Substantial Functional Disability Research Articles

Acquired High Flow Arteriovenous Malformation of the Lower Lip Induced by Hormonal Variation- Report of a Rare Case and Review

Arteriovenous malformations (AVMs) are uncommon vascular lesions. AVMs are the most serious type of vascular malformations, causing substantial deformity and functional disability. AVMs of the acquired type are rarely confronted in the head and neck region. They may present as a medical emergency while performing dental procedures due to their potential for uncontrollable haemorrhage. Dental professionals should be aware of their potentially fatal complications and management. Accurate diagnosis of AVMs is critical and their management remains challenging. Vascular anomalies involving the lips can negatively impact the functionality and facial appearance. In this article, we discuss a very rare case of acquired AVM of the lower lip triggered by hormonal variation occurring during menopause in a female patient, 58 years of age. There are no reported cases of acquired AVM of the lip with hormonal variation occurring during menopause as the trigger for proliferation of the lesion. An overview of the clinical, etiological, diagnostic and management aspects of head and neck region-acquired AVMs is also presented in this paper.

Dapoxetine prevents neuronal damage and improves functional outcomes in a model of ischemic stroke through the modulation of inflammation and oxidative stress

Stroke is a medical emergency that is associated with substantial mortality and functional disability in adults. The most popular class of antidepressants, selective serotonin reuptake inhibitors SSRIs, have recently been shown in studies to have positive effects on post-stroke motor and cognitive function. Thus, we hypothesized that dapoxetine (DAP), a short-acting SSRI, would be effective against cerebral ischemia/reperfusion injury. Adult male Wister rats (200–250 g) were subjected to a sham operation or bilateral common carotid artery occlusion (BCCAO) for 30 min followed by 24 h of reperfusion to induce global cerebral ischemia/reperfusion (I/R) injury. Rats were treated with vehicle or DAP (30 or 60 mg/kg, i.p.) 1 h before BCCAO. The neurobehavioral performance of rats was assessed. The infarct volume, histopathological changes, oxidative stress parameters, and apoptotic and inflammatory mediators were determined in the brain tissues of euthanized rats. Our results confirmed that DAP significantly ameliorated cerebral I/R-induced neurobehavioral deficits, reduced cerebral infarct volume, and histopathological damage. Moreover, DAP pretreatment reduced lipid peroxidation, caspase-3, and inflammatory mediators (TNF-α and iNOS) compared to I/R-injured rats. Thus, DAP pretreatment potentially improves neurological function, and cerebral damage in cerebral ischemic rats may be partly related to the reduction in the inflammatory response, preservation of oxidative balance, and suppression of cell apoptosis in brain tissues.

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Neural basis of memory impairments and relation to functional disability in fully or partially remitted patients with affective disorders

Bipolar disorder (BD) and major depressive disorder (MDD) are associated with cognitive and functional impairment. Cognitive impairment is often associated with dorsal prefrontal cortex (dPFC) hypo-activity, but the neuronal correlates of functional disability is largely unknown. In this study, 91 patients with affective disorders in full or partial remission (BD, n = 67; MDD, n = 24) with objectively verified cognitive impairment and substantial functional disability underwent neuropsychological assessment and functional magnetic resonance imaging (fMRI) scan during which they completed a strategic picture-encoding task. For comparison, 36 matched healthy controls underwent an identical test protocol. Patients showed encoding-related hypo-activity in the dPFC compared to controls. In patients, lower right dlPFC activity was associated with poorer overall functioning and more antipsychotic drug use. In conclusion, memory impairments were underpinned by failure to recruit the dPFC during task performance which was associated with impaired functioning in fully or partially remitted patients with affective disorders. This aberrant neurocircuitry activity has implications for the design of future pro-cognitive interventions that aim to improve not only cognition but also real-world functioning.

Pathophysiology, cellular and molecular mechanisms of large and small vessel diseases.

Cerebrovascular disease (CVD) is the second most common cause of cognitive impairment and dementia in aged population. CVD presents in a myriad number of clinical ways based on the functional location of pathology. While primary clinical emphasis has been placed on motor, speech and visual deficits, vascular cognitive decline is a vastly under recognized and devastating condition afflicting millions of Americans. CVD, a disease of the blood vessels that supply blood to brain involves an integration between small and large vessels. Cerebral large vessel diseases (LVD) are associated with atherosclerosis, artery-to-artery embolism, intracardiac embolism and a large vessel stroke leading to substantial functional disability. Cerebral small vessel disease (SVD) is critically involved in stroke, brain hemorrhages, cognitive decline and functional loss in elderly patients. An evolving understanding of cellular and molecular mechanisms emphasizes that inflammatory vascular changes contribute to systemic pathologic conditions of the central nervous systems (CNS), with specific clinical presentations including, cognitive decline. Advances in an understanding of pathophysiology of disease processes and therapeutic interventions may help improve outcomes. This review will focus on large and small vessels diseases and their relationship to vascular cognitive decline, atherosclerosis, stroke, and inflammatory neurodegeneration. We will also emphasize the molecular and cellular mechanisms, as well as genetic and epigenetic factors associated with LVD and SVD.

Polypharmacy and Potential Drug–Drug Interactions in Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease with protean manifestations. It is characterized by symmetric polyarticular inflammation, which can lead to progressive joint damage. As a result, RA is associated with substantial functional disability, morbidity, and accelerated mortality, which pose an enormous and growing societal burden. Polypharmacy is a major public health concern, which is growing worldwide. Polypharmacy is associated with adverse outcomes including mortality, falls, adverse drug reactions, increased length of stay in hospital and readmission to hospital soon after discharge. Objectives: The aim of this study was to quantify polypharmacy in a group of patients with RA, its relationship with patients’ characteristics and to assess the risk of potential undesirable interactions between medications used for managing RA and those used for chronic and non-chronic diseases. Materials and Methods: A cross-sectional study was conducted at Baghdad Teaching Hospital, Rheumatology Unit during the period from December 2019 to December 2020. A total of 188 adult patients, previously diagnosed with RA according to the 2010 American College of Rheumatology/ European League against Rheumatism rheumatoid arthritis classification criteria, were included in the study. Data were collected using a pre-constructed data collection sheet. Questionnaires included demographic and clinical data of the patients. In this study, polypharmacy was defined as the association of five or more medications, regardless of the duration. Drug interactions were identified by use of the Medscape’s drug interaction checker® database. Results: Among 188 RA patients in this study, polypharmacy was found in 71.8% of the patients and there were 331 potential drug–drug interactions (1.77 ± 2.52 DDIs/patient). Most of the potential drug–drug interactions were related to the use of methotrexate, with nonsteroidal anti-inflammatory drugs being the major representative of these drug–drug interactions with methotrexate. Conclusion: High prevalence of polypharmacy was found in RA patients. Positive correlation between polypharmacy and patient’s age, disease activity and the presence of other comorbid conditions. Polypharmacy was associated with increased incidence of potential drug–drug interactions in RA patients. Methotrexate was involved in most drug–drug interactions.

Clinical Manifestations and Outcomes in Disease-Modifying Antirheumatic Drug-Naive Adult Patients with Chronic Chikungunya Arthritis.

Most studies on chronic chikungunya virus (CHIKV) arthritis include patients treated with disease-modifying antirheumatic drugs (DMARDs), likely altering the expression of clinical manifestations and outcome. Therefore, we sought to evaluate the clinical features and correlates in DMARD-naive patients with chronic CHIKV arthritis. We conducted a case-control study in adult patients with serologically confirmed CHIKV infection in Puerto Rico. Demographic features, clinical manifestations, comorbidities, disease activity (per Clinical Disease Activity Index [CDAI]), functional status (per Health Assessment Questionnaire Disability Index [HAQ-DI]), and pharmacologic treatment were ascertained. Patients with and without chronic CHIKV arthritis were compared. Furthermore, a sub-analysis was performed among patients with chronic CHIKV who presented with mild disease activity versus moderate-to-high disease activity at study visit. In total, 61 patients were studied; 33 patients had chronic arthritis and 28 had resolved arthritis. Patients with chronic arthritis had significantly more diabetes mellitus, chronic back pain, and fever, tiredness, and myalgias on the acute phase. The mean (SD) HAQ score was 0.95 (0.56), and 57.6% had moderate-to-high disease activity. Patients with moderate-to-high disease activity had higher scores in overall HAQ-DI and HAQ-DI categories (dressing and grooming, arising, hygiene, reaching, and activities) than in those with mild activity. In conclusion, in this group of DMARD-naive patients with chronic CHIKV arthritis, nearly 58% had moderate-to-high disease activity and had substantial functional disability. Diabetes mellitus, chronic back pain, and some manifestations on acute infection were associated with chronic CHIKV arthritis.

Headache Characteristics and Psychological Factors Associated with Functional Impairment in Individuals with Persistent Posttraumatic Headache.

Persistent posttraumatic headache (PPTH), one of the most common symptoms following mild traumatic brain injury, is often associated with substantial functional disability. The objective of this study was to assess the contribution of demographics, headache characteristics, and psychological symptoms to disability associated with PPTH. Participants completed the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Pain Catastrophizing Scale (PCS), and the Migraine Disability Assessment (MIDAS) questionnaire. Two linear regression models were formulated to interrogate the relationships between 1) demographics and headache characteristics with the MIDAS questionnaire and 2) demographics, headache characteristics, and psychological symptoms with the MIDAS questionnaire. A two-way stepwise regression using the Akaike information criterion was performed to find a parsimonious model describing the relationships between demographics, headache characteristics, and psychological measures with the MIDAS questionnaire. Participants included 58 patients with PPTH and 39 healthy controls (HCs). The median MIDAS score among those with PPTH was 48.0 (first quartile [1Q] = 20.0, third quartile [3Q] = 92.0), indicative of severe disability. Compared with the HCs, those with PPTH had higher scores on the BDI, STAI, and PCS. Older age predicted lower MIDAS scores (age: B=-0.11, P<0.01), whereas higher headache frequency, greater headache intensity, and higher trait anxiety scores predicted higher MIDAS scores in individuals with PPTH (headache frequency: B=0.07, P<0.001; headache intensity: B=0.51, P=0.04; trait anxiety score: B=1.11, P=0.01). Individuals with PPTH had substantial psychological symptoms and headache-related disability. Disability was partially explained by age, headache frequency and intensity, and trait anxiety. Holistic management of patients with PPTH to address headaches and psychological symptoms might reduce headache-associated disability.

Dynamic Psychotherapy: The Therapeutic Process in the Treatment of Obsessive-Compulsive Disorder.

Dynamic Psychotherapy (DP) was developed to overcome the limitations of traditional psychoanalysis, responding to a broader demand of patients who seek help to cope with specific problems in the short term, such as Obsessive-Compulsive Disorder (OCD). OCD is a chronic disabling mental disorder that leads to substantial distress, functional disability and severe occupational and social impairments. Recognizing the literature gap in this field, and the improvements reported by dynamic therapists who have dealt with patients suffering from OCD, a study on the treatment of these patients was conducted in order to discuss the effects of this technique. The method involved a narrative literature review and the analysis of two clinical cases to discuss therapeutic processes, which include the specificities of OCD patients and the mechanisms adopted in the treatment through DP. The therapist’s active stance seemed to be essential to encourage the patient to face feared situations and identify the core conflict. Both patients who were treated through DP presented similarities, such as high anxiety, feelings of guilt and inhibition of aggressive and sexual impulses. Through emotional exploration, confrontation of defensive functioning and interpretative interventions of inner conflicts, patients had reached awareness of their hidden feelings and experiences, and their symptoms and feelings of guilt decreased. They also showed significant improvements in their interpersonal relationships. Although both treatments do not fit into short-term therapies, this technique has led to long-term results, providing evidence that DP may produce favorable outcomes in the treatment of OCD.

Automated assessment of joint synovitis activity from medical ultrasound and power doppler examinations using image processing and machine learning methods.

ObjectivesRheumatoid arthritis is the most common rheumatic disease with arthritis, and causes substantial functional disability in approximately 50% patients after 10 years. Accurate measurement of the disease activity is crucial to provide an adequate treatment and care to the patients.The aim of this study is focused on a computer aided diagnostic system that supports an assessment of synovitis severity.Material and methodsThis paper focus on a computer aided diagnostic system that was developed within joint Polish–Norwegian research project related to the automated assessment of the severity of synovitis. Semiquantitative ultrasound with power Doppler is a reliable and widely used method of assessing synovitis. Synovitis is estimated by ultrasound examiner using the scoring system graded from 0 to 3. Activity score is estimated on the basis of the examiner’s experience or standardized ultrasound atlases. The method needs trained medical personnel and the result can be affected by a human error.ResultsThe porotype of a computer-aided diagnostic system and algorithms essential for an analysis of ultrasonic images of finger joints are main scientific output of the MEDUSA project. Medusa Evaluation System prototype uses bone, skin, joint and synovitis area detectors for mutual structural model based evaluation of synovitis. Finally, several algorithms that support the semi-automatic or automatic detection of the bone region were prepared as well as a system that uses the statistical data processing approach in order to automatically localize the regions of interest.ConclusionsSemiquantitative ultrasound with power Doppler is a reliable and widely used method of assessing synovitis. Activity score is estimated on the basis of the examiner’s experience and the result can be affected by a human error. In this paper we presented the MEDUSA project which is focused on a computer aided diagnostic system that supports an assessment of synovitis severity.

Development of a brief psychoeducational group intervention for carers of people with hoarding disorder: A proof-of-concept study

BackgroundHoarding Disorder (HD) is a burdensome and disabling mental health condition, which is associated with substantial functional disability and represents a major public health issue. Hoarding problems can also have a major adverse impact on the relatives/carers of people who hoard. The current study evaluated the impact and acceptability of a brief psychoeducational group intervention for carers of people with HD. MethodsTwelve family carers of people with HD took part in a six-week manualised psychoeducational group. Measures of knowledge about HD, caregiving experiences, expressed emotion, wellbeing, distress, and coping styles were taken at pre-, post-intervention, and 1-month follow-up. ResultsThe results indicated significant improvements post-intervention in carer reported wellbeing, positive experiences of caregiving, and understanding of HD. No changes were observed in carer reports of caregiver burden, distress, expressed emotion, and coping styles. Satisfaction and perceived helpfulness were high. ConclusionA relatively brief, group-based intervention can support carers in their understanding of HD and positively impact on their own wellbeing and relationship with their relative with HD. Replication with a larger sample and controlled design is required.

Role of Fresh Osteochondral Allografts for Large Talar Osteochondral Lesions.

Osteochondral lesions of the talus, large or small, present a challenge to the treating orthopaedic surgeon. These cartilage and bony defects can cause substantial pain and functional disability. Surgical treatment of small lesions of the talus has been thoroughly explored and includes retrograde drilling, arthroscopic débridement and marrow stimulation, osteochondral autografting from cartilage/bone unit harvested from the ipsilateral knee (mosaicplasty), and autologous chondrocyte implantation. Although each of these reparative, replacement, or regenerative techniques has various degrees of success, they may be insufficient for the treatment of large osteochondral lesions of the talus. Large-volume osteochondral lesions of the talus (>1.5 cm in diameter or area >150 mm) often involve sizable portions of the weight-bearing section of the talar dome, medially or laterally. To properly treat these osteochondral lesions of the talus, a fresh structural osteochondral allograft is a viable treatment option.

Effects of denosumab on pain and analgesic use in giant cell tumor of bone: Interim results from a phase II study

Background. Giant cell tumor of bone (GCTB) is an aggressive primary osteolytic tumor. GCTB often involves the epiphysis, usually causing substantial pain and functional disability. Denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor κΒ ligand (RANKL), is an effective treatment option for patients with advanced GCTB. This analysis of data from an ongoing, open-label study describes denosumab's effects on pain and analgesic use in patients with GCTB.Material and methods. Patients with unresectable disease (e.g. sacral or spinal GCTB, or multiple lesions including pulmonary metastases) were enrolled into Cohort 1 (N = 170), and patients with resectable disease whose planned surgery was associated with severe morbidity (e.g. joint resection, limb amputation, or hemipelvectomy) were enrolled into Cohort 2 (N = 101). Patients received denosumab (120 mg) subcutaneously every four weeks, with additional doses on study days 8 and 15. Patients assessed worst pain severity with the Brief Pain Inventory – Short Form (BPI-SF) at baseline, at each visit for the first six months, and every three months thereafter.Results. Clinically relevant pain improvement was reported by 29% of patients in Cohort 1 and 35% in Cohort 2 during week 1 and by ≥ 50% of patients in each cohort at each study visit from months 2–30. Median time to clinically relevant improvement was 30 (95% CI 16, 57) days in Cohort 1 and 15 (95% CI 15, 29) days in Cohort 2. Results in patients with moderate/severe pain at baseline were similar. Fewer than 30% of patients in Cohort 1 and 10% in Cohort 2 experienced clinically relevant pain worsening at any visit through 27 months. Most patients had no/low analgesic use during the study.Conclusion. Most patients treated with denosumab experienced clinically relevant decreases in pain within two months.

Including a Range of Outcome Targets Offers a Broader View of Fibromyalgia Treatment Outcome: Results from a Retrospective Review of Multidisciplinary Treatment

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness.

THU0209 Disease Activity and Structural Damage-Related Differences in Functional Disability in Early and Established Rheumatoid Arthritis

BackgroundA measure of functional impairment, the Health Assessment Questionnaire Disability Index (HAQ), consists of a reversible disease activity-related component (ACT-HAQ) and a joint damage component that increases with time (DAM-HAQ).ObjectivesTo...

The Use of VA Disability Benefits and Social Security Disability Insurance Among Veterans

Although there is substantial functional limitation and disability among veterans of all ages, relatively little is known about veterans’ uptake of Department of Veterans Affairs (VA) Disability Benefits and Social Security Disability Insurance (DI). This project uses data from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation to examine veterans’ participation in VA and DI programs. The results indicate that the majority of veterans do not receive VA or DI benefits, but veterans’ use of these programs has been increasing over time. A higher percentage of veterans receive VA compensation only, which ranges from 4.9 percent in 1992 to 13.2 percent in 2008, than DI compensation only, which ranges from 2.9 percent in 1992 to 6.7 percent in 2008. Furthermore, the rate of joint participation in these two programs is low, ranging from less than 1 percent in 1992 to 3.6 percent in 2008. Veterans experience relatively few within-panel transitions between VA and DI programs. Overall, the likelihood of any disability program use is higher among veterans who served during multiple time periods, are older, black or Hispanic, currently married, and have less than a high school education. Among users, the likelihood of any VA use in contrast to only DI use is higher among veterans who served since 1990, are younger, Hispanic, highly educated, and currently married. Among users, variation in the likelihood of any DI use relative to only VA use generally mirrors variation in the likelihood of any VA use, although there are differences in associations with race/ethnicity, education, and marital status.

Normal Imaging in Patients with Cerebral Palsy: What Does It Tell Us?

To identify distinctive clinical features characterizing children with cerebral palsy (CP) and normal-appearing magnetic resonance imaging (MRI) findings. Using a population-based CP registry, the Registre de la Paralysie Cérébrale au Québec (Quebec Cerebral Palsy Registry), various antenatal, perinatal, and postnatal predictor variables, as well as current phenotype, were compared in patients with normal-appearing MRI findings and those with abnormal MRI findings. Of the 213 patients evaluated, 126 (60%) had MRI imaging results available and were included in our analysis. Of these 126 patients, 90 (71%; 51 males, 39 females) had abnormal findings and 36 (29%; 17 males and 19 females) had normal-appearing findings. Compared with other CP variants, normal-appearing MRI was more prevalent (P = .001) in dyskinetic CP (72.7%; 8 of 11) and less prevalent (P = .002) in spastic hemiplegic CP (10%; 4 of 40). There were no significant differences between the 2 groups (P > .05) in terms of the prevalence of perinatal or postnatal clinical features or clinical outcomes. Furthermore, 42% (15 of 36) of the children with normal-appearing MRI exhibited a high degree of functional disability (Gross Motor Functional Classification System IV-V), compared with 33% (30 of 90) with abnormal MRI. No clinical features, except a higher prevalence of dyskinetic CP, was identified in the children with normal-appearing MRI. More refined imaging techniques may be needed to evaluate patients with normal-appearing MRI findings. Furthermore, genetic or functional, rather than gross structural lesions, may underlie the pathophysiology of CP in this cohort. Finally, the high proportion of substantial functional disability underscores the importance of continuous follow-up even in the absence of early structural abnormalities on imaging.

Functional disability and health-related quality of life in South Africans with early rheumatoid arthritis

Background: The severity and predictors of functional disability and health-related quality of life (HRQoL) in a cohort of South Africans with early rheumatoid arthritis (RA) were investigated.Methods: Changes in the Health Assessment Questionnaire Disability Index (HAQ) and the 36-Item Short Form Health Survey (SF-36) following 12 months of traditional disease-modifying anti-rheumatic drugs (DMARDs) were studied in previously DMARD-naïve adults with disease duration ≤ 2 years.Results: The majority of the 171 patients were female (82%), Black Africans (89%) with a mean (SD) symptom duration of 11.6 (7.0) months. In the 134 patients seen at 12 months, there were significant improvements in the HAQ and all domains of the SF-36 but 92 (69%) still had substantial functional disability (HAQ > 0.5) and 89 (66%) had suboptimal mental health [SF-36 mental composite score (MCS) < 66.6]. Multivariate analysis showed that female sex (p = 0.05) and high baseline HAQ score (p < 0.01) predicted substantial functional disability at 12 months. Unemployment (p = 0.03), high baseline pain (p = 0.02), and HAQ score (p = 0.04) predicted suboptimal mental health, with a trend towards a low level of schooling being significant (p = 0.08).Conclusions: Early RA has a broad impact on HRQoL in indigent South Africans, with a large proportion of patients still showing substantial functional disability and suboptimal mental health despite 12 months of DMARD therapy. Further research is needed to establish the role of interventions including psychosocial support, rehabilitation programmes, and biological therapy to improve physical function and HRQoL in this population.

Management of psoriatic arthritis from the view of the dermatologist

Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. Although the main assessment measures for PsA are borrowed from the standard criteria used to assess rheumatoid arthritis, a number of new criteria such as the PsAJAI and CPDAI are being developed specifically for PsA. Long-term consequences of untreated PsA include persistent inflammation, progressive joint damage and, in many cases, substantial functional limitations, pain and disability. Moreover, patients with PsA have an increased mortality risk and an increased risk of developing cardiovascular disease and metabolic syndrome. Both GRAPPA and the AAD have developed treatment guidelines, which are discussed here. Psoriasis commonly precedes arthritic symptoms; thus, dermatologists are ideally placed to make the initial diagnosis of PsA and treat it appropriately, affording the opportunity to slow disease progression, improve physical function and enhance quality of life. This Review explores the management of patients with PsA, with a particular emphasis on assessment tools, long-term consequences and treatment issues from the viewpoint of the dermatologist.

A 15-year prospective follow-up of bipolar affective disorders: comparisons with unipolar nonpsychotic depression

Outcome studies have previously documented substantial functional disability among individuals with bipolar disorder, although few follow-up studies have examined the prospective course of illness beyond 10 years' duration. A total of 95 patients with mood disorders (46 with bipolar I disorder and 49 with unipolar nonpsychotic depression) were assessed 15 years after index hospitalization. Logistic and linear regression models were used to identify predictors of global functioning, work disability, and social adjustment. At 15-year follow-up, good overall functioning was significantly less common among subjects with bipolar disorder (35%) than unipolar depression (73%) (p<0.001). Work disability was significantly more extensive in bipolar than unipolar disorder subjects (p<0.001). Logistic regression indicated that good outcome 15 years after index hospitalization was significantly predicted by a unipolar rather than bipolar disorder diagnosis and the absence of a depressive episode in the preceding year. Past-year depressive, but not past-year manic, syndromes were associated with poorer global outcome and greater work disability. In addition, subsyndromal depression was significantly associated with poorer global, work, and social outcome among bipolar, but not unipolar disorder subjects. A majority of individuals with bipolar I disorder manifest problems with work and global functioning 15 years after an index hospitalized manic episode Recurrent syndromal and subsyndromal depression disrupts multiple domains of functional outcome more profoundly in bipolar than unipolar mood disorders. The prevalence, and correlates, of impaired long-term outcome parallel those reported in shorter-term functional outcome studies of bipolar disorder.