title: The effect of personalized guideline-concordant treatment on quality of life and functional impairment in bipolar disorder.
abstract: OBJECTIVE
  The aims of this study were to evaluate correlates and predictors of life functioning and quality of life in bipolar disorder during a comparative effectiveness trial of moderate doses of lithium.
  
  
  METHODS
  In the Lithium treatment moderate-dose use study (LiTMUS), 283 symptomatic outpatients with bipolar disorder type I or II were randomized to receive lithium plus "optimal personalized treatment (OPT)", or OPT alone. Participants were assessed using structured diagnostic interviews, clinician-rated blinded assessments, and questionnaires. We employ linear mixed effects models to test the effect of treatment overall and adjunct lithium specifically on quality of life or functioning. Similar models are used to examine the association of baseline demographics and clinical features with quality of life and life functioning.
  
  
  RESULTS
  Quality of life and impaired functioning at baseline were associated with lower income, higher depressive severity, and more psychiatric comorbid conditions. Over 6 months, patients in both treatment groups improved in quality of life and life functioning (p-Values<0.0001); without a statistically significant difference between the two treatment groups (p-Values>0.05). Within the lithium group, improvement in quality of life and functioning was not associated with concurrent lithium levels at week 12 or week 24 (p-Values>0.05). Lower baseline depressive severity and younger age of onset predicted less improvement in functioning over 6 months.
  
  
  CONCLUSIONS
  Optimized care for bipolar disorder improves overall quality of life and life functioning, with no additional benefit from adjunct moderate doses of lithium. Illness burden and psychosocial stressors were associated with worse quality of life and lower functioning in individuals with bipolar disorder.
authors.affiliation: Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States. Electronic address: lsylvia2@partners.org.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.affiliation: Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States.
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.affiliation: Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: University of Texas Health Science Center, San Antonio, United States.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.affiliation: University of Pittsburgh School of Medicine, United States.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.affiliation: Mount Sinai School of Medicine, United States.
authors.forename: Dan V
authors.initials: DV
authors.lastname: Iosifescu
authors.affiliation: University of Pennsylvania School of Medicine, United States.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: Stanford University, United States.
authors.forename: Terence
authors.initials: T
authors.lastname: Ketter
authors.affiliation: Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Greiter
authors.affiliation: Case Western Reserve University School of Medicine, United States.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.affiliation: Weill Cornell Medical College, United States.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Leon
authors.affiliation: VA Palo Alto Health Care System and Stanford University, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ostacher
authors.affiliation: Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States.
authors.forename: Noreen
authors.initials: N
authors.lastname: Reilly-Harrington
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D008094:Lithium
keywords: Bipolar disorder; Life functioning; Lithium; Quality of life