Functional outcome assessment in bipolar disorder: A systematic literature review

Abstract

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.

Functioning in euthymic patients with bipolar disorder: A systematic review and meta‐analysis using the Functioning Assessment Short Test

“…The analysis of the articles followed previously determined eligibility criteria: (a) adults (≥18 years old); (b) both genders; (c) BD type I, type II and/or not otherwise specified, all diagnosed through structured clinical interviews (SCID‐I/MINI); (d) separate data from patients clearly defined as being in the euthymic phase; and (e) the assessment of functional measures only with the FAST (which is considered one of the most recommended instruments for the assessment of functioning in patients with BD, 29‐31 as it probes both global and specific functional domains and was developed to focus on the main areas of difficulties experienced by this specific population). Studies with overlapping samples were excluded; in such cases, we selected the paper that was more compatible with our criteria.…”

What else is needed for a full functional recovery in bipolar disorder?

“…Recently, a systematic review about the psychosocial functional assessment outcome in bipolar disorders was published in the journal . The article is in line with the current patient care approaches which are nowadays focusing on achieving full functional recovery, which is equivalent to resuming the life quality and ability that they had before the onset of illness, at work and also at the family and social level.…”

“…There is no question that having good assessment tools is crucial. As found in the systematic review, the clinician‐rated FAST scale is one possibility, seeing that it views different functional domains and is not limited to a simply global measure. Even so, it could be of value to pair this with other objective measures which reflect the functionality of patients in the real world (e.g., employment status, educational achievements, marital and residential status, social support, etc), as well as subjective measures of well‐being or satisfaction, in order to capture a better picture of the patients positions in life.…”

Understanding the Impact of Bipolar Disorder Experience from an Insiders' Perspective

“…Occupational or psychosocial impairment is also present between the mood episodes [5]. These findings have resulted in growing interest in the assessment of functioning in persons living with bipolar disorder [6]. The early description of symptom-free euthymia has been reviewed.…”