The impact of neurocognitive impairment on occupational recovery of clinically stable patients with bipolar disorder: a prospective study.

OBJECTIVE: Many patients with bipolar disorder do not regain their premorbid level of occupational functioning even after mood episodes have resolved. The reasons for this are not well understood. We evaluated the relationship between neurocognition and occupational function in bipolar disorder patients, following symptomatic recovery. METHODS: A total of 79 previously employed adults with bipolar I disorder who achieved symptomatic recovery (i.e., at least six weeks clinically euthymic) following a manic episode underwent a neurocognitive evaluation and assessment of occupational functioning. Study participants were evaluated every three months thereafter for up to nine months. Factor analysis was applied to reduce the initial set of neurocognitive variables to five domains: episodic memory, working memory/attention, executive function, visual scanning, and speed of processing. Multiple logistic regression models were used to examine the joint predictive values of these domains for determining occupational recovery. RESULTS: At the time of symptomatic recovery, four of five neurocognitive factors were significant predictors of concomitant occupational recovery and the fifth, executive function, showed a trend in the same direction. For those not occupationally recovered at baseline, longitudinal analyses revealed that changes between baseline and the three-month follow-up timepoint in most cognitive domains were robust and highly significant predictors of occupational recovery at three months. CONCLUSIONS: These findings indicate that better neurocognitive function in multiple domains and improvement in these domains over time are strongly predictive of subsequent occupational recovery. Treatments that target cognitive deficit may therefore have potential for improving long-term vocational functioning in bipolar illness.

Modal subcomponents of metabolic syndrome in patients with bipolar disorder.

BACKGROUND: The metabolic syndrome is a growing global public health problem. OBJECTIVE: To evaluate the prevalence rate and modal subcomponents of the metabolic syndrome in subjects treated at the West Los Angeles Veterans Administration Medical Center Bipolar Clinic. METHODS: In this cross-sectional design study, using the National Cholesterol Education Program definition, metabolic syndrome prevalence rates were calculated. RESULTS: 48/98 (49%) of subjects met criteria for metabolic syndrome. There was no difference in prevalence rate by gender or race. Almost 70% of the cohort met criteria for metabolic syndrome by the components of reduced HDL and increased waist circumference. Treatment with carbamazepine at study entry was associated with a lower prevalence rate of metabolic syndrome. LIMITATIONS AND CONCLUSIONS: This study is limited by its small size and non-structured assessment of Axis I diagnosis. Nonetheless, bipolar patients in this select cohort have high rates of metabolic syndrome; given this cardiovascular risk, close clinical monitoring for these parameters is recommended. While not controlling for genetics, environmental influences, and/or medical factors such as additional comorbidity and treatment duration, psychotropic drug use may confer differential risk for developing the metabolic syndrome.

Alcoholism and anxiety in bipolar illness: differential lifetime anxiety comorbidity in bipolar I women with and without alcoholism.

INTRODUCTION: This study was undertaken to evaluate the prevalence rate of anxiety comorbidity in bipolar subjects with and without alcohol use disorders (AUD). METHODS: Bipolar men and women who entered the Stanley Foundation Bipolar Network (SFBN) underwent a Structured Clinical Interview for DSM-IV (SCID-IV) and were divided into those subjects meeting current or lifetime criteria for an alcohol use disorder (AUD=213) vs. those subjects who did not (non-AUD=137). Lifetime rates of comorbid anxiety disorder were evaluated between groups. RESULTS: Of 350 subjects, 163 (46.5%) met criteria for an anxiety disorder. Panic disorder and OCD were the most common anxiety disorders in the AUD and non-AUD groups. OCD and specific phobia were significantly less prevalent in BP I patients with AUD compared to those without. Bipolar women with AUD had a significantly higher rate of PTSD than those without. CONCLUSION: These data highlight the added liability of anxiety comorbidity in BP disorder. Specifically, the greater amount of PTSD and lesser amount of OCD in bipolar women with alcohol comorbidity may have important diagnostic and treatment implications beyond dual diagnosis. Further study in comorbidity patterns is encouraged to not only better understand illness burden, but to maximize pattern-specific treatment outcomes.