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Clinical correlates of current level of functioning in primary care-treated bipolar patients


  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Martin Alda MD, FRCPC, Department of Psychiatry, Dalhousie University, 5909 Veteran's Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada. Fax: 1 902 473 1583;


Objectives:  In this study we examined general assessment of functioning (GAF), and its relation to clinical and demographic factors in bipolar patients. A number of studies, mostly from specialized programs, show that bipolar disorder often leads to occupational and social impairment. Here we report data from patients in a primary care setting.

Methods:  A total of 252 patients from the Maritime Bipolar Registry with DSM-IV diagnoses of bipolar I or bipolar II disorder participated in the study. GAF ratings during maintenance treatment were compared across clinical and demographic variables.

Results:  The mean GAF score in this sample was 67 ± 17 (range 10–100). The GAF scores followed bimodal distribution with mean values of 50.5 ± 10.3 and 79.0 ± 10.3. Decreased functioning was found in patients with chronic illness course, history of rapid cycling, suicidal behaviour, psychiatric comorbidity, hypothyroidism, and diabetes mellitus, regardless of treatment of these conditions. There were no differences in the level of functioning between men and women, bipolar I and II patients, those with and without psychotic episodes, hypertension, treatment with antidepressants or antipsychotics.

Conclusions:  Functioning in primary care-treated bipolar patients in maintenance phase of treatment is decreased not only due to specific disorder-related variables, but also due to frequent comorbidity with other psychiatric and medical conditions.