title: Baseline disability and poor functioning in bipolar disorder predict worse outcomes: results from the Bipolar CHOICE study.
abstract: OBJECTIVE
  To examine the effects of treatment on functioning impairments and quality of life and assess baseline functioning and employment status as predictors of treatment response in symptomatic individuals from the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (Bipolar CHOICE) study.
  
  
  METHODS
  Bipolar CHOICE was an 11-site, 6-month randomized effectiveness study comparing lithium to quetiapine, each with adjunctive personalized treatments (APTs). We examined post hoc (1) the effects of treatment on functioning, (2) how changes in functioning differed between treatment responders and nonresponders, and (3) whether functioning and employment status mediated treatment response in 482 participants with DSM-IV-TR bipolar I or II disorder from September 2010 to September 2013.
  
  
  RESULTS
  Treatment was associated with significant improvements in functioning and quality of life, regardless of treatment group (P values < .0001). Responders showed greater improvements in quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire P values < .05) and functioning (Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool P values < .05) than nonresponders. Unemployed or disabled participants at baseline had significantly greater illness severity at baseline than employed participants (P values < .05). Over the study duration, employed participants reported greater improvements in physical health and quality of life in leisure activities than both unemployed and disabled participants (P values < .05). Individuals who saw greater improvement in functioning and quality of life tended to show greater improvements in depressive and anxiety symptoms (P values ≤ .0001), as well as overall illness severity (P values < .001). Early (8 weeks) and very early (4 weeks) clinical changes in mood symptoms predicted changes in functioning and quality of life at 6 months (P values < .001).
  
  
  CONCLUSIONS
  Prior disability status was associated with a worse treatment response and prospective illness course. Results implicate functioning and employment status as important markers of illness severity and likelihood of recovery in bipolar disorder, suggesting that interventions that target functional impairment may improve outcomes.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier for the Bipolar CHOICE study: NCT01331304.
authors: Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Ste 580, Boston, MA 02114 tdeckersbach@partners.org.
authors: Thilo
authors: T
authors: Deckersbach
authors: Andrew A
authors: AA
authors: Nierenberg
authors: Melvin G
authors: MG
authors: McInnis
authors: Stephanie
authors: S
authors: Salcedo
authors: Emily E
authors: EE
authors: Bernstein
authors: David E
authors: DE
authors: Kemp
authors: Richard C
authors: RC
authors: Shelton
authors: Susan L
authors: SL
authors: McElroy
authors: Louisa G
authors: LG
authors: Sylvia
authors: James H
authors: JH
authors: Kocsis
authors: William V
authors: WV
authors: Bobo
authors: Edward S
authors: ES
authors: Friedman
authors: Vivek
authors: V
authors: Singh
authors: Mauricio
authors: M
authors: Tohen
authors: Charles L
authors: CL
authors: Bowden
authors: Terence A
authors: TA
authors: Ketter
authors: Joseph R
authors: JR
authors: Calabrese
authors: Michael E
authors: ME
authors: Thase
authors: Noreen A
authors: NA
authors: Reilly-Harrington
authors: Dustin J
authors: DJ
authors: Rabideau
authors: Gustavo
authors: G
authors: Kinrys
authors: Masoud
authors: M
authors: Kamali
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D000069348:Quetiapine Fumarate / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate; D008094:Lithium