[Training in the detection of bipolar disorders for psychologists and primary health agents: a pilot study]. / Entrenamiento en detección de trastornos bipolares para psicólogos y médicos generalistas: reporte de una experiencia piloto.

OBJECTIVES: At present, Bipolar Disorders are considered a real public health problem. There is an agreement that it is a priority to solve the existent flaws as regards the certainty of a correct and timely diagnosis of these disorders. This paper report the results of a pilot experience in workshops of training in the detection of Bipolar Disorders aimed at psychologists and primary health agents. METHOD: A survey was carried out before and after the training sessions with the aim of measuring prior knowledge about bipolar disorders and thus evaluating the impact of the training workshops. RESULTS: 227 people completed the surveys. The results showed a scarce knowledge about these disorders, even among those professionals who acknowledged having bipolar patients in treatment and who had interest in being trained. On the other hand, these surveys revealed significant changes in their knowledge of bipolar disorders. CONCLUSION: This pilot experience suggests that with low cost events such as the organized workshops it would be possible to increase the ability of timely detection of bipolar disorders in the key agents of the health system. Reducing frequents delays and mistakes in the diagnosis of these disorders which would determine a significant reduction in their morbid impact.

Heterogeneity in cognitive functioning among patients with bipolar disorder.

BACKGROUND: Nowadays it is not clear if in bipolar disorders (BD) cognitive impairments are heterogeneous and if so which are the variables that determine it. METHODS: Fifty patients with BD and thirty healthy controls were clinically evaluated including measures of obstetric complications history. All subjects completed an extensive neuropsychological battery selected to asses premorbid IQ and different cognitive domains. RESULTS: Compared with standardized norms, 38% of patients had none cognitive domain affected, while 40% had 1 to 2, and 22% had 3 to 5. Patients with cognitive functioning within normal limits had higher psychosocial functioning and premorbid IQ, and lower history of obstetric complications. LIMITATIONS: The small sample size could limit the generalizability of the results; since these data should be taken as preliminaries. CONCLUSIONS: The extension and severity of cognitive impairments may be heterogeneous in patients with BD, and it might contribute to explain the variability in functional outcome. Bipolar patients with low premorbid IQ and history of obstetric complications may represent a subgroup with lower cognitive performance and psychosocial functioning.

Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: a prospective 1 year follow-up study.

BACKGROUND: The aim of this study was to estimate the predictive value of cognitive impairments and time spent ill in long-term functional outcome of patients with bipolar disorder (BD). METHODS: Thirty five patients with euthymic BD completed a neurocognitive battery to assess verbal memory, attention, and executive functions at study entry. The course of illness was documented prospectively for a period longer than 12 months using a modified life charting technique based on the NIMH life-charting method. Psychosocial functioning was assessed with the General Assessment of Functioning (GAF) and the Functioning Assessment Short Test (FAST) at the end of follow-up period when patients were euthymic. RESULTS: Impairments in verbal memory and in attention, as well as subsyndromal depressive symptomatology were independent predictors of GAF score at the end of the study explaining 43% of variance. Similarly, impairments in attention and executive functioning were independent predictors of FAST score explaining 28% of variance. LIMITATIONS: We did not control factors that could affect functional outcome such as psychosocial interventions, familiar support and housing and financial resources. CONCLUSIONS: Both cognitive impairments and time spent with subsyndromal depressive symptomatology may be illness features associated with poorer long-term functional outcome. Developing strategies to treat these illness features might contribute to enhance long-term functional outcome among patients with BD.