Background

Functional impairment is a major target in the treatment of bipolar disorder (BD), but the magnitude and type of functional difficulties differ across patients. Findings on predictors of overall functioning and specific functional areas are inconsistent. We aimed to characterize functional difficulties and identify factors associated with global functioning and individual domains in euthymic patients.

Methods

The Functional Assessment Short Test (FAST) was used to assess overall psychosocial functioning and specific functional domains in 80 euthymic participants with BD. Participants also completed a clinical interview and a cognitive assessment. Model selection with elastic net regression was performed to identify predictors of global functioning. We then examined the association of these predictors with individual functional domains using correlation.

Results

FAST scores indicated moderate or severe impairment for 54% of the sample, with occupational functioning showing the highest impairment rate. Elastic net regression selected a model with three variables (higher residual depressive symptoms, lower executive functioning, more perceived cognitive deficits) as predictors of overall functioning. No significant associations were found between these predictors. Depressive symptoms were associated with interpersonal relationships and leisure time, executive skills with occupational functioning, and perceived deficits with cognitive functioning.

Conclusions

Residual depressive symptoms were the strongest predictor of overall functioning which highlights the importance of assessing and targeting subthreshold symptoms for recovery. Executive difficulties were associated with functioning, particularly occupational skills, independently of depressive symptoms. Interventions targeting these difficulties, such as cognitive and functional remediation, may be key treatment options towards facilitating functional recovery.

中文翻译：

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双相情感障碍患者心理社会功能的预测因素：模型选择方法

背景

功能障碍是治疗双相情感障碍 (BD) 的主要目标，但功能障碍的程度和类型因患者而异。整体功能和特定功能区域的预测结果不一致。我们旨在表征功能障碍并确定与心境正常患者的整体功能和个体域相关的因素。

方法

功能评估短期测试 (FAST) 用于评估 80 名心境正常的 BD 参与者的整体心理社会功能和特定功能领域。参与者还完成了临床访谈和认知评估。使用弹性网络回归进行模型选择以识别全局功能的预测因子。然后，我们使用相关性检查了这些预测因子与各个功能域的关联。

结果

FAST 分数表明 54% 的样本中度或重度受损，职业功能受损率最高。弹性净回归选择了一个模型，该模型具有三个变量（较高的残留抑郁症状、较低的执行功能、更多的认知缺陷）作为整体功能的预测因子。未发现这些预测因子之间存在显着关联。抑郁症状与人际关系和休闲时间、具有职业功能的执行技能以及认知功能的感知缺陷有关。

结论

残留的抑郁症状是整体功能的最强预测因子，这突出了评估和针对阈下症状对恢复的重要性。执行困难与功能有关，尤其是职业技能，与抑郁症状无关。针对这些困难的干预措施，例如认知和功能修复，可能是促进功能恢复的关键治疗选择。