title: The difficult lives of individuals with bipolar disorder: A review of functional outcomes and their implications for treatment.
abstract: Most longitudinal or treatment studies in bipolar disorder have used symptomatic or syndromal status as the primary outcome variable. More recently, psychosocial functioning has been highlighted as a key domain of outcome. Patients with bipolar disorder appear to be impaired in all functional domains, although the factors that cause impairment have not been clearly specified.
  
  
  
  This paper reviews cross-sectional and longitudinal studies on functional impairment and its relationship to symptomatic, neurocognitive, personality, and stress variables in bipolar disorder; and the implications of these relationships for defining treatment targets. 93 articles were located through comprehensive MEDLINE, SCOPUS and Web of Science searches.
  
  
  
  Functional recovery following a mood episode consistently lags behind symptomatic and syndromal recovery. Longer term functional impairment is only partly explained by the number of manic/hypomanic episodes. Depression (including subsyndromal states) and persistent neurocognitive impairment are the strongest correlates of functional impairment in bipolar disorder, with personality and psychosocial stressors playing secondary roles. Possible treatment options include: more aggressive treatment of subthreshold depressive states, pharmacotherapies that target cognition (e.g., stimulants), and adjunctive psychotherapies including cognitive remediation.
authors.affiliation: Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address: Mgitlin@mednet.ucla.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gitlin
authors.affiliation: Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000339:Affect; D001714:Bipolar Disorder / Q000523:psychology*; D003071:Cognition; D003863:Depression / Q000523:psychology*; D006801:Humans; D011788:Quality of Life / Q000523:psychology*
keywords: Cognitive remediation; Depression; Mania; Mood stabilizers; Neurocognition; Stimulants