The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review.

BACKGROUND: Patients with bipolar disorder experience impairments in their occupational functioning, despite remission of symptoms. Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia and are associated with diminished occupational functioning. OBJECTIVES: The aim of this scoping review was to identify published studies that report on the relationships between executive functions and occupational functioning in BD to review current knowledge and identify knowledge gaps. In addition to traditional neuropsychological approaches, we aimed to describe executive functioning from a self-regulation perspective, including emotion regulation. METHODS: We applied the methodological framework as described by Arksey and O'Malley (Int J Soc Res Methodol Theory Pract 8:19-32, 2005) and Levac et al. (Implement Sci 5:1-9, 2010). We searched PubMed and psycINFO for literature up to November 2021, after which we screened papers based on inclusion criteria. Two reviewers independently performed the screening process, data charting process, and synthesis of results. RESULTS: The search yielded 1202 references after deduplication, of which 222 remained after initial screening. The screening and inclusion process yielded 82 eligible papers in which relationships between executive functions and occupational functioning are examined. CONCLUSION: Neurocognitive deficits, including in executive functions and self-regulation, are associated with and predictive of diminished occupational functioning. Definitions and measurements for neurocognitive functions and occupational functioning differ greatly between studies, which complicates comparisons. Studies on functional remediation show promising results for improving occupational functioning in patients with BD. In research and clinical practice more attention is needed towards the quality of work functioning and the various contexts in which patients with BD experience deficits.

"Doing" social inclusion with ELSiTO: empowering learning for social inclusion through occupation.

OBJECTIVES: The European partnership ELSiTO aimed to develop understanding of the nature and processes of social inclusion for persons experiencing mental illness. PARTICIPANTS: Partners were from Belgium, Greece and The Netherlands with over 30 members including mental health service users, occupational therapists and other staff. APPROACH: A knowledge-creation learning process was used during four international, experiential, visits and local meetings, which included visiting and describing good practice, telling stories of experiences, reflection and discussion. RESULTS: The partnership developed understandings of the nature and process of social inclusion, including both subjective and objective aspects interrelated with the doing of daily activities in the community. Members' work-related experiences, illustrated through their stories, depict the subjective aspects of social inclusion as they are shaped and framed by the objective conditions within a variety of work opportunities. Experiences in paid work, supported employment and voluntary work may both threaten and enhance mental health. Features of successful (voluntary) work experiences are identified. CONCLUSIONS: The importance is revealed of looking critically at current understandings of work and to move beyond a narrow focus on paid work in order to provide a range of work opportunities that will empower the individual's potential and promote inclusive communities.

Understanding living skills: first steps to evidence-based practice. Lessons learned from a practice-based journey in the Netherlands.

Living skills training is a commonly used but sparsely described and researched - occupational therapy - intervention for people with severe mental health problems. A service improvement project was established in a mental health organization in the Netherlands starting in 2006 to design more effective living skills training courses for individuals and groups. The steps of the evidence-based practice process underpinned the project. Theoretical and empirical evidence was derived from an extensive literature review. This was supplemented by the preferences of clients and their families as an equally valued source of evidence as is the experience and knowledge of a range of mental health professionals. Information from these three sources provided building blocks for the development of living skills training, resulting in an individual process guideline and two group courses. Implications for practice is that living skills training needs to be part of multidisciplinary treatment and can be best provided in the client's natural context. Limitations of this study are the lack of an evaluation of both the group courses and of the individual process guideline, also due to the continuous implementation in an ever-changing context. There is further need for research into the clinical and cost effectiveness of living skills training, both for individuals and groups, to support evidence-based decision making and service planning.