title: Functional impairment and disability across mood states in bipolar disorder.
abstract: BACKGROUND
  Bipolar disorder (BD) represents a chronic and recurrent illness that can lead to severe disruptions in family, social, and occupational functioning. The severity of mood symptomatology has been associated with functional impairment in this population. However, the majority of studies have assessed global functioning without considering specific domains. The main objective of the current study was to assess specific life domains of functioning as well as the overall functioning in patients with BD across different mood states ([hypo] mania, depression, or euthymia) compared with healthy controls by the means of a standardized scale validated for BD.
  
  
  METHODS
  The sample included 131 subjects with BD (68 in remission, 31 hypo [manic], and 32 depressed) and 61 healthy controls. The Functioning Assessment Short Test was used to assess overall and multiple areas of functional impairment (autonomy, occupational functioning, cognitive functioning, interpersonal relationships, financial issues, and leisure time).
  
  
  RESULTS
  The results showed significant intergroup differences; depressed patients had the lowest functioning (48.03 ± 12.38) followed by (hypo) manic patients (39.81 ± 13.99). The euthymic group showed least impairment in functioning compared with the depression and (hypo) mania groups (11.76 ± 12.73) but still displayed significant impairment when compared with the healthy control group (5.93 ± 4.43).
  
  
  CONCLUSIONS
  This study indicates that depressive symptoms are associated with greater negative impact on psychosocial functioning than (hypo) manic symptoms. Further deficits in functioning seem to persist during remission. The results highlight the importance of aggressively treating depression and mania and the need to develop psychosocial interventions targeting to improve functional outcomes.
authors.affiliation: Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Adriane R
authors.initials: AR
authors.lastname: Rosa
authors.forename: María
authors.initials: M
authors.lastname: Reinares
authors.forename: Erin E
authors.initials: EE
authors.lastname: Michalak
authors.forename: C Mar
authors.initials: CM
authors.lastname: Bonnin
authors.forename: Brisa
authors.initials: B
authors.lastname: Sole
authors.forename: Carolina
authors.initials: C
authors.lastname: Franco
authors.forename: Mercè
authors.initials: M
authors.lastname: Comes
authors.forename: Carla
authors.initials: C
authors.lastname: Torrent
authors.forename: Flávio
authors.initials: F
authors.lastname: Kapczinski
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology*; D016022:Case-Control Studies; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D056344:Executive Function; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D026684:Personal Autonomy; D017009:Professional Autonomy; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index