Clinical predictors of functional outcome of bipolar patients in remission

Authors

  • Adriane R Rosa,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
    2. Bipolar Disorder Program, Centro de Pesquisas, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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  • Maria Reinares,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona
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  • Carolina Franco,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
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  • Mercè Comes,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona
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  • Carla Torrent,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona
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  • Jose Sánchez-Moreno,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
    2. Psychiatry Medical School, Universidad Autonoma de Madrid, Madrid, Spain
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  • Anabel Martínez-Arán,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona
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  • Manel Salamero,

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
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  • Flávio Kapczinski,

    1. Bipolar Disorder Program, Centro de Pesquisas, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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  • Eduard Vieta

    1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona
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  • EV has served as consultant, advisor, or speaker for Almirall, AstraZeneca, Bial, Bristol-Myers Squibb, Eli Lilly & Co., Forest Research Institute, GlaxoSmithKline, Janssen-Cilag, Jazz, Lundbeck, Merck Sharp and Dohme, Novartis, Organon, Otsuka, Pfizer, Inc., Sanofi-aventis, Servier, and UBC. ARR, MR, CF, MC, CT, JS-M, AM-A, MS and FK have no reported conflicts of interest to disclose.

Corresponding author:
Eduard Vieta, M.D, Ph.D.
Bipolar Disorders Program
Clinical Institute of Neuroscience
Hospital Clinic
University of Barcelona, IDIBAPS
Villarroel 170
08036, Barcelona, Spain
Fax: +34932279876
e-mail: evieta@clinic.ub.es

Abstract

Objectives:  A number of studies have now shown that subjects with bipolar disorder (BD) have significant psychosocial impairment during interepisode intervals. This study was carried out to assess the level of functioning as well as to identify potential predictors of functioning in a well-defined, euthymic bipolar sample.

Methods:  The study included 71 euthymic bipolar patients and 61 healthy controls. The Functioning Assessment Short Test (FAST) was used to assess multiple areas of functioning such as autonomy, occupational functioning, cognitive functioning, interpersonal relationships, financial issues, and leisure time. Multivariate analysis was used to determine the global and specific clinical predictors of outcome.

Results:  Sixty percent (n = 42) of the patients had overall functional impairment (defined as a FAST total score > 11) compared to 13.1% (n = 8) of the control group (p = 0.001). Bipolar patients showed a worse functioning in all the areas of the FAST. Only four variables—older age, depressive symptoms, number of previous mixed episodes, and number of previous hospitalizations—were associated with poor functioning, on a linear regression model, which accounted for 44% of the variance (= 12.54, df = 58, p < 0.001).

Conclusions:  A substantial proportion of bipolar patients experience unfavorable functioning, suggesting that there is a significant degree of morbidity and dysfunction associated with BD, even during remission periods. Previous mixed episodes, current subclinical depressive symptoms, previous hospitalizations, and older age were identified as significant potential clinical predictors of functional impairment.

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