Manic morbidity and executive function impairment as determinants of long-term psychosocial dysfunction in bipolar disorder

Abstract

Objective: In this study, we aimed to evaluate the role of cognitive performance and measures of clinical course—including both syndromal and subsyndromal symptomatology—as determinants of the functional outcome of patients with Bipolar Disorder (BD) during a mean follow-up period of more than 4 years. Methods: Seventy patients with euthymic BD completed a neurocognitive battery at study entry. Clinical course was assessed prospectively for a period longer than 48 months by two measures: time spent ill (documented using a modified life charting technique) and density of affective episodes (defined as the number of depressive and hypo/manic episodes per year of follow-up). Psychosocial functioning was assessed during euthymia using the Functioning Assessment Short Test (FAST) total score at the end of follow-up period. Results: Baseline deficits in phonological fluency, a measure of executive functions (β = −2.49; 95% CI = −3.98, −0.99), and density of hypo/manic episodes during follow-up (β = 6.54; 95% CI = 0.43, 12.65) were independently associated with FAST total score at the end of study. Conclusions: Although interrelated, manic morbidity and executive function impairments independently contribute to long-term psychosocial dysfunction in BD and could be potential targets of intervention.