Functional impairment in the remission phase of bipolar disorder


  • AF is a consultant to Bristol-Myers Squibb; consultant/scientific advisory board for Pfizer, Inc.; and serves on the speakers bureau of Bristol-Myers Squibb, Eli Lilly-Italy, Pfizer, Inc., Shire. DJK is a consultant to Servier Amerique and serves on the advisory boards of Pfizer, Inc., Eli Lilly & Co., Forest Pharmaceuticals, Inc., F. Hoffman-La Roche, Ltd. EF is a consultant to Pfizer Italia, Servier Amerique and serves on the advisory boards of Pfizer, Inc., Eli Lilly & Co. AM, JAS and PRH have no reported conflict of interest.

Andrea Fagiolini, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. Fax: 412 246 5520; e-mail:


Objectives:  The purpose of this study was to evaluate functional impairment in a group of patients with bipolar disorder in remission and to determine the extent of relationships between overall functioning and current depressive, manic and panic spectrum symptoms.

Method:  A subset of the patient population at the Pittsburgh site of the Systematic Treatment Enhancement Program in Bipolar Disorder (STEP-BD) study was evaluated in this study. The subsample comprises 103 male and female subjects with bipolar I disorder (n = 70), bipolar II disorder (n = 24), schizoaffective disorder – bipolar type (n = 4), or bipolar disorder NOS (n = 5). Subjects were evaluated in a period of remission (at least 4 weeks with no more than two depressive or manic symptoms). Subjects were assessed for overall functional status using the Work and Social Adjustment Scale (WSAS) and for current bipolar and panic spectrum symptoms using the Mood Spectrum Self-Report questionnaire (MOODS-SR) and Panic-Agoraphobic Spectrum Self-Report questionnaire (PAS-SR).

Results:  The median WSAS total score in these remitted subjects was 14, indicating significant functional impairment. Regressing WSAS on current depressive, manic, and panic spectrum total scores, we observed a highly significant depressive spectrum effect (t = 4.9, df = 94, p < 0.0001), but non-significant panic and manic spectrum effects (t = 1.3, df = 94, p = 0.19 and t = −1.8, df = 94, p = 0.07, respectively).

Conclusion:  Bipolar disorder is associated with functional deficits even during periods of sustained and substantial remission. The degree of functional impairment is correlated with the degree of depressive spectrum symptoms.