Many people who experience a serious mood episode with psychosis often have cognitive impairments that continue long after they recover from the mood episode. The actual percentages vary from study to study, but approximately 50% of those with mania and 15% of those with major depression experience mood episodes with psychotic features, so recovery from cognitive impairment is a serious concern for those with bipolar disorder.
A study published in the American Journal of Psychiatry entitled “Two-Year Syndromal and Functional Recovery in 219 Cases of First-Episode Major Affective Disorder With Psychotic Features,” found that while most patients recovered from symptoms soon after hospitalization, only about one third with psychotic affective disorders recovered functionality by 24 months.
Medication is effective in treating acute bipolar mood episodes. Medication and psychoeducation are both effective in reducing recurrences in euthymic periods (when symptoms are not present). Unfortunately, neither treatment option has much effect on restoring cognitive facilities or one’s ability to function as they did prior to the episode. But there may be hope on the horizon.
Sherry Boshert, reporting for the Internal Medicine News Digital Network, has posted an excellent article entitled “Functional Training Helps Patients With Bipolar Disorder” that focuses on a study presented by Dr. Eduard Vieta (director of the Bipolar Disorders Program at the Clinical Institute of Neuroscience, University of Barcelona) at the annual congress of the European College of Neuropsychopharmacology. The study followed 220 adult patients with bipolar disorder to compare the effectiveness of a 21-week functional remediation program compared to that of psychosocial education and standard bipolar treatments.
The study measured functional status using the Functional Assessment Short Test (FAST). Previous data using FAST show that patients with bipolar disorder have significantly lower functioning in measures of autonomy, cognition, financial issues, interpersonal functioning, leisure time, and overall scores compared to people without bipolar disorder (see “Clinical predictors of functional outcome of bipolar patients in remission“).
At a 6-month follow-up, participants in the functional remediation group had significantly higher FAST scores than those in the psychoeducation group or the control group.
The 21-week functional remediation program consisted of one 90-minute session per week broken down as follows:
- 15-minute discussion of assigned homework
- 5-minute warm-up task
- 20 minutes of theory and cognitive strategies
- 45 minutes of practical exercises
- 5 minutes to highlight take-home points and tasks to perform at home
In certain cases, family members participated to help the study participant practice strategies and reinforce the material being learned.
The sessions employed modeling techniques, role playing, verbal instructions, self-instruction, positive reinforcement, and metacognitive cues to focus improvement in the following areas:
- Executive functions (programming and organizing activities, establishing priorities and time management, and problem-solving techniques)
- Stress management
Dr. Vieta suggests that the ideal combination of treatments for bipolar disorder may consist of medication, patient and family psychoeducation, training in healthy habits, and functional remediation.
We’ve found few details about this 21-week functional remediation program, but many of the same areas of focus overlap with those of occupational therapy. After all, the entire goal of occupational therapy is to reintegrate individuals into every aspect of their lives, including career, home, and community. See our previous post “What Can an Occupational Therapist Do for You?”
Photo by Jerome, available under a Creative Commons attribution license.