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Vol. 78, No. 5, 2009
Issue release date: August 2009

Functioning and Disability in Bipolar Disorder: An Extensive Review

Sanchez-Moreno J. · Martinez-Aran A. · Tabarés-Seisdedos R. · Torrent C. · Vieta E. · Ayuso-Mateos J.L.
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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.

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  1. Segal ZV, Dobson KS: Cognitive models of depression: report from a consensus development conference. Psychol Inq 1992;3:219–224.

    External Resources

  2. World Health Organization: The World Health Report 2001 – mental health: new understanding; in World Health Organization (ed): New Understanding, New Hope. Geneva, WHO, 2001.
  3. Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, Solomon DA, Leon AC, Keller MB: A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261–269.
  4. Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, Leon AC, Rice JA, Keller MB: The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530–537.
  5. Gitlin MJ, Swendsen J, Heller TL, Hammen C: Relapse and impairment in bipolar disorder. Am J Psychiatry 1995;152:1635–1640.
  6. Tohen M, Hennen J, Zarate CM Jr, Baldessarini RJ, Strakowski SM, Stoll AL, Faedda GL, Suppes T, Gebre-Medhin P, Cohen BM: Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am J Psychiatry 2000;157:220–228.
  7. Zarate CA Jr, Tohen M, Land M, Cavanagh S: Functional impairment and cognition in bipolar disorder. Psychiatr Q 2000;71:309–329.
  8. Carlson GA, Kotin J, Davenport YB, Adland M: Follow-up of 53 bipolar manic-depressive patients. Br J Psychiatry 1974;124:134–139.
  9. O’Connell RA, Mayo JA, Eng LK, Jones JS, Gabel RH: Social support and long-term lithium outcome. Br J Psychiatry 1985;147:272–275.
  10. Dion GL, Tohen M, Anthony WA, Waternaux CS: Symptoms and functioning of patients with bipolar disorder six months after hospitalization. Hosp Community Psychiatry 1988;39:652–657.
  11. Coryell W, Keller M, Endicott J, Andreasen N, Clayton P, Hirschfeld R: Bipolar II illness: course and outcome over a five-year period. Psychol Med 1989;19:129–141.
  12. Tohen M, Waternaux CM, Tsuang MT, Hunt AT: Four-year follow-up of twenty-four first-episode manic patients. J Affect Disord 1990;19:79–86.
  13. Tohen M, Waternaux CM, Tsuang MT: Outcome in mania: a 4-year prospective follow-up of 75 patients utilizing survival analysis. Arch Gen Psychiatry 1990;47:1106–1111.
  14. Harrow M, Goldberg JF, Grossman LS, Meltzer HY: Outcome in manic disorders: a naturalistic follow-up study. Arch Gen Psychiatry 1990;47:665–671.
  15. Coryell W, Scheftner W, Keller M, Endicott J, Maser J, Klerman GL: The enduring psychosocial consequences of mania and depression. Am J Psychiatry 1993;150:720–727.
  16. Goldberg JF, Harrow M, Grossman LS: Course and outcome in bipolar affective disorder: a longitudinal follow-up study. Am J Psychiatry 1995;152:379–384.
  17. Strakowski SM, Keck PE Jr, McElroy SL, West SA, Sax KW, Hawkins JM, Kmetz GF, Upadhyaya VH, Tugrul KC, Bourne ML: Twelve-month outcome after a first hospitalization for affective psychosis. Arch Gen Psychiatry 1998;55:49–55.
  18. Keck PE Jr, McElroy SL, Strakowski SM, West SA, Sax KW, Hawkins JM, Bourne ML, Haggard P: 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. Am J Psychiatry 1998;155:646–652.
  19. World Health Organization: International Classification of Functioning, Disability and Health: ICF. Geneva, WHO, 2001.
  20. Ustun TB, Chatterji S, Bickenbach J, Kostanjsek N, Schneider M: The International Classification of Functioning, Disability and Health: a new tool for understanding disability and health. Disabil Rehabil 2003;25:565–571.
  21. Vieta E, Cieza A, Stucki G, Chatterji S, Nieto M, Sanchez-Moreno J, Jaeger J, Grunze H, Ayuso-Mateos JL: Developing core sets for persons with bipolar disorder based on the International Classification of Functioning, Disability and Health. Bipolar Disord 2007;9:16–24.
  22. Leonardi M, Bickenbach J, Ustun TB, Kostanjsek N, Chatterji S: The definition of disability: what is in a name? Lancet 2006;368:1219–1221.
  23. Martinez-Aran A, Vieta E, Torrent C, Sanchez-Moreno J, Goikolea JM, Salamero M, Malhi GS, Gonzalez-Pinto A, Daban C, Alvarez-Grandi S, Fountoulakis K, Kaprinis G, Tabares-Seisdedos R, Ayuso-Mateos JL: Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord 2007;9:103–113.
  24. Suppes T, Dennehy EB, Gibbons EW: The longitudinal course of bipolar disorder. J Clin Psychiatry 2000;61(suppl 9):23–30.

    External Resources

  25. Goldberg JF, Keck PE: Poor-outcome bipolar disorders; in Goldberg JF, Harrow M (eds): Bipolar Disorders: Clinical Course and Outcome. Washington, American Psychiatric Press, 1999, pp 1–19.
  26. Feinman JA, Dunner DL: The effect of alcohol and substance abuse on the course of bipolar affective disorder. J Affect Disord 1996;37:43–49.
  27. Vieta E, Colom F, Martinez-Aran A, Benabarre A, Reinares M, Gasto C: Bipolar II disorder and comorbidity. Compr Psychiatry 2000;41:339–343.
  28. Kupfer DJ: The increasing medical burden in bipolar disorder. JAMA 2005;293:2528–2530.
  29. Colom F, Vieta E, Martinez-Aran A, Reinares M, Benabarre A, Gasto C: Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry 2000;61:549–555.
  30. Colom F, Vieta E, Reinares M, Martinez-Aran A, Torrent C, Goikolea JM, Gasto C: Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. J Clin Psychiatry 2003;64:1101–1105.
  31. Johnson L, Lundstrom O, Aberg-Wistedt A, Mathe AA: Social support in bipolar disorder: its relevance to remission and relapse. Bipolar Disord 2003;5:129–137.
  32. Cohen AN, Hammen C, Henry RM, Daley SE: Effects of stress and social support on recurrence in bipolar disorder. J Affect Disord 2004;82:143–147.
  33. Ellicott A, Hammen C, Gitlin M, Brown G, Jamison K: Life events and the course of bipolar disorder. Am J Psychiatry 1990;147:1194–1198.
  34. Martinez-Aran A, Vieta E, Colom F, Torrent C, Sanchez-Moreno J, Reinares M, Benabarre A, Goikolea JM, Brugue E, Daban C, Salamero M: Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004;6:224–232.
  35. Martinez-Aran A, Vieta E, Reinares M, Colom F, Torrent C, Sanchez-Moreno J, Benabarre A, Goikolea JM, Comes M, Salamero M: Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004;161:262–270.
  36. Reinares M, Martinez-Aran A, Colom F, Benabarre A, Salamero M, Vieta E: Long[-]term effects of the treatment with risperidone versus conventional neuroleptics on the neuropsychological performance of euthymic bipolar patients (in Spanish). Actas Esp Psiquiatr 2000;28:231–238.
  37. Dean BB, Gerner D, Gerner RH: A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Curr Med Res Opin 2004;20:139–154.
  38. Staner L, Tracy A, Dramaix M, Genevrois C, Vanderelst M, Vilane A, Bauwens F, Pardoen D, Mendlewicz J: Clinical and psychosocial predictors of recurrence in recovered bipolar and unipolar depressives: a one-year controlled prospective study. Psychiatry Res 1997;69:39–51.
  39. Fredman L, Weissman MM, Leaf PJ, Bruce ML: Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic Catchment Area Study. J Affect Disord 1988;15:103–112.
  40. Bauwens F, Tracy A, Pardoen D, Vander EM, Mendlewicz J: Social adjustment of remitted bipolar and unipolar out-patients: a comparison with age- and sex-matched controls. Br J Psychiatry 1991;159:239–244.
  41. Leader JB, Klein DN: Social adjustment in dysthymia, double depression and episodic major depression. J Affect Disord 1996;37:91–101.
  42. Bauwens F, Pardoen D, Staner L, Dramaix M, Mendlewicz J: Social adjustment and the course of affective illness: a one-year controlled longitudinal study involving bipolar and unipolar outpatients. Depress Anxiety 1998;8:50–57.
  43. De Lisio G, Maremmani I, Perugi G, Cassano GB, Deltito J, Akiskal HS: Impairment of work and leisure in depressed outpatients: a preliminary communication. J Affect Disord 1986;10:79–84.
  44. Perugi G, Maremmani I, McNair DM, Cassano GB, Akiskal HS: Differential changes in areas of social adjustment from depressive episodes through recovery. J Affect Disord 1988;15:39–43.
  45. Depp CA, Davis CE, Mittal D, Patterson TL, Jeste DV: Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder. J Clin Psychiatry 2006;67:215–221.
  46. Conus P, Cotton S, Abdel-Baki A, Lambert M, Berk M, McGorry PD: Symptomatic and functional outcome 12 months after a first episode of psychotic mania: barriers to recovery in a catchment area sample. Bipolar Disord 2006;8:221–231.
  47. Shapira B, Zislin J, Gelfin Y, Osher Y, Gorfine M, Souery D, Mendlewicz J, Lerer B: Social adjustment and self-esteem in remitted patients with unipolar and bipolar affective disorder: a case-control study. Compr Psychiatry 1999;40:24–30.
  48. Serretti A, Cavallini MC, Macciardi F, Namia C, Franchini L, Souery D, Lipp O, Bauwens F, Smeraldi E, Mendlewicz J: Social adjustment and self-esteem in remitted patients with mood disorders. Eur Psychiatry 1999;14:137–142.
  49. Altshuler LL, Gitlin MJ, Mintz J, Leight KL, Frye MA: Subsyndromal depression is associated with functional impairment in patients with bipolar disorder. J Clin Psychiatry 2002;63:807–811.
  50. Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ: The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry 2003;160:2099–2107.
  51. Goldberg JF, Harrow M: Consistency of remission and outcome in bipolar and unipolar mood disorders: a 10-year prospective follow-up. J Affect Disord 2004;81:123–131.
  52. Michalak EE, Yatham LN, Kolesar S, Lam RW: Bipolar disorder and quality of life: a patient-centered perspective. Qual Life Res 2006;15:25–37.
  53. Morgan VA, Mitchell PB, Jablensky AV: The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Bipolar Disord 2005;7:326–337.
  54. Dean BB, Gerner D, Gerner RH: A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Curr Med Res Opin 2004;20:139–154.
  55. Blairy S, Linotte S, Souery D, Papadimitriou GN, Dikeos D, Lerer B, Kaneva R, Milanova V, Serretti A, Macciardi F, Mendlewicz J: Social adjustment and self-esteem of bipolar patients: a multicentric study. J Affect Disord 2004;79:97–103.
  56. Michalak EE, Yatham LN, Maxwell V, Hale S, Lam RW: The impact of bipolar disorder upon work functioning: a qualitative analysis. Bipolar Disord 2007;9:126–143.
  57. Morselli PL, Elgie R, Cesana BM: GAMIAN-Europe/BEAM survey II: cross-national analysis of unemployment, family history, treatment satisfaction and impact of the bipolar disorder on life style. Bipolar Disord 2004;6:487–497.
  58. Chengappa KN, Hennen J, Baldessarini RJ, Kupfer DJ, Yatham LN, Gershon S, Baker RW, Tohen M: Recovery and functional outcomes following olanzapine treatment for bipolar I mania. Bipolar Disord 2005;7:68–76.
  59. Mitchell PB, Slade T, Andrews G: Twelve-month prevalence and disability of DSM-IV bipolar disorder in an Australian general population survey. Psychol Med 2004;34:777–785.
  60. Sierra P, Livianos L, Rojo L: Quality of life for patients with bipolar disorder: relationship with clinical and demographic variables. Bipolar Disord 2005;7:159–165.
  61. Suppes T, Leverich GS, Keck PE, Nolen WA, Denicoff KD, Altshuler LL, McElroy SL, Rush AJ, Kupka R, Frye MA, Bickel M, Post RM: The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. J Affect Disord 2001;67:45–59.
  62. Goetz I, Tohen M, Reed C, Lorenzo M, Vieta E, EMBLEM Advisory Board: Functional impairment in patients with mania: baseline results of the EMBLEM study. Bipolar Disord 2007;9:45–52.
  63. Reinares M, Vieta E, Colom F, Martinez-Aran A, Torrent C, Comes M, Goikolea JM, Benabarre A, Sanchez-Moreno J: Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients. Psychother Psychosom 2004;73:312–319.
  64. Das AK, Olfson M, Gameroff MJ, Pilowsky DJ, Blanco C, Feder A, Gross R, Neria Y, Lantigua R, Shea S, Weissman MM: Screening for bipolar disorder in a primary care practice. JAMA 2005;293:956–963.
  65. Chakrabarti S, Gill S: Coping and its correlates among caregivers of patients with bipolar disorder: a preliminary study. Bipolar Disord 2002;4:50–60.
  66. Chakrabarti S, Kulhara P, Verma SK: Extent and determinants of burden among families of patients with affective disorders. Acta Psychiatr Scand 1992;86:247–252.
  67. Perlick D, Clarkin JF, Sirey J, Raue P, Greenfield S, Struening E, Rosenheck R: Burden experienced by care-givers of persons with bipolar affective disorder. Br J Psychiatry 1999;175:56–62.
  68. Heru AM, Ryan CE: Burden, reward and family functioning of caregivers for relatives with mood disorders: 1-year follow-up. J Affect Disord 2004;83:221–225.
  69. Perlick DA, Rosenheck RR, Clarkin JF, Raue P, Sirey J: Impact of family burden and patient symptom status on clinical outcome in bipolar affective disorder. J Nerv Ment Dis 2001;189:31–37.
  70. Reinares M, Vieta E, Colom F, Martinez-Aran A, Torrent C, Comes M, Goikolea JM, Benabarre A, Daban C, Sanchez-Moreno J: What really matters to bipolar patients’ caregivers: sources of family burden. J Affect Disord 2006;94:157–163.
  71. Targum SD, Dibble ED, Davenport YB, Gershon ES: The Family Attitudes Questionnaire. Patients’ and spouses’ views of bipolar illness. Arch Gen Psychiatry 1981;38:562–568.
  72. Judd LL, Akiskal HS: The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 2003;73:123–131.
  73. Sanchez-Moreno J, Martinez-Aran A, Nieto-Moreno M, Torrent C, Vieta E, Martinez H, Ayuso-Mateos JL: Detection of functional impairments in euthymic bipolar patients using the international classification of functioning, disability and health (ICF). 160th Annu Meet Am Psychiatr Assoc, San Diego, 2007.
  74. Keck PE Jr, McElroy SL, Strakowski SM, Stanton SP, Kizer DL, Balistreri TM, Bennett JA, Tugrul KC, West SA: Factors associated with pharmacologic noncompliance in patients with mania. J Clin Psychiatry 1996;57:292–297.
  75. McElroy SL, Keck PE Jr, Pope HG Jr, Hudson JI, Faedda GL, Swann AC: Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am J Psychiatry 1992;149:1633–1644.
  76. Strakowski SM, Tohen M, Stoll AL, Faedda GL, Mayer PV, Kolbrener ML, Goodwin DC: Comorbidity in psychosis at first hospitalization. Am J Psychiatry 1993;150:752–757.
  77. Lish JD, Dime-Meenan S, Whybrow PC, Price RA, Hirschfeld RM: The National Depressive and Manic-Depressive Association (DMDA) survey of bipolar members. J Affect Disord 1994;31:281–294.
  78. Young LT, Cooke RG, Robb JC, Levitt AJ, Joffe RT: Anxious and non-anxious bipolar disorder. J Affect Disord 1993;29:49–52.
  79. Feske U, Frank E, Mallinger AG, Houck PR, Fagiolini A, Shear MK, Grochocinski VJ, Kupfer DJ: Anxiety as a correlate of response to the acute treatment of bipolar I disorder. Am J Psychiatry 2000;157:956–962.
  80. Zis AP, Grof P, Webster M, Goodwin FK: Prediction of relapse in recurrent affective disorder. Psychopharmacol Bull 1980;16:47–49.
  81. Keller MB, Lavori PW, Coryell W, Andreasen NC, Endicott J, Clayton PJ, Klerman GL, Hirschfeld RM: Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. JAMA 1986;255:3138–3142.
  82. Tohen M, Stoll AL, Strakowski SM, Faedda GL, Mayer PV, Goodwin DC, Kolbrener ML, Madigan AM: The McLean First-Episode Psychosis Project: six-month recovery and recurrence outcome. Schizophr Bull 1992;18:273–282.
  83. Goldberg JF, Harrow M, Grossman LS: Recurrent affective syndromes in bipolar and unipolar mood disorders at follow-up. Br J Psychiatry 1995;166:382–385.
  84. MacQueen GM, Young LT, Robb JC, Marriott M, Cooke RG, Joffe RT: Effect of number of episodes on wellbeing and functioning of patients with bipolar disorder. Acta Psychiatr Scand 2000;101:374–381.
  85. Hajek T, Slaney C, Garnham J, Ruzickova M, Passmore M, Alda M: Clinical correlates of current level of functioning in primary care-treated bipolar patients. Bipolar Disord 2005;7:286–291.
  86. Vieta E, Calabrese JR, Hennen J, Colom F, Martinez-Aran A, Sanchez-Moreno J, Yatham LN, Tohen M, Baldessarini RJ: Comparison of rapid-cycling and non-rapid-cycling bipolar I manic patients during treatment with olanzapine: analysis of pooled data. J Clin Psychiatry 2004;65:1420–1428.
  87. Kilbourne AM, Cornelius JR, Han X, Pincus HA, Shad M, Salloum I, Conigliaro J, Haas GL: Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord 2004;6:368–373.
  88. Hecht H, Genzwurker S, Helle M, van Calker D: Social functioning and personality of subjects at familial risk for affective disorder. J Affect Disord 2005;84:33–42.
  89. Hammen C, Gitlin M, Altshuler L: Predictors of work adjustment in bipolar I patients: a naturalistic longitudinal follow-up. J Consult Clin Psychol 2000;68:220–225.
  90. Ozer S, Ulusahin A, Batur S, Kabakci E, Saka MC: Outcome measures of interepisode bipolar patients in a Turkish sample. Soc Psychiatry Psychiatr Epidemiol 2002;37:31–37.
  91. Abood Z, Sharkey A, Webb M, Kelly A, Gill M: Are patients with bipolar affective disorder socially disadvantaged? A comparison with a control group. Bipolar Disord 2002;4:243–248.
  92. Cooke RG, Robb JC, Young LT, Joffe RT: Well-being and functioning in patients with bipolar disorder assessed using the MOS 20-item short form (SF-20). J Affect Disord 1996;39:93–97.
  93. Bauer MS, Williford WO, Dawson EE, Akiskal HS, Altshuler L, Fye C, Gelenberg A, Glick H, Kinosian B, Sajatovic M: Principles of effectiveness trials and their implementation in VA Cooperative Study No 430: Reducing the efficacy-effectiveness gap in bipolar disorder. J Affect Disord 2001;67:61–78.
  94. Fagiolini A, Kupfer DJ, Masalehdan A, Scott JA, Houck PR, Frank E: Functional impairment in the remission phase of bipolar disorder. Bipolar Disord 2005;7:281–285.
  95. Fava GA: Conceptual obstacles to research progress in affective disorders. Psychother Psychosom 1997;66:283–285.
  96. Fava GA: Subclinical symptoms in mood disorders: pathophysiological and therapeutic implications. Psychol Med 1999;29:47–61.
  97. Post RM, Denicoff KD, Leverich GS, Altshuler LL, Frye MA, Suppes TM, Rush AJ, Keck PE Jr, McElroy SL, Luckenbaugh DA, Pollio C, Kupka R, Nolen WA: Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry 2003;64:680–690.
  98. Nolen WA, Luckenbaugh DA, Altshuler LL, Suppes T, McElroy SL, Frye MA, Kupka RW, Keck PE Jr, Leverich GS, Post RM: Correlates of 1-year prospective outcome in bipolar disorder: results from the Stanley Foundation Bipolar Network. Am J Psychiatry 2004;161:1447–1454.
  99. Judd LL, Akiskal HS, Schettler PJ, Endicott J, Leon AC, Solomon DA, Coryell W, Maser JD, Keller MB: Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Arch Gen Psychiatry 2005;62:1322–1330.
  100. MacQueen GM, Marriott M, Begin H, Robb J, Joffe RT, Young LT: Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Bipolar Disord 2003;5:349–355.
  101. Grunze H: Reevaluating therapies for bipolar depression. J Clin Psychiatry 2005;66:17–25.
  102. Calabrese JR, Hirschfeld RM, Frye MA, Reed ML: Impact of depressive symptoms compared with manic symptoms in bipolar disorder: results of a US community-based sample. J Clin Psychiatry 2004;65:1499–1504.
  103. Goldberg JF, Harrow M: Subjective life satisfaction and objective functional outcome in bipolar and unipolar mood disorders: a longitudinal analysis. J Affect Disord 2005;89:79–89.
  104. Lewinsohn PM, Klein DN, Seeley JR: Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 1995;34:454–463.
  105. Akiskal HS, Bourgeois ML, Angst J, Post R, Moller H, Hirschfeld R: Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000;59 (suppl 1):S5–S30.
  106. Keck PE Jr, McElroy SL, Havens JR, Altshuler LL, Nolen WA, Frye MA, Suppes T, Denicoff KD, Kupka R, Leverich GS, Rush AJ, Post RM: Psychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness. Compr Psychiatry 2003;44:263–269.
  107. Goldberg TE, Gold JM, Greenberg R, Griffin S, Schulz SC, Pickar D, Kleinman JE, Weinberger DR: Contrasts between patients with affective disorders and patients with schizophrenia on a neuropsychological test battery. Am J Psychiatry 1993;150:1355–1362.
  108. Daban C, Martinez-Aran A, Torrent C, Tabares-Seisdedos R, Balanza-Martinez V, Salazar-Fraile J, Selva-Vera G, Vieta E: Specificity of cognitive deficits in bipolar disorder versus schizophrenia: a systematic review. Psychother Psychosom 2006;75:72–84.
  109. Atre-Vaidya N, Taylor MA, Seidenberg M, Reed R, Perrine A, Glick-Oberwise F: Cognitive deficits, psychopathology, and psychosocial functioning in bipolar mood disorder. Neuropsychiatry Neuropsychol Behav Neurol 1998;11:120–126.
  110. Zubieta JK, Huguelet P, O’Neil RL, Giordani BJ: Cognitive function in euthymic bipolar I disorder. Psychiatry Res 2001;102:9–20.
  111. Dickerson FB, Sommerville J, Origoni AE, Ringel NB, Parente F: Outpatients with schizophrenia and bipolar I disorder: do they differ in their cognitive and social functioning? Psychiatry Res 2001;102:21–27.
  112. Dickerson FB, Boronow JJ, Stallings CR, Origoni AE, Cole S, Yolken RH: Association between cognitive functioning and employment status of persons with bipolar disorder. Psychiatr Serv 2004;55:54–58.
  113. Tsai SY, Lee HC, Chen CC, Huang YL: Cognitive impairment in later life in patients with early-onset bipolar disorder. Bipolar Disord 2007;9:868–875.
  114. Goswami U, Sharma A, Khastigir U, Ferrier IN, Young AH, Gallagher P, Thompson JM, Moore PB: Neuropsychological dysfunction, soft neurological signs and social disability in euthymic patients with bipolar disorder. Br J Psychiatry 2006;188:366–373.
  115. Laes JR, Sponheim SR: Does cognition predict community function only in schizophrenia? A study of schizophrenia patients, bipolar affective disorder patients, and community control subjects. Schizophr Res 2006;84:121–131.
  116. Mur M, Portella MJ, Martinez-Aran A, Pifarre J, Vieta E: Persistent neuropsychological deficit in euthymic bipolar patients: executive function as a core deficit. J Clin Psychiatry 2007;68:1078–1086.
  117. Dittmann S, Seemuller F, Schwarz MJ, Kleindienst N, Stampfer R, Zach J, Born C, Bernhard B, Fast K, Grunze H, Engel RR, Severus E: Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results. Bipolar Disord 2007;9:63–70.
  118. Jaeger J, Berns S, Loftus S, Gonzalez C, Czobor P: Neurocognitive test performance predicts functional recovery from acute exacerbation leading to hospitalization in bipolar disorder. Bipolar Disord 2007;9:93–102.
  119. Tabares-Seisdedos R, Balanza-Martinez V, Sanchez-Moreno J, Martinez-Aran A, Salazar-Fraile J, Selva-Vera G, Rubio C, Mata I, Gomez-Beneyto M, Vieta E: Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up. J Affect Disord 2008;109:286–299.
  120. Loyd D, Simpson JC, Tsuang MT: Are there sex differences in the long-term outcome of schizophrenia? Comparisons with mania, depression, and surgical controls. J Nerv Ment Dis 1985;173:643–649.
  121. Kessing LV: Recurrence in affective disorder. II. Effect of age and gender. Br J Psychiatry 1998;172:29–34.
  122. Robb JC, Young LT, Cooke RG, Joffe RT: Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores. J Affect Disord 1998;49:189–193.
  123. Solomon DA, Ristow WR, Keller MB, Kane JM, Gelenberg AJ, Rosenbaum JF, Warshaw MG: Serum lithium levels and psychosocial function in patients with bipolar I disorder. Am J Psychiatry 1996;153:1301–1307.
  124. Cannon M, Jones P, Gilvarry C, Rifkin L, McKenzie K, Foerster A, Murray RM: Premorbid social functioning in schizophrenia and bipolar disorder: similarities and differences. Am J Psychiatry 1997;154:1544–1550.
  125. Cannon M, Caspi A, Moffitt TE, Harrington H, Taylor A, Murray RM, Poulton R: Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Arch Gen Psychiatry 2002;59:449–456.
  126. Reichenberg A, Weiser M, Rabinowitz J, Caspi A, Schmeidler J, Mark M, Kaplan Z, Davidson M: A population-based cohort study of premorbid intellectual, language, and behavioral functioning in patients with schizophrenia, schizoaffective disorder, and nonpsychotic bipolar disorder. Am J Psychiatry 2002;159:2027–2035.
  127. Shi L, Juarez R, Hackworth J, Edgell ET, Haro JM, Vieta E, Tohen MF: Open-label olanzapine treatment in bipolar I disorder: clinical and work functional outcomes. Curr Med Res Opin 2006;22:961–966.
  128. Shi L, Namjoshi MA, Swindle R, Yu X, Risser R, Baker RW, Tohen M: Effects of olanzapine alone and olanzapine/fluoxetine combination on health-related quality of life in patients with bipolar depression: secondary analyses of a double-blind, placebo-controlled, randomized clinical trial. Clin Ther 2004;26:125–134.
  129. Vieta E, Colom F, Martinez-Aran A: Chronicity, milder forms, and cognitive impairment in bipolar disorder; in Maj M, Akiskal HS, Lopez-Ibor JJ, Sartorius N (eds): Bipolar Disorders. WPA Series Evidence and Experience in Psychiatry. Chichester, Wiley & Sons, 2002, pp 182–184.
  130. O’Connell RA, Mayo JA, Flatow L, Cuthbertson B, O’Brien BE: Outcome of bipolar disorder on long-term treatment with lithium. Br J Psychiatry 1991;159:123–129.
  131. Winokur G, Coryell W, Keller M, Endicott J, Akiskal H: A prospective follow-up of patients with bipolar and primary unipolar affective disorder. Arch Gen Psychiatry 1993;50:457–465.
  132. Chisholm D, van Ommeren M, Ayuso-Mateos JL, Saxena S: Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder. Br J Psychiatry 2005;187:559–567.
  133. Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea JM, Benabarre A, Torrent C, Comes M, Corbella B, Parramon G, Corominas J: A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003;60:402–407.
  134. Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr N, Parr-Davis G, Sham P: A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003;60:145–152.
  135. Scott J, Colom F: Gaps and limitations of psychological interventions for bipolar disorders. Psychother Psychosom 2008;77:4–11.
  136. Cochran SD: Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. J Consult Clin Psychol 1984;52:873–878.
  137. Colom F, Vieta E, Sanchez-Moreno J, Martinez-Aran A, Torrent C, Reinares M, Goikolea JM, Benabarre A, Comes M: Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004;6:294–298.
  138. Vieta E: Improving treatment adherence in bipolar disorder through psychoeducation. J Clin Psychiatry 2005;66(suppl 1):24–29.
  139. Shiah IS, Yatham LN: Serotonin in mania and in the mechanism of action of mood stabilizers: a review of clinical studies. Bipolar Disord 2000;2:77–92.
  140. Colom F, Vieta E: Sudden glory revisited: cognitive contents of hypomania. Psychother Psychosom 2007;76:278–288.
  141. Pradhan SC, Sinha VK, Singh TB: Psycho-social dysfunctions in patients after recovery from mania and depression. Int J Rehabil Res 1999;22:303–309.
  142. De Fruyt J, Demyttenaere K: Bipolar (spectrum) disorder and mood stabilization: standing at the crossroads? Psychother Psychosom 2007;76:77–88.
  143. Ghaemi SN, Baldessarini RJ: The manic-depressive spectrum and mood stabilization: Kraepelin’s ghost. Psychother Psychosom 2007;76:65–69.
  144. Benazzi F: Is there a continuity between bipolar and depressive disorders? Psychother Psychosom 2007;76:70–76.
  145. Martinez-Aran A, Vieta E, Colom F, Reinares M, Benabarre A, Gasto C, Salamero M: Cognitive dysfunctions in bipolar disorder: evidence of neuropsychological disturbances. Psychother Psychosom 2000;69:2–18.
  146. Goodwin G, Vieta E: Effective maintenance treatment – breaking the cycle of bipolar disorder. Eur Psychiatry 2005;20:365–371.
  147. Rosa AR, Sanchez-Moreno J, Martinez-Aran A, Salamero M, Torrent C, Reinares M, Comes M, Colom F, Van Riel W, Ayuso-Mateos JL, Kapczinski F, Vieta E: Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health 2007;3:5.
  148. Kebede D, Alem A, Shibire T, Deyassa N, Negash A, Beyero T, Medhin G, Fekadu A: Symptomatic and functional outcome of bipolar disorder in Butajira, Ethiopia. J Affect Disord 2006;90:239–249.

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