Psychosocial Disability Fluctuates In Parallel With Bipolar Symptom Changes

With every increase or decrease in depressive symptom severity, there is a corresponding significant and stepwise increase or decrease in psychosocial disability among patients with bipolar disorder, according to a study in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.


Bipolar disorder is characterized by cycles of depression and abnormal elation, or mania. It has been found to be associated with increased suicidal behavior, increased health care use and costs, higher unemployment, higher dependence on public assistance, lower annual income, increased work absenteeism owing to illness, decreased work productivity, poorer overall functioning, lower quality of life, and decreased life span, according to background information in the article.

Bipolar I disorder (BP-I), which includes episodes of mania, and bipolar II disorder (BP-II), which includes less severe episodes of abnormal mood elevation called hypomania, are dimensional illnesses in which patients experience fluctuating levels of severity of manic and depressive symptoms, interspersed with symptom-free periods.


Lewis L. Judd, M.D., of the University of California, San Diego School of Medicine, and colleagues conducted a study to provide detailed data on psychosocial disability in relation to symptom status during the long-term course of BP-I and BP-II. They analyzed data on 158 patients with BP-I and 133 patients with BP-II who were followed up for an average of 15 years in the National Institute of Mental Health Collaborative Depression Study.


The authors found that symptom severity and psychosocial disability fluctuate together during the course of illness.



"Psychosocial impairment increases significantly with each increment in depressive symptom severity for BP-I and BP-II and with most increments in manic symptom severity for BP-I," they write.


When patients with BP-I or BP-II are asymptomatic, their psychosocial functioning is good, but not as good as that of well controls.


"When patients with BP-I or BP-II have no mood disorder symptoms, their psychosocial functioning normalizes and is rated as good; when they are experiencing subsyndromal depression, psychosocial functioning is between good and fair; when minor depressive or dysthymic symptoms are present, functioning is fair; and when patients have symptoms at the threshold for major depression, functioning is poor," the authors write.


"These findings indicate that the depressive phase of bipolar illness is equal in importance to the manic or hypomanic phase, and they confirm the advantage of studying BP-I and BP-II separately," the authors conclude.


(Arch Gen Psychiatry. 2005;62:1322-1330.)


Debra Kain

JAMA and Archives Journals

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