MedWire News: A significant proportion of bipolar disorder (BD) patients who receive specialized mental health care achieve symptomatic recovery, but functional recovery is much less common, study results show.
Eduard Vieta (University of Barcelona, Spain) and team explain that "30-60% of [BD] patients suffer from significant functional impairment even during periods of remission [and] a marked disparity between functional recovery and symptomatic improvement has also been supported by some follow-up reports."
They add: "The majority of clinical studies on bipolar disorder, however, have focused primarily on symptomatic recovery while paying much less attention to psychosocial functioning, leaving, therefore, this aspect of recovery relatively understudied. In addition, most of the previous functional studies in bipolar disorder have been conducted in the USA and there are just a few from Europe on this topic."
To address these issues, the researchers studied data from a 6-month follow-up study of 97 BD patients, aged 18 years or older (mean age 47.6 years), who received treatment as part of the Bipolar Disorders Program at the Hospital Clinic of the University of Barcelona in 2007.
The participants were assessed for symptoms and functioning at baseline (n=97), 21 days (n=77), 3 months (n=74), and 6 months (n=69) using the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS), and the Functioning Assessment Short Test (FAST), respectively.
There were no significant differences in baseline clinical or sociodemographic characteristics between patients who were followed up for 6 months and those lost to follow-up, except for Axis I comorbidity, which was higher in the former group.
The researchers found that there was significant improvement in symptoms among the patients over the study period, as indicated by a reduction in mean HAM-D scores from 10.36 at baseline to 7.15 at the 6-month follow-up, and a reduction in mean YMRS scores from 10.08 to 4.85. Furthermore, 43.3% of the patients achieved symptomatic remission over the study period, as indicated by HAM-D and YMRS scores of less than 8.
There was also a significant improvement in global functioning among patients, as indicated by a reduction in mean FAST total scores from 39.97 at baseline to 30.65 at the 6-month assessment.
However, only 26.2% of patients who achieved symptomatic remission met criteria for global functional recovery by the end of the study, as indicated by a FAST total score of 11 or less.
Vieta and team conclude in Bipolar Disorders: "The present 6-month follow-up study indicates that although many patients experience syndromal remission, only a minority reach normal levels of functioning in multiple areas, even after specialized mental health care."
They add that "new strategies including intensive pharmacological treatment and psychosocial interventions" should be employed to improve functional recovery in BD patients."
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
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