Functioning and Disability in Bipolar Disorder: An Extensive Review

Abstract

Background: Bipolar disorder has generally been regarded as having a better functional outcome than schizophrenia. However, studies have suggested low functioning in bipolar patients even when they are in clinical remission. Our aim was to determine the degree of functioning and disability in bipolar patients. Secondly, we reviewed factors potentially associated with the low functioning of bipolar patients. Method: The authors conducted an extensive Medline and Pubmed search of the published literature from 1980 up to December 2007, using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further analysed for publications of interest. Articles that reported clinically significant findings on functioning and disability, and research reports were reviewed in detail. Results: From these articles, we determined that bipolar disorder is associated with significant impairment in work, family and social life, beyond the acute phases of the illness. The aspects that appear to increase the risk of low functioning and disability in bipolar patients are mainly subsyndromal symptoms and neurocognitive impairment, among others. Conclusions: Suitable pharmacological and psychological interventions may improve the level of functioning and reduce the disability in bipolar patients. Potential targets to be considered for intervention should be residual symptoms, comorbid conditions and neurocognitive deficits. Further research is required to better identify the factors that best predict functioning in bipolar patients.

Psychosocial Functioning in Bipolar Disorder from a Social Justice Perspective

“…The effects of disability in BD pervade all areas of functioning (Coryell et al, 1993;Elgie & Morselli, 2007;Pope et al, 2007;Sanchez-Moreno et al, 2009;Sanchez-Moreno et al, 2010). People with BD have more familial conflict and fewer enjoyable social interactions or leisure activities than people without psychiatric diagnoses (Bauwens, Tracy, Pardoen, Vander Elst, & Mendlewicz, 1991;Bauwens, Pardoen, Staner, Dramaix, & Mendlewicz, 1998;Elgie & Morselli, 2007;Sanchez-Moreno et al, 2009;Shapira et al, 1999).…”

“…People with BD have more familial conflict and fewer enjoyable social interactions or leisure activities than people without psychiatric diagnoses (Bauwens, Tracy, Pardoen, Vander Elst, & Mendlewicz, 1991;Bauwens, Pardoen, Staner, Dramaix, & Mendlewicz, 1998;Elgie & Morselli, 2007;Sanchez-Moreno et al, 2009;Shapira et al, 1999). In a five-year study following the outcome of an acute mood episode, people with BD were only half as likely as the general population to be married (Coryell et al, 1993).…”

“…Despite studies reporting people with BD to have more years of college and more B.A. degrees than is average in the general population of the U.S. (Kupfer et al, 2002), they demonstrate a much higher degree of unemployment, disability rates, workplace absenteeism, and other occupational impairments (Bowden, 2005;Latalova et al, 2011;Lloyd & Waghorn, 2007;McMorris et al, 2010;Reed, Goetz, Vieta, Bassi, & Haro, 2010;Rosa et al, 2010;Sanchez-Moreno et al, 2009). On average, about 60% of people with BD who are in syndromal remission and have either some college education or a college degree, are unemployed (compared to the average of 6% in the general population), and up to 88% suffer from reduced occupational functioning (Bearden et al, 2011;Elgie & Morselli, 2007;Hirschfeld, Lewis, & Vornick, 2003;Huxley & Baldessarini, 2007;Kessler et al, 2006).…”

“…A more severe illness history -including a younger age at onset (Hays, Krishnan, George, & Blazer, 1998) and a greater number of mood episodes (MacQueen et al, 2000) and psychiatric hospitalizations (Altshuler et al, 2007) -yields reduced functioning even during euthymia (Martinez-Aran et al, 2004;Zubieta, Huguelet, O'Neil, & Giordani, 2001). In addition, common comorbidities of BD, such as anxiety (Boylan et al, 2004;Kauer-Sant Anna et al, 2007) and substance use disorders (SUD; Jaworski et al, 2011;Lagerberg et al, 2010), disrupt identity development (Michalak et al, 2011), increase symptoms and social avoidance (Jaworski et al, 2011;Otto et al, 2006), interfere with interpersonal engagement (Elgie & Morselli, 2007), exacerbate cognitive impairment (Latvala et al, 2009;Levy & Weiss, 2009;Silva & Leite, 2000), and generally reduce functioning (Goldstein & Levitt, 2008;Sanchez-Moreno et al, 2009 In euthymic BD, two of the strongest predictors of social and occupational functioning are subsyndromal depressive symptoms and cognitive impairment (Bearden et al, 2011;Bonnin et al, 2010;Dickerson et al, 2010;Martínez-Arán et al, 2011;Martino et al, 2009;Tabares-Seisdedos et al, 2008). Even very mild subsyndromal depression leads to reduced functioning including poorer vocational performance (Bearden et al, 2011;Gitlin, Mintz, Sokolski, Hammen, & Altshuler, 2010).…”

Patient perspectives on use of long-acting antipsychotics in bipolar disorder: focus on risperidone injection

“…[1][2][3] Its periodic course and clinical heterogeneity require a complex psychosocial and pharmacologic approach, as well as control of compliance.…”