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Lifetime Psychotic Symptoms, Subthreshold Depression and Cognitive Impairment as Barriers to Functional Recovery in Patients with Bipolar Disorder

Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, 08036 Catalonia, Spain
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, 113 30 Stockholm, Sweden
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(7), 1046;
Received: 3 June 2019 / Revised: 10 July 2019 / Accepted: 16 July 2019 / Published: 18 July 2019
(This article belongs to the Special Issue Improving Cognitive Functioning in People with Schizophrenia)
PDF [551 KB, uploaded 18 July 2019]


(1) Background: bipolar disorder (BD) is a chronic disease that often leads to functional impairment. The objective of this study is to elucidate which variables are associated with better functional outcomes in a sample of euthymic patients with BD. (2) Methods: patients were recruited at the Hospital Clinic of Barcelona and they underwent a clinical interview, a functional assessment, and a comprehensive neuropsychological evaluation. After that, patients were divided into two groups according to the Functioning Assessment Short Test total score: functionally remitted vs. functionally impaired. Following this, a multivariate logistic regression was run in order to identify clinical, demographic and cognitive factors associated with functional remission. (3) Results: a total of 420 euthymic patients with BD were assessed for this study, distributed as follows: functionally remitted (n = 221) and functionally impaired (n = 199). Finally, the multivariate logistic regression revealed that only five variables significantly contributed to the model, including: lifetime history of psychotic symptoms (the variable that contributed the most to the model), followed by the Hamilton Depression total score, and cognitive performance (executive functions and verbal memory). (4) Conclusions: treatments to ensure a good functional outcome in BD should specially prevent psychosis, target subthreshold depressive symptoms and enhance cognition, more specifically executive functions and verbal memory. View Full-Text
Keywords: bipolar disorder; psychosocial functioning; psychotic symptoms; depressive symptoms bipolar disorder; psychosocial functioning; psychotic symptoms; depressive symptoms

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Bonnín, C.M.; Jiménez, E.; Solé, B.; Torrent, C.; Radua, J.; Reinares, M.; Grande, I.; Ruíz, V.; Sánchez-Moreno, J.; Martínez-Arán, A.; Vieta, E. Lifetime Psychotic Symptoms, Subthreshold Depression and Cognitive Impairment as Barriers to Functional Recovery in Patients with Bipolar Disorder. J. Clin. Med. 2019, 8, 1046.

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