Bipolar Patients' Quality of Life in Mixed States: A Preliminary Qualitative Study

Abstract

Background: Approximately 20% of patients with bipolar disorder experience mixed states. Mixed states are associated with more comorbidity, poorer treatment response and prognosis, increased relapse rate, and decreased functioning. This study aimed to produce in-depth knowledge about bipolar patients' quality of life (QoL) and functioning related to mixed states. Sampling and Methods: This study used qualitative research methods. A semi-structured interview guide based on a literature study was applied in interviews with 6 remitted bipolar I patients having experienced mixed states. A medical anthropological approach was applied to analyse the data. Results: Participants described mixed states as worse than other bipolar disorder states and their residual symptoms were prolonged. Mixed states affected the functioning of patients in key life domains such as self-esteem, family, love and social life, physical well-being, and working capability. Conclusions: Mixed states may severely affect the QoL and functioning of bipolar patients. Our results indicate that improving these should be a main goal of patient treatment. With an aim of adequately identifying and treating mixed states, our findings highlight the need for knowledge about this particularly severe expression of bipolar disorder. These results should be confirmed in a larger sample of patients with varying socioeconomic status.

The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder

“…In contrast to previous studies, we found no association between mixed mood and either quality of life or functioning in the present study. Further, previous studies have suggested that mixed symptoms in patients with bipolar disorder are associated with poorer prognosis and aggravated long‐term course of illness, including poorer treatment response , increased risk of relapse , decreased quality of life , decreased functioning and increased risk of suicide . In addition, in exploratory analyses we found results suggesting that there is no association between subsyndromal clinically rated manic symptoms and functioning and quality of life respectively.…”

“…However, a substantial proportion of patients with bipolar disorder experience subsyndromal symptoms on a daily basis, and this has been associated with impaired functioning, increased risk of hospitalization, high risk of relapse, and comorbid substance use disorder , overall emphasizing the chronic and serious nature of bipolar disorder. Within bipolar disorder, mixed states and mixed symptoms represent a complex and heterogenous syndrome which has been associated with overall poorer prognosis and aggravated long‐term course of illness, including poorer treatment response , increased risk of relapse , decreased quality of life , decreased functioning and increased risk of suicide .…”

Interepisodic Functioning in Patients with Bipolar Disorder in Remission

“…[ 27 43 44 45 ] Only one study so far reported that functioning of patients in key life domains such as self-esteem, love and social life, family, physical well-being, and working capability was affected in mixed states of BD. [ 46 ] This study has found that the effect of the disorder per say on the self-esteem seems to be lasting even after illness is remitted.…”

More than Half of Bipolar Patients attending Emanuel Mental Specialized Hospital has Poor Quality of Life, Emanuel Mental Specialized Hospital, Ethiopia: Facility- Based Cross-Sectional Study Design

“…This study was in line with study done in UK. Participants with higher educational attainment appeared to have good quality of life [22][23][24][25][26][27][28][29][30][31][32]. People with bipolar disorder have poor quality of life than the general population which is in line with study done in pristine, England [33].…”