Heterogeneity of functional outcomes in patients with bipolar disorder: a cluster‐analytic approach

Solé, Brisa; Bonnín, C.M.; Jiménez, Esther; Torrent, Carla; Torres, Ivan J.; Varo, Cristina; Valls, E.; Montejo, Laura; Gómez-Ocaña, Clara; Tomioka, Y.; Vieta, Eduard; Martínez‐Arán, Anabel; Reinares, María

doi:10.1111/acps.12871

Cited by 85 publications

(55 citation statements)

References 64 publications

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“…Lastly, the financial domain was the least affected across the sample studied (28.8%), which corroborates findings in the literature 79 . With respect to this, the succinct examination of this domain on FAST scale cannot be disregarded, as it is composed of only two items, in contrast to the other domains, which are assessed by a set of four to six items.…”

Section: Discussionsupporting

confidence: 88%

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

2020

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Objectives Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. Methods Meta‐analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand‐searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two‐step meta‐analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed‐effects model for categorical variables. Results In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI. Conclusions This study reinforces the relevant functional impact of BD in this population and suggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.

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Section: Discussionsupporting

confidence: 88%

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

2020

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“…Patients with mixed activation had poorer cognitive functioning ( p < 0.0001), those with hyperactivation had difficulties in financial issues ( p = 0.026), and patients with hypoactivation had severe difficulties in autonomy ( p = 0.012) and leisure ( p = 0.0003) (Table 1). Our findings reinforce the idea that functional impairment persists during the inter-episode periods [8], and it may be a consequence not only of enduring toxicity of the previous acute episodes but also, if not more importantly, a of persistent, altered activation levels. Understanding the relationship between activation levels and functioning may contribute to enhanced therapeutic interventions to normalize levels of activation in order to improve functioning through non-pharmacological approaches such as psychoeducation, functional remediation, mindfulness, etc.…”

supporting

confidence: 88%

Activation Levels, Cardiovascular Risk, and Functional Impairment in Remitted Bipolar Patients: Clinical Relevance of a Dimensional Approach

Dargél¹,

Volant²,

Saha³

et al. 2018

Psychother Psychosom

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“…Clinicians who treat patients with BD can attest to the vast range of functioning seen within BD, with some individuals achieving high‐level occupational and social status while others are broadly disabled for most of their lives . Research has shown that at the group level, cognitive deficits are present in euthymic BD patients, and are qualitatively similar to those seen in schizophrenia (SZ), albeit consistently less severe; however, group‐level comparisons inherently fail to take into account heterogeneity in cognitive profiles within the disorder.…”

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confidence: 99%

The International Consortium Investigating Neurocognition in Bipolar Disorder (ICONIC‐BD)

et al. 2019

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Bipolar disorder (BD) is the fourth leading cause of disability worldwide among young people of age range 10-24 years. Although the diagnosis is largely defined by the mood episodes associated with the illness, cognitive deficits are among the most persistent and disabling symptoms of illness and have a profound impact on clinical course and functional outcome. Specifically, trait-like impairment is common in the domains of attention, verbal learning, and executive function; these deficits contribute to functional disability and are targets for emerging treatments and preventions. Although considerable progress has been made over the past two decades, our understanding of the underlying causes of the cognitive deficits in BD remains surprisingly limited. As such, there are no approved treatments for this disabling symptom specific to BD. 1 Clinicians who treat patients with BD can attest to the vast range of functioning seen within BD, with some individuals achieving highlevel occupational and social status while others are broadly disabled for most of their lives. 2 Research has shown that at the group level, cognitive deficits are present in euthymic BD patients, and are qual- Site Investigator name(s) LocationBrigham and Women's Hospital/ Harvard

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Heterogeneity of functional outcomes in patients with bipolar disorder: a cluster‐analytic approach

Abstract: Two of three functional profiles showed some kind of impairment which was associated with subsyndromal symptoms and cognitive performance. These patterns should be taken into consideration to develop more individualized interventions to restore, or improve, psychosocial outcomes.

Cited by 85 publications

References 64 publications

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

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

Activation Levels, Cardiovascular Risk, and Functional Impairment in Remitted Bipolar Patients: Clinical Relevance of a Dimensional Approach

The International Consortium Investigating Neurocognition in Bipolar Disorder (ICONIC‐BD)

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