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12-08-2013 | Mental health | Article

Preventing manic episodes ‘key to work success’


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medwireNews: Repeated manic episodes and executive dysfunction are significant contributors to poor work adjustment in people with bipolar disorder, a study suggests.

The finding highlights the importance of preventing manic episodes and preserving executive function in order to help people with bipolar disorder be successful in their working lives.

“Many bipolar patients present some kind of impairment in this area such as lack of continuity in work history, interpersonal problems at work or just inability to work,” explain Eduard Vieta (University of Barcelona, Catalonia, Spain) and co-authors.

To examine the factors that contribute to poor occupational outcomes, the team studied 85 euthymic patients with bipolar I disorder, of whom 63.5% met criteria for “good work adjustment” and 36.5% were considered to have “poor work adjustment.”

These two groups differed in a number of ways, with poorly adjusted patients being older, having a higher number of hospitalizations and mood episodes (both manic and depressive), and higher scores on the Hamilton Depression Rating Scale, as compared with well-adjusted patients.

People with poor work adjustment also showed worse performances on some but not all measures of neuropsychologic function, namely, the Trail Making Test-part B and preservative errors on the Wisconsin Card Sorting Test (WCST).

In logistic regression analysis, just two of these factors were significantly and independently predictive of poor work performance: the total number of manic episodes and the number of preservative errors on the WCST, with odds ratios of 1.40 and 1.06, respectively.

These two variables explained between 26.6% and 36.5% of variance in work adjustment and correctly classified 91.5% of cases, report Vieta et al in the European Archives of Psychiatry and Clinical Neuroscience.

Noting that the recurrence of mood episodes “potentially carries neurotoxic effects and leads to neurocognitive decline over the course of illness,” the researchers conclude: “Psychological interventions such as functional remediation may be useful in order to help [enhance] functional outcome and delay functional decline in bipolar disorder.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Joanna Lyford, Senior medwireNews Reporter

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