Functional impairment and cognition in bipolar disorder

Bipolar disorder is a common, chronic and severe mental disorder, affecting ap-proximately 2Vo ofthe adult population. Bipolar disorder causes substantial psy-chosocial morbidity that frequently affects the patient's marriage, children, occu-pation, and other aspects of the patient's life. Few studies have examined the functional impairment in patients with affective illness. Earlier outcome studies of mania reported favorable long-term outcomes. However, modern outcome studies have found that a majority of bipolar patients evidence high rates of functional impairment. These low reports of functional recovery rates are partic-ularly surprising. The basis for such limited functional recovery is not entirely clear. Factors associated with functional dysfunction include presence of inter-episode symptoms, neuroleptic treatment, lower social economic class, and lower premorbid function. Cognitive dysfunction, a symptom domain of schizophrenia, has been identified as an important measure of outcome in the treatment of schizophrenia. Recently, there has been some suggestion that there may be im-paired neuropsychological performance in euthymic patients with recurring mood disorders. Whether impaired neuropsychological performance in associ-ated with the functional impairment in bipolar patients who have achieved syn-dromal recovery is an intriguing question. The literature on functional impair-ment and cognition in bipolar disorder is reviewed