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Rosa AR, González-Ortega I, González-Pinto A, Echeburúa E, Comes M, Martínez-Àran A, Ugarte A, Fernández M, Vieta E. One-year psychosocial functioning in patients in the early vs. late stage of bipolar disorder. Objective: The aim of this 1-year follow-up study was to compare functional outcome as well as clinical differences between patients with first- and multiple-episode bipolar disorder. Method: Bipolar disorder patients with first ( n = 60) and multiple episodes ( n = 59) were recruited from two hospitals in Spain. The Functioning Assessment Short Test (FAST) was used to assess functioning. The Hamilton Depression Rating Scale (HAMD) and the Young Mania Rating Scale (YMRS) were administered to assess mood symptoms. Results: As expected, patients with first episode experienced a greater functioning compared to patients with multiple episodes (11.26 ± 10.94 vs. 26.91 ± 13.96; t = 6.436, P < 0.001). There were significant demographic and clinical differences between both groups. Baseline depressive symptoms ( F = 9.553, df = 4, 102; P < 0.001) and age ( F = 14.145, df = 4, 103; P < 0.001) were significantly associated with poor functional recovery at 6-month and 12-month assessment, respectively, in a group of patients with multiple episodes. Conclusion: Our data give support to the model of staging in bipolar disorder, showing that the enduring neurotoxicity of repeated episodes may contribute to sustained impairment in multiple areas of psychosocial functioning. [ABSTRACT FROM AUTHOR]

Abstract: Background: Identifying and modifying burdensome aspects might reduce the level of burden and their negative effects both on caregivers and patients'' outcome. Most studies evaluate acutely ill patients, whereas the most relevant problems may be related to subthreshold symptoms and long-term outcome. The aims of the present study were to assess caregiver''s subjective burden, to analyse which were the most burdensome aspects for caregivers and to study which variables could explain the caregiver''s subjective burden. Methods: Caregivers of 86 euthymic bipolar patients completed the subjective burden subscale from an adapted version of the Social Behaviour Assessment Schedule. Results: Caregivers showed a moderate level of subjective burden. The highest levels of distress were reported regarding the patient''s behaviour; the most distressing behaviours were hyperactivity, irritability, sadness and withdrawal. Regarding the patient''s role performance, the most worrying aspects were those associated with the patient''s work or study and social relationships. Regarding adverse effects on others, caregivers were especially distressed by the way the illness had affected their emotional health and their life in general. Poorer social and occupational functioning, an episode in the last 2years, history of rapid cycling and the caregiver being responsible for medication intake explained a quarter of the variance of the caregiver''s subjective burden. Limitations: This was a cross-sectional study focused only on primary caregivers, there was no control group of non-bipolar patients. Conclusions: This study provides relevant data concerning the burden of caregivers of stable bipolar patients, pointing at potential targets for psychosocial interventions. [Copyright &y& Elsevier]

Introduction: Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample. Methods: Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. Results: The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001). Discussion: In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course. [Copyright &y& Elsevier]