Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.
Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil.
Bipolar Disord. 2020 Sep;22(6):569-581. doi: 10.1111/bdi.12904. Epub 2020 Apr 20.
Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population.
Meta-analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand-searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two-step meta-analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed-effects model for categorical variables.
In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI.
This study reinforces the relevant functional impact of BD in this population and suggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.
系统地回顾仅使用功能评估简短测试（FAST）评估的轻躁期双相情感障碍（BD）患者的功能障碍（FI）患病率，探讨所有领域的这种障碍的患病率，确定最受影响的领域以及与该人群功能低下相关的临床变量。
进行了荟萃分析，从 2007 年至 2019 年在 Medline、Embase、Cochrane、PsycINFO 数据库中以及通过手动搜索，无语言限制地搜索相关文献。最初确定了 1128 项研究，最终根据入选标准选择了 13 项研究。使用均值差进行两步荟萃分析，对于连续变量使用 95%置信区间，对于分类变量使用固定效应模型进行比例估计。
在第一步中，所有 FAST 领域的患者都比健康对照组表现出更严重的 FI，组间存在显著差异。在第二步中，FI 领域的患病率如下：总体，58.6%；职业，65.6%；认知，49.2%；自主，42.6%；人际关系，42.1%；休闲，29.2%；财务问题，28.8%。残留的抑郁症状是与 FI 最常相关的变量。
这项研究强调了 BD 在该人群中的相关功能影响，并表明职业领域可能是最受影响的领域。应更加努力针对患者护理中的功能进行治疗，因为它是治疗反应的最有意义的终点，尤其是职业和认知康复，从而使患者能够克服疾病过程并过上充实的生活。
