Psychosocial functioning in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia

Jiménez‐López, Estela; Sánchez-Morla, Eva María; Aparicio, Ana Isabel; López-Villarreal, Ana; Martínez‐Vizcaíno, Vicente; Rodríguez‐Jiménez, Roberto; Vieta, Eduard; Santos, José Luís

doi:10.1016/j.jad.2017.12.094

Cited by 23 publications

(16 citation statements)

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“…Likewise, as has been found in other studies, BD-P showed lower impairment than SZ in overall functioning measures [71,72]. In addition, BD-P had a worse level of psychosocial functioning than BD-NP, in a way that we could not replicate the findings of our previous cross-sectional study [29]. However, the present results are in accordance with other authors which also reported that patients with BD-P had a worse functional performance than patients with BD-NP [20,[40][41][42][43].…”

Section: Discussioncontrasting

confidence: 59%

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: Discussioncontrasting

confidence: 59%

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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“…Study designs were all cross‐sectional (including one validation study). Three studies 34,37,38 included samples composed only of BD‐I patients; the other 10 studies reported data on mixed BD samples (composed of type I, type II and/or not otherwise specified). The sample size mostly varied between 12 and 150 individuals, with only one study having a large sample of 241 individuals, 39 thus differing from the others.…”

Section: Resultsmentioning

confidence: 99%

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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“…Caetano and colleagues showed that psychotic symptoms in youths with BD were associated with more suicidal ideation and plans and psychiatric hospitalizations . Finally, although not consistently, the adult BD literature has also reported that the presence of psychosis in patients with BD is associated with poor course and outcome …”

Section: Discussionmentioning

confidence: 99%

“…8 Finally, although not consistently, the adult BD literature has also reported that the presence of psychosis in patients with BD is associated with poor course and outcome. 9,10,12,13,[15][16][17][18][19]33,34 BDP+ youths appear to be a distinct subgroup of BD, as evidenced by the fact that they had more severe psychopathology, and had families with lower SES and more psychopathology, even before These findings may represent a common physiological mechanism associated with the vulnerability to psychosis in people with BD, and may suggest that the presence of psychosis in BD represents a unique subtype of the disorder. 14 Also, the experience of being psychotic may have a significant impact on one's self-concept (eg, poor self-esteem, depression, anxiety), 36 and lead to environmental stressors (eg, peer rejection) 37 and PTSD-like symptoms regarding the traumatic psychotic experience, which may last for months after the psychosis has resolved.…”

Section: Schizoaffective Disorder and Schizophreniamentioning

confidence: 99%

“…Both cross-sectional and longitudinal studies report that adults with BDP+ have more severe psychopathology, including mood symptoms, poorer functioning, [9][10][11][12][13] and more cognitive deficits 14 than BDP− adults. Nevertheless, some of the cross-sectional studies showed no clinical or functional differences between BDP+ and BDP− adults, [15][16][17] and some even show a clinical advantage of BDP+ compared to BDP−. 18,19 The above-noted findings should be considered with caution, because the existing studies had one or more of the following limitations.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal course and risk factors associated with psychosis in bipolar youths

et al. 2019

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Objectives To compare the longitudinal clinical course of youths with bipolar disorder (BD) spectrum with lifetime (past, intake, and/or follow‐up) psychosis (BDP+) to youths with BD without lifetime psychosis (BDP−). Also, to identify risk factors associated with increased risk of first onset of psychosis during prospective follow‐up. Method Bipolar disorder youths (BDP+ = 137, BDP− = 233), aged 7‐17 years old, were followed on average every 7 months for 11.7 years and were evaluated using standardized instruments. Data were analyzed using linear and generalized linear models for the full sample, as well as for youths who developed first period of psychosis (n = 55). Results After adjusting for confounders, BDP+ youths with one, and in particular ≥2 lifetime psychotic episodes, had higher rates and more severe mood and anxiety symptoms, higher rates of suicidality, psychiatric hospitalizations, and sexual/physical abuse, and poorer psychosocial functioning than BDP− youths. Even before the first onset of psychosis during follow‐up, BDP+ youths showed more psychopathology and had more family history of psychiatric illness than those who never developed psychosis. First‐onset psychosis was associated with low socioeconomic status (SES), living with one parent, bipolar disorder type one and type two, comorbid anxiety, history of hospitalizations, and family history of mania and suicidality. Conclusion BDP+ is associated with poor prognosis and worse clinical picture, even before the onset of psychosis, indicating the need for prompt identification and treatment of these youths. Studies aimed to treat acute symptoms of psychosis, as well as prevent the onset of psychosis, including risk factors amenable to change, are warranted.

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Psychosocial functioning in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia

Cited by 23 publications

References 95 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

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

Longitudinal course and risk factors associated with psychosis in bipolar youths

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