Functional Outcome in the Middle Course of Bipolar Disorder

Martino, Diego Javier; Igoa, Ana; Scápola, María; Marengo, Eliana; Samamé, Cecilia; Strejilevich, Sergio

doi:10.1097/nmd.0000000000000583

Cited by 19 publications

(17 citation statements)

References 17 publications

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“…The stability found in the neurocognitive impairment is in accordance with the results obtained in most longitudinal studies which have examined the course of neurocognitive function both in patients with BD [31,[54][55][56], and patients with SZ [57][58][59]. Likewise, in accordance with our results, other authors could not establish a progressive course of the psychosocial impairment in patients with BD [35], or in patients with SZ [60,61]. In this regard, although it cannot be dismissed the possibility of a subset of patients with BD with a progressive course [39], our results suggest that the presence of a history of psychotic symptoms is not associated with a progression of the neurocognitive or psychosocial impairment.…”

Section: Discussionsupporting

confidence: 93%

Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up

et al. 2018

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Background:Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up.Methods:Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2).Results:The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration.Conclusions:We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.

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Section: Discussionsupporting

confidence: 93%

Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up

et al. 2018

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“…Table lists the 24 scales and functional domains addressed by each. Three scales, the GAF, the LGOS, and the Functional Recovery Self‐assessment (a 1‐question [yes/no] self‐assessment) only provide a global assessment of general functioning, whereas the remaining 21 scales provide assessments related to specific domains such as work/education, residential life, social relationships, family relationships, psychological health, autonomy and performance, and recreation. Thirteen instruments include an occupational functioning domain.…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen longitudinal observational studies met the inclusion criteria. Five studies (all published between 2011 and 2016) only used the FAST scale; two (published between 2010 and 2013) used both the GAF and the FAST; three (published between 2003 and 2017) used the GAF along with functional scales other than FAST; and five (published between 2005 and 2010) used scales other than the GAF and the FAST to assess functioning …”

Section: Resultsmentioning

confidence: 99%

“…A second study used the GAF along with the WHO Psychiatric Disability Assessment Schedule (WHODAS) to assess the relationship between global functioning (GAF); personal care, occupational, family, and social functioning (WHODAS); and neurocognition in patients with BP‐I, patients with schizophrenia, and healthy controls over 1 year. A third study assessed the relationship between functioning and number of previous episodes and the long‐term (4 years) functional outcome of patients with euthymic BP‐I or BP‐II under naturalistic treatment conditions, using the GAF to assess global functioning and a self‐reported assessment to measure functional recovery.…”

Section: Resultsmentioning

confidence: 99%

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Functional outcome assessment in bipolar disorder: A systematic literature review

et al. 2019

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Objectives Functional impairment is an important driver of disability in patients with bipolar disorder (BD) and can persist even when symptomatic remission has been achieved. The objectives of this systematic literature review were to identify studies that assessed functioning in patients with BD and describe the functional scales used and their implementation. Methods A systematic literature review of English‐language articles published between 2000 and 2017 reporting peer‐reviewed, original research related to functional assessment in patients with BD was conducted. Results A total of 40 articles met inclusion criteria. Twenty‐four different functional scales were identified, including 13 clinician‐rated scales, 7 self‐reported scales, and 4 indices based on residential and vocational data. The Global Assessment of Functioning (GAF) and the Functional Assessment Short Test (FAST) were the most commonly used global and domain‐specific scales, respectively. All other scales were used in ≤2 studies. Most studies used ≥1 domain‐specific scale. The most common applications of functional scales in these studies were evaluations of the relationships between global or domain‐specific psychosocial functioning and cognitive functioning (eg, executive function, attention, language, learning, memory) or clinical variables (eg, symptoms, duration of illness, number of hospitalizations, number of episodes). Conclusions The results of this review show growing interest in the assessment of functioning in patients with BD, with an emphasis on specific domains such as work/educational, social, family, and cognitive functioning and high utilization of the GAF and FAST scales in published literature.

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“…Few studies have shown evidence that worsening of functional outcome throughout the course of BD is linked to neuroprogression [64][65][66][67][68]. Additionally, Martino et al [69] a longitudinal study showed that BD patients with more than five previous affective episodes at baseline exhibited poorer outcomes on all measures of functioning than patients with less than five previous episodes; however, during the follow-up period of the study, the level of functioning remained stable in BD patients. Despite the fact that the functional outcome is highly variable among individuals with BD [70], difficulties with activities of daily living, living conditions, occupational/recreational activities, and relationships have been associated with increased risks of mortality in general population samples and other patient groups [71][72][73][74].…”

Section: Discussionmentioning

confidence: 98%

TSPO upregulation in bipolar disorder and concomitant downregulation of mitophagic proteins and NLRP3 inflammasome activation

Scaini

Barichello

Fries

et al. 2018

Neuropsychopharmacol.

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Bipolar disorder (BD) is a chronic, debilitating illness with a global prevalence of up to 4.8%. The importance of understanding how dysfunctional mitochondria and mitophagy contribute to cell survival and death in BD is becoming increasingly apparent. Therefore, the purpose of this study was to evaluate the mitophagic pathway and NLRP3 inflammasome activation in peripheral blood mononuclear cells (PBMCs) of patients with BD and healthy individuals. Since 18-kDa translocator protein (TSPO) plays an important role in regulating mitochondrial function and since TSPO itself impairs cellular mitophagy, we also investigated the changes in the TSPO-related pathway. Our results showed that patients with BD had lower levels of Parkin, p62/SQSTM1 and LC3A and an upregulation of TSPO pathway proteins (TSPO and VDAC), both in terms of mRNA and protein levels. Additionally, we found a negative correlation between mitophagy-related proteins and TSPO levels, while VDAC correlated negatively with p62/SQSTM1 and LC3 protein levels. Moreover, we found that the gene expression levels of the NLRP3-related proteins NLRP3, ASC, and pro-casp1 were upregulated in BD patients, followed by an increase in caspase-1 activity as well as IL-1β and IL-18 levels. As expected, there was a strong positive correlation between NLRP3-related inflammasome activation and TSPO-related proteins. The data reported here suggest that TSPO-VDAC complex upregulation in BD patients, the simultaneous downregulation of mitophagic proteins and NLRP3 inflammasome activation could lead to an accumulation of dysfunctional mitochondria, resulting in inflammation and apoptosis. In summary, the findings of this study provide novel evidence that mitochondrial dysfunction measured in peripheral blood is associated with BD.

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Functional Outcome in the Middle Course of Bipolar Disorder

Cited by 19 publications

References 17 publications

Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up

Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up

Functional outcome assessment in bipolar disorder: A systematic literature review

TSPO upregulation in bipolar disorder and concomitant downregulation of mitophagic proteins and NLRP3 inflammasome activation

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