People with bipolar disorder commonly exhibit functional impairment despite being euthymic and clinically “in remission”, say the authors of a new study.

The team believes that a number of clinical factors can predict functional impairment in bipolar disorder, such as previous mixed mood episodes, current subclinical depression, previous hospitalization, and older age.

Eduard Vieta (University of Barcelona, Spain) and coworkers studied 71 patients with a diagnosis of bipolar disorder but currently defined as euthymic (scoring ?8 on the 17-item Hamilton Depression Rating Scale) and 61 healthy controls.

All subjects underwent a battery of tests including the Functioning Assessment Short Test (FAST), which assesses autonomy, occupational functioning, cognition, relationships, financial issues, and leisure time.

In all, 60% of the bipolar patients were considered to be functionally impaired (based on a FAST score >11) compared with just 13.1% of controls. In multivariate analysis, four variables ??” older age, depressive symptoms, previous mixed episodes, and previous hospitalizations ??” were significantly associated with impaired functioning.

Together, these four factors accounted for 44% of the variance in global functioning, Vieta’s team calculated.

Writing in Bipolar Disorders journal, the researchers say their study supports the hypothesis that more severe forms of bipolar disorder have long-term adverse consequences, notably cognitive and functional impairment, that are apparent in-between acute episodes.

“Psychosocial interventions in combination with pharmacotherapy should be considered to treat residual depressive symptoms and enhance the level of functioning,” write Vieta et al.

“In addition, low rates of functional recovery as shown here underscore the importance of including specific functioning measures as well as symptomatic assessments in the comprehensive evaluation of bipolar disorder.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Bipolar I disorder patients with a predominant manic/hypomanic polarity (MP) are similar in temperament to those with a predominant depressive polarity (DP), but differ from patients with unipolar major depression (UP), research shows.

Writing in the Journal of Affective Disorders, Eduard Vieta (University of Barcelona, Spain) and team explain: “Recently, the concept of predominant polarity… has been introduced to further characterize subtypes of bipolar disorders.”

They add: “This concept has been proven to have diagnostic and therapeutic implications, but little is known on the underlying psychopathology and temperaments.“

To validate the concept of predominant polarity and investigate the relationship with temperament, the team studied 124 patients with bipolar I disorder and 19 with UP.

The bipolar patients were assessed for predominant polarity, with DP defined as at least two thirds of past episodes fulfilling the DSM-IV criteria for major depressive episode, and MP defined as at least two thirds of past episodes fulfilling DSM-IV criteria for manic or hypomanic episodes.

All the participants underwent temperament assessments using the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto questionnaire (TEMPS-A). Temperament was assessed when patients were in full remission according to the DSM-IV criteria (no significant signs or symptoms of the disorder during the past 2 months).

The team found that 55% of the bipolar disorder patients met criteria for predominant polarity, with 47 classified as MP and 22 as DP.

Age at onset was lower in both the MP and DP bipolar groups compared with the UP group. Unipolar patients showed a longer duration of depression compared with both the MP and DP bipolar groups, but there were no significant differences in the number of suicide attempts between the groups.

Regarding temperament assessments, the mean TEMPS-A scores on the hyperthymic and cyclothymic subscales were higher in MP and DP patients compared with UP patients, while the UP group scored significantly higher than both MP and DP bipolar groups on the depressive temperament scores.

Anxious temperament scores were statistically higher in the UP group than the MP group, but did not differ between DP and UP groups. Irritable temperament scores did not differ among the three groups.

Overall, there were no significant differences in temperament profiles between the MP and DP bipolar groups.

Vieta et al conclude: “Our results show that both bipolar I MP and DP subgroups are temperamentally similar and different from UP. Depression in DP bipolar I patients should be viewed as the overlap of depression on a hyperthymic/cyclothymic temperament.”

They add: “These findings confirm the value of the predominant polarity concept as well as the importance of temperaments to separate bipolar from unipolar disorders.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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