FUNCTIONAL IMPAIRMENT AND COGNITION
IN BIPOLAR DISORDER
Carlos A. Zarate, Jr., M.D., Mauricio Tohen, M.D., Dr. P.H.,
Michelle Land, B.S., and Sarah Cavanagh, B.S.
Bipolar disorder is a common, chronic and severe mental disorder, affecting ap-
proximately 2% of the 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.
From the The Bipolar and Psychotic Disorders Program, University of Massa-
chusetts Medical School, Worcester, MA (Zarate, Land, Cavanagh), McLean Hos-
pital, Harvard Medical School, Belmont, MA (Tohen), and Lilly Research Labo-
ratories, Indianapolis, IN (Tohen).
Address correspondence to Dr. Carlos A. Zarate, Jr., University of Massachu-
setts Medical School, 361 Plantation Street, Worcester, MA 01605; e-mail:
PSYCHIATRIC QUARTERLY, Vol. 71, No. 4, Winter 2000
0033-2720/00/1200-0309$18.00/0 2000 Human Sciences Press, Inc.