Objective: We examine dimensions of function in bipolar disorder with special emphasis on the elderly.
Background: Patients with bipolar disorder have significant impairment in their function, the degree of which is comparable to that of in some non-psychiatric illness. This impairment is present even in syndromic remission. Functioning and well-being have been understudied in bipolar disorder, particularly in the elderly patients.
Method: We conducted an extensive literature review of functioning and well-being of patients with bipolar disorder. In addition, we examined the correlates of multiple facets of functioning in 500 mixed age patients with bipolar disorders (STEP-BD 500 sample) using hierarchical regression modeling.
Results: In the STEP-BD 500 sample functioning was not only affected by the severity of the illness (depression, mania, chronicity of illness, co-morbid psychiatric illnesses) but personality characteristics as well. The proportion of elderly (65 years or older) in this sample was low(<10%). There is evidence, that cerebral vascular pathology, cortical atrophy and other CNS pathology worsen illness course in the elderly. Social support and community living improve functioning of the elderly bipolar patients. Poor functioning can predict symptomatic worsening.
Conclusions: Functional outcome and its determinants need more study in the elderly. The effectiveness of mood stabilizers, psychotherapy, social support and cognitive rehabilitation for improving the course and function in elderly bipolar patients also need further exploration.
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