Executive Functioning but Not IQ or Illness Severity Predicts Occupational Status in Bipolar Disorder

Overview

Journal Int J Bipolar Disord

Date 2020 Feb 8

PMID 32030544

Citations 12

Authors

Julia Drakopoulos

Timea Sparding

Caitlin Clements

Erik Palsson

Mikael Landen

Affiliations

Soon will be listed here.

Abstract

Background: Bipolar disorder is associated with significant functional deficits including occupational functioning. Despite the high rates of unemployment and sick leave in the patient population, only a limited number of studies have examined factors associated with occupational functioning in bipolar disorder. The aim of the study was to investigate the relative importance of demographic, clinical, and neuropsychological factors on occupational dysfunction in bipolar disorder.

Methods: A sample of 120 partially or fully remitted bipolar disorder I and II patients were included in the study. Patients were stratified into an active and an inactive group based on the number of hours per week working or studying. Active (n = 86) and inactive (n = 34) patients were compared with respect to demographic factors, clinical characteristics, medication, measures of psychosocial functioning, and cognitive functioning (i.e., IQ and executive functions). No other cognitive domains were examined.

Results: Univariate analyses revealed better overall cognitive function in active patients in terms of IQ and executive functioning. However, only executive functioning accounted for a significant amount of the variance in occupational status when other significant predictors were taken into account.

Conclusions: Executive functioning was a more powerful predictor of occupational status in bipolar disorder patients than IQ and other clinical factors, including illness severity.

Citing Articles

Exploring cognitive characteristics and impairments in bipolar disorder: Insights from the BiDiLoS-Ng pilot study.

Adiukwu F, Adesokun O, Amuta-Igwe C, Metu I, Jack I Glob Ment Health (Camb). 2025; 11():e120.

PMID: 39776980 PMC: 11704381. DOI: 10.1017/gmh.2024.125.

The clinical significance of emotional urgency in bipolar disorder: a scoping review.

Teh W, Si S, Liu J, Subramaniam M, Ho R BMC Psychol. 2024; 12(1):273.

PMID: 38750587 PMC: 11097479. DOI: 10.1186/s40359-024-01700-1.

Cognitive flexibility is associated with sickness resilience.

Vestberg T, Lebedev A, Jacobsen H, Lekander M, Sparding T, Landen M Front Psychol. 2024; 15:1253152.

PMID: 38746926 PMC: 11091381. DOI: 10.3389/fpsyg.2024.1253152.

Understanding social and clinical associations with unemployment for people with schizophrenia and bipolar disorders: large-scale health records study.

Chilman N, Laporte D, Dorrington S, Hatch S, Morgan C, Okoroji C Soc Psychiatry Psychiatr Epidemiol. 2024; 59(10):1709-1719.

PMID: 38378812 PMC: 11464607. DOI: 10.1007/s00127-024-02620-6.

Impact of cognitive reserve on bipolar disorder: a systematic review.

Matsumoto K, Hamatani S Front Psychiatry. 2024; 14:1341991.

PMID: 38371715 PMC: 10869457. DOI: 10.3389/fpsyt.2023.1341991.

References

Depp C, Mausbach B, Bowie C, Wolyniec P, Thornquist M, Luke J . Determinants of occupational and residential functioning in bipolar disorder. J Affect Disord. 2011; 136(3):812-8. PMC: 3639009. DOI: 10.1016/j.jad.2011.09.035. View

Hajek T, Slaney C, Garnham J, Ruzickova M, Passmore M, Alda M . Clinical correlates of current level of functioning in primary care-treated bipolar patients. Bipolar Disord. 2005; 7(3):286-91. DOI: 10.1111/j.1399-5618.2005.00182.x. View

Barkley R, Murphy K . Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Arch Clin Neuropsychol. 2010; 25(3):157-73. PMC: 2858600. DOI: 10.1093/arclin/acq014. View

Schmidt F, Hunter J . General mental ability in the world of work: occupational attainment and job performance. J Pers Soc Psychol. 2004; 86(1):162-73. DOI: 10.1037/0022-3514.86.1.162. View

Royall D, Lauterbach E, Cummings J, Reeve A, Rummans T, Kaufer D . Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci. 2002; 14(4):377-405. DOI: 10.1176/jnp.14.4.377. View

Ryden E, Thase M, Straht D, Aberg-Wistedt A, Bejerot S, Landen M . A history of childhood attention-deficit hyperactivity disorder (ADHD) impacts clinical outcome in adult bipolar patients regardless of current ADHD. Acta Psychiatr Scand. 2009; 120(3):239-46. DOI: 10.1111/j.1600-0447.2009.01399.x. View

Saunders J, Aasland O, Babor T, De la Fuente J, Grant M . Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993; 88(6):791-804. DOI: 10.1111/j.1360-0443.1993.tb02093.x. View

Reed C, Goetz I, Vieta E, Bassi M, Haro J . Work impairment in bipolar disorder patients--results from a two-year observational study (EMBLEM). Eur Psychiatry. 2010; 25(6):338-44. DOI: 10.1016/j.eurpsy.2010.01.001. View

Judd L, Akiskal H, Schettler P, Endicott J, Maser J, Solomon D . The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002; 59(6):530-7. DOI: 10.1001/archpsyc.59.6.530. View

10.

Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E . The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1999; 59 Suppl 20:22-33;quiz 34-57. View

11.

Mur M, Portella M, Martinez-Aran A, Pifarre J, Vieta E . Influence of clinical and neuropsychological variables on the psychosocial and occupational outcome of remitted bipolar patients. Psychopathology. 2009; 42(3):148-56. DOI: 10.1159/000207456. View

12.

Ekman C, Lind J, Ryden E, Ingvar M, Landen M . Manic episodes are associated with grey matter volume reduction - a voxel-based morphometry brain analysis. Acta Psychiatr Scand. 2010; 122(6):507-15. DOI: 10.1111/j.1600-0447.2010.01586.x. View

13.

Goetz I, Tohen M, Reed C, Lorenzo M, Vieta E . Functional impairment in patients with mania: baseline results of the EMBLEM study. Bipolar Disord. 2007; 9(1-2):45-52. DOI: 10.1111/j.1399-5618.2007.00325.x. View

14.

Martinez-Aran A, Vieta E, Torrent C, Sanchez-Moreno J, Goikolea J, Salamero M . Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord. 2007; 9(1-2):103-13. DOI: 10.1111/j.1399-5618.2007.00327.x. View

15.

Asberg M, SCHALLING D . Construction of a new psychiatric rating instrument, the Comprehensive Psychopathological Rating Scale (CPRS). Prog Neuropsychopharmacol. 1979; 3(4):405-12. DOI: 10.1016/0364-7722(79)90055-9. View

16.

Mur M, Portella M, Martinez-Aran A, Pifarre J, Vieta E . Persistent neuropsychological deficit in euthymic bipolar patients: executive function as a core deficit. J Clin Psychiatry. 2007; 68(7):1078-86. DOI: 10.4088/jcp.v68n0715. View

17.

Perlis R, Dennehy E, Miklowitz D, DelBello M, Ostacher M, Calabrese J . Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study. Bipolar Disord. 2009; 11(4):391-400. PMC: 3992980. DOI: 10.1111/j.1399-5618.2009.00686.x. View

18.

Sparding T, Silander K, Palsson E, Ostlind J, Sellgren C, Ekman C . Cognitive functioning in clinically stable patients with bipolar disorder I and II. PLoS One. 2015; 10(1):e0115562. PMC: 4304812. DOI: 10.1371/journal.pone.0115562. View

19.

Friedman N, Miyake A, Corley R, Young S, DeFries J, Hewitt J . Not all executive functions are related to intelligence. Psychol Sci. 2006; 17(2):172-9. DOI: 10.1111/j.1467-9280.2006.01681.x. View

20.

Sanchez-Moreno J, Martinez-Aran A, Vieta E . Treatment of Functional Impairment in Patients with Bipolar Disorder. Curr Psychiatry Rep. 2017; 19(1):3. DOI: 10.1007/s11920-017-0752-3. View