title: Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study.
abstract: BACKGROUND
  Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder (BP-I) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder (BP-II).
  
  
  OBJECTIVE
  To provide detailed data on psychosocial disability in relation to symptom status during the long-term course of BP-I and BP-II.
  
  
  METHODS
  A naturalistic study with 20 years of prospective, systematic follow-up.
  
  
  METHODS
  Inpatient and outpatient treatment facilities at 5 US academic centers. Patients One hundred fifty-eight patients with BP-I and 133 patients with BP-II who were followed up for a mean (SD) of 15 (4.8) years in the National Institute of Mental Health Collaborative Depression Study.
  
  
  METHODS
  The relationship, by random regression, between Range of Impaired Functioning Tool psychosocial impairment scores and affective symptom status in 1-month periods during the long-term course of illness from 6-month and yearly Longitudinal Interval Follow-up Evaluation interviews.
  
  
  RESULTS
  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. Subsyndromal hypomanic symptoms are not disabling in BP-II, and they may even enhance functioning. Depressive symptoms are at least as disabling as manic or hypomanic symptoms at corresponding severity levels and, in some cases, significantly more so. At each level of depressive symptom severity, BP-I and BP-II are equally impairing. When asymptomatic, patients with bipolar disorder have good psychosocial functioning, although it is not as good as that of well controls.
  
  
  CONCLUSIONS
  Psychosocial disability fluctuates in parallel with changes in affective symptom severity in BP-I and BP-II. Important findings for clinical management are the following: (1) depressive episodes and symptoms, which dominate the course of BP-I and BP-II, are equal to or more disabling than corresponding levels of manic or hypomanic symptoms; (2) subsyndromal depressive symptoms, but not subsyndromal manic or hypomanic symptoms, are associated with significant impairment; and (3) subsyndromal hypomanic symptoms appear to enhance functioning in BP-II.
authors.affiliation: Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA. ljudd@ucsd.edu
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Judd
authors.forename: Hagop S
authors.initials: HS
authors.lastname: Akiskal
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schettler
authors.forename: Jean
authors.initials: J
authors.lastname: Endicott
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Leon
authors.forename: David A
authors.initials: DA
authors.lastname: Solomon
authors.forename: William
authors.initials: W
authors.lastname: Coryell
authors.forename: Jack D
authors.initials: JD
authors.lastname: Maser
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012917:Social Adjustment