Researchers have developed and validated a self-report measure for quantifying functional status across different clinical states in patients with bipolar disorder.

Bipolar disorder patients often show persistent impairments in psychosocial functioning and the researchers found that few instruments satisfactorily measure the psychometric characteristics experienced specifically by these patients.

Existing instruments tend to use adapted functional outcome measures originally developed for use in other conditions such as schizophrenia or major depression. In contrast, the new instrument ??” the Bipolar Functional Status Questionnaire (BFSQ) ??” was developed using domains identified a priori as fundamental to psychosocial adjustment in patients with bipolar disorder.

From a literature review, interviews with patients with bipolar disorder, and recommendations from a six-member academic advisory panel, eight constructs were identified as fundamental to functional status in bipolar disorder patients. These were cognitive function, sleep, role functioning, emotional functioning, energy/vitality, social functioning, personal management, and sexual functioning.

A 33-item questionnaire was developed based on these eight constructs and its effectiveness tested in 596 patients with bipolar disorder aged between 18 and 76 years. Initial testing resulted in the questionnaire being reduced to 24 items, based on exploratory factor analysis results, item-level statistics, and item content.

Further testing of this 24-item questionnaire showed high internal consistency (coefficient ?’s=0.93??”0.95) and high re-test reliability (intraclass correlation coefficient=0.86).

It also showed strong convergent validity with other functional disability measures and highly significant discriminant validity across illness phases, with large effect sizes.

Joseph Goldberg, from Mount Sinai School of Medicine in New York, USA, and colleagues report: “The discriminant validity of the 24-item BFSQ was strongly supported by statistically significant mean differences among the three clinical states (stable, hypomanic/manic, and depressed), with large effect size estimates, suggesting its potential utility to track changes in functional status across changing clinical states in treatment outcome studies of bipolar disorder.”

They add in the journal Bipolar Disorders that, as changes in functional status may precede clinical symptoms, further studies should examine the potential sensitivity of the BFSQ for identifying shifts in clinical status or prodromal signs of an impending affective episode.

“Because patients themselves appear able to detect prodromal signs of affective relapse only approximately half of the time, decremental changes in BFSQ scores over time may provide useful corroboration for detecting associated signs of relapse before fulminant episodes occur,” the team concludes.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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