieve life goals in areas such as education, occupation, and personal relationships (Judd et al., 2005). Poor sleep quality is a state marker and symptom of depressive and manic episodes (Goodwin and Jamison, 2007). "
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    ABSTRACT: Sleep disturbance is bi-directionally related to mood de-stabilization in bipolar disorder (BD), and sleep quality differs in men and women. We aimed to determine whether perception of poor sleep quality would have a different effect on mood outcome in men versus women. We assessed association between sleep quality (Pittsburgh Sleep Quality Index (PSQI)) at study intake and mood outcome over 2 years in subjects from the Prechter Longitudinal Study of Bipolar Disorder (N=216; 29.6% males). The main outcome measure was the severity, variability, and frequency of mood episodes measured by self-report over 2 years of follow-up. Multivariable linear regression models stratified by sex examined the relationship between PSQI with mood outcomes, while age, stressful life events, mood state and neuroticism at baseline were controlled. In women, poor sleep quality at baseline predicted increased severity (B=0.28, p<0.001) and frequency of episodes (B=0.32, p<0.001) of depression, and poor sleep quality was a stronger predictor than baseline depression; poor sleep quality predicted increased severity (B=0.19, p<0.05) and variability (B=0.20, p<0.05) of mania, and frequency of mixed episodes (B=0.27, p<0.01). In men, baseline depression and neuroticism were stronger predictors of mood outcome compared to poor sleep quality. We measured perception of sleep quality, but not objective changes in sleep. In a longitudinal study of BD, women reported poorer perceived sleep quality than men, and poor sleep quality predicted worse mood outcome in BD. Clinicians should be sensitive to addressing sleep complaints in women with BD early in treatment to improve outcome in BD. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Apr 2015 · Journal of Affective Disorders
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