Everyday functional ability across different phases of bipolar disorder

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Psychology

Background:

• Bipolar disorder (BD) is a chronic mental illness associated with significant neurocognitive and functional impairments.
• Current functional assessments in BD rely on subjective self-report or observer ratings, limited by insight and judgment.
• Performance-based measures for assessing real-world functional ability in BD have been underutilized.

Purpose of the Study:

• To evaluate functional ability in individuals with bipolar disorder across manic, depressed, and euthymic states using a performance-based assessment.
• To investigate the relationship between symptom severity, executive functioning, and functional deficits in bipolar disorder.
• To compare functional performance in bipolar disorder patients with healthy controls.

Main Methods:

• The UCSD Performance-Based Skills Assessment (UPSA-2) was administered to assess functional ability in real-world tasks.
• Participants included individuals with manic/hypomanic BD (n=17), depressed BD (n=14), euthymic BD (n=23), and healthy comparison (HC) participants (n=28).
• Psychopathology was assessed using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), and Positive and Negative Syndrome Scale (PANSS); executive functioning was measured with the Wisconsin Card Sorting Task (WCST).

Main Results:

• All bipolar disorder groups demonstrated significant functional deficits on the UPSA-2 and impaired executive functioning on the WCST compared to healthy controls.
• Individuals in manic/hypomanic states exhibited lower UPSA-2 scores than other BD groups, with mania symptoms correlating with functional impairment.
• Poorer performance on the WCST was associated with worse functional ability as measured by the UPSA-2.

Conclusions:

• Functional deficits are present in bipolar disorder across manic, depressed, and euthymic phases.
• Executive dysfunction is linked to functional impairments in bipolar disorder.
• Performance-based assessments like the UPSA-2 are valuable tools for objectively measuring functional status in bipolar disorder.