Baseline disability and poor functioning in Bipolar disorder predict worse outcomes: Results from the Bipolar CHOICE study

Thilo Deckersbach; Andrew A. Nierenberg; Melvin G. McInnis; Stephanie Salcedo; Emily E. Bernstein; David E. Kemp; Richard C. Shelton; Susan L. McElroy; Louisa G. Sylvia; James H. Kocsis; William V. Bobo; Edward S. Friedman; Vivek Singh; Mauricio Tohen; Charles L. Bowden; Terence A. Ketter; Joseph R. Calabrese; Michael E. Thase; Noreen A. Reilly-Harrington; Dustin J. Rabideau; Gustavo Kinrys; Masoud Kamali

doi:10.4088/JCP.14m09210

Baseline disability and poor functioning in Bipolar disorder predict worse outcomes: Results from the Bipolar CHOICE study

Thilo Deckersbach, Andrew A. Nierenberg, Melvin G. McInnis, Stephanie Salcedo, Emily E. Bernstein, David E. Kemp, Richard C. Shelton, Susan L. McElroy, Louisa G. Sylvia, James H. Kocsis, William V. Bobo, Edward S. Friedman, Vivek Singh, Mauricio Tohen, Charles L. Bowden, Terence A. Ketter, Joseph R. Calabrese, Michael E. Thase, Noreen A. Reilly-Harrington, Dustin J. RabideauGustavo Kinrys, Masoud Kamali

Psychiatry and Psychology

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

Objective: To examine the effects of treatment on functioning impairments and quality of life and assess baseline functioning and employment status as predictors of treatment response in symptomatic individuals from the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (Bipolar CHOICE) study. Method: Bipolar CHOICE was an 11-site, 6-month randomized effectiveness study comparing lithium to quetiapine, each with adjunctive personalized treatments (APTs). We examined post hoc (1) the effects of treatment on functioning, (2) how changes in functioning differed between treatment responders and nonresponders, and (3) whether functioning and employment status mediated treatment response in 482 participants with DSM-IV-TR bipolar I or II disorder from September 2010 to September 2013. Results: Treatment was associated with significant improvements in functioning and quality of life, regardless of treatment group (P values <.0001). Responders showed greater improvements in quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire P values <.05) and functioning (Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool P values <.05) than nonresponders. Unemployed or disabled participants at baseline had significantly greater illness severity at baseline than employed participants (P values <.05). Over the study duration, employed participants reported greater improvements in physical health and quality of life in leisure activities than both unemployed and disabled participants (P values <.05). Individuals who saw greater improvement in functioning and quality of life tended to show greater improvements in depressive and anxiety symptoms (P values ≥.0001), as well as overall illness severity (P values <.001). Early (8 weeks) and very early (4 weeks) clinical changes in mood symptoms predicted changes in functioning and quality of life at 6 months (P values <.001). Conclusions: Prior disability status was associated with a worse treatment response and prospective illness course. Results implicate functioning and employment status as important markers of illness severity and likelihood of recovery in bipolar disorder, suggesting that interventions that target functional impairment may improve outcomes. Trial Registration: ClinicalTrials.gov identifier for the Bipolar CHOICE study: NCT01331304.

Original language	English (US)
Pages (from-to)	100-108
Number of pages	9
Journal	Journal of Clinical Psychiatry
Volume	77
Issue number	1
DOIs	https://doi.org/10.4088/JCP.14m09210
State	Published - Jan 2016

ASJC Scopus subject areas

Psychiatry and Mental health

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10.4088/JCP.14m09210

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Deckersbach, T., Nierenberg, A. A., McInnis, M. G., Salcedo, S., Bernstein, E. E., Kemp, D. E., Shelton, R. C., McElroy, S. L., Sylvia, L. G., Kocsis, J. H., Bobo, W. V., Friedman, E. S., Singh, V., Tohen, M., Bowden, C. L., Ketter, T. A., Calabrese, J. R., Thase, M. E., Reilly-Harrington, N. A., ... Kamali, M. (2016). Baseline disability and poor functioning in Bipolar disorder predict worse outcomes: Results from the Bipolar CHOICE study. Journal of Clinical Psychiatry, 77(1), 100-108. https://doi.org/10.4088/JCP.14m09210

Deckersbach, T, Nierenberg, AA, McInnis, MG, Salcedo, S, Bernstein, EE, Kemp, DE, Shelton, RC, McElroy, SL, Sylvia, LG, Kocsis, JH, Bobo, WV, Friedman, ES, Singh, V, Tohen, M, Bowden, CL, Ketter, TA, Calabrese, JR, Thase, ME, Reilly-Harrington, NA, Rabideau, DJ, Kinrys, G & Kamali, M 2016, 'Baseline disability and poor functioning in Bipolar disorder predict worse outcomes: Results from the Bipolar CHOICE study', Journal of Clinical Psychiatry, vol. 77, no. 1, pp. 100-108. https://doi.org/10.4088/JCP.14m09210

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title = "Baseline disability and poor functioning in Bipolar disorder predict worse outcomes: Results from the Bipolar CHOICE study",

abstract = "Objective: To examine the effects of treatment on functioning impairments and quality of life and assess baseline functioning and employment status as predictors of treatment response in symptomatic individuals from the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (Bipolar CHOICE) study. Method: Bipolar CHOICE was an 11-site, 6-month randomized effectiveness study comparing lithium to quetiapine, each with adjunctive personalized treatments (APTs). We examined post hoc (1) the effects of treatment on functioning, (2) how changes in functioning differed between treatment responders and nonresponders, and (3) whether functioning and employment status mediated treatment response in 482 participants with DSM-IV-TR bipolar I or II disorder from September 2010 to September 2013. Results: Treatment was associated with significant improvements in functioning and quality of life, regardless of treatment group (P values <.0001). Responders showed greater improvements in quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire P values <.05) and functioning (Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool P values <.05) than nonresponders. Unemployed or disabled participants at baseline had significantly greater illness severity at baseline than employed participants (P values <.05). Over the study duration, employed participants reported greater improvements in physical health and quality of life in leisure activities than both unemployed and disabled participants (P values <.05). Individuals who saw greater improvement in functioning and quality of life tended to show greater improvements in depressive and anxiety symptoms (P values ≥.0001), as well as overall illness severity (P values <.001). Early (8 weeks) and very early (4 weeks) clinical changes in mood symptoms predicted changes in functioning and quality of life at 6 months (P values <.001). Conclusions: Prior disability status was associated with a worse treatment response and prospective illness course. Results implicate functioning and employment status as important markers of illness severity and likelihood of recovery in bipolar disorder, suggesting that interventions that target functional impairment may improve outcomes. Trial Registration: ClinicalTrials.gov identifier for the Bipolar CHOICE study: NCT01331304.",

author = "Thilo Deckersbach and Nierenberg, {Andrew A.} and McInnis, {Melvin G.} and Stephanie Salcedo and Bernstein, {Emily E.} and Kemp, {David E.} and Shelton, {Richard C.} and McElroy, {Susan L.} and Sylvia, {Louisa G.} and Kocsis, {James H.} and Bobo, {William V.} and Friedman, {Edward S.} and Vivek Singh and Mauricio Tohen and Bowden, {Charles L.} and Ketter, {Terence A.} and Calabrese, {Joseph R.} and Thase, {Michael E.} and Reilly-Harrington, {Noreen A.} and Rabideau, {Dustin J.} and Gustavo Kinrys and Masoud Kamali",

year = "2016",

month = jan,

doi = "10.4088/JCP.14m09210",

language = "English (US)",

volume = "77",

pages = "100--108",

journal = "Journal of Clinical Psychiatry",

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publisher = "Physicians Postgraduate Press Inc.",

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T1 - Baseline disability and poor functioning in Bipolar disorder predict worse outcomes

T2 - Results from the Bipolar CHOICE study

AU - Deckersbach, Thilo

AU - Nierenberg, Andrew A.

AU - McInnis, Melvin G.

AU - Salcedo, Stephanie

AU - Bernstein, Emily E.

AU - Kemp, David E.

AU - Shelton, Richard C.

AU - McElroy, Susan L.

AU - Sylvia, Louisa G.

AU - Kocsis, James H.

AU - Bobo, William V.

AU - Friedman, Edward S.

AU - Singh, Vivek

AU - Tohen, Mauricio

AU - Bowden, Charles L.

AU - Ketter, Terence A.

AU - Calabrese, Joseph R.

AU - Thase, Michael E.

AU - Reilly-Harrington, Noreen A.

AU - Rabideau, Dustin J.

AU - Kinrys, Gustavo

AU - Kamali, Masoud

PY - 2016/1

Y1 - 2016/1

N2 - Objective: To examine the effects of treatment on functioning impairments and quality of life and assess baseline functioning and employment status as predictors of treatment response in symptomatic individuals from the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (Bipolar CHOICE) study. Method: Bipolar CHOICE was an 11-site, 6-month randomized effectiveness study comparing lithium to quetiapine, each with adjunctive personalized treatments (APTs). We examined post hoc (1) the effects of treatment on functioning, (2) how changes in functioning differed between treatment responders and nonresponders, and (3) whether functioning and employment status mediated treatment response in 482 participants with DSM-IV-TR bipolar I or II disorder from September 2010 to September 2013. Results: Treatment was associated with significant improvements in functioning and quality of life, regardless of treatment group (P values <.0001). Responders showed greater improvements in quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire P values <.05) and functioning (Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool P values <.05) than nonresponders. Unemployed or disabled participants at baseline had significantly greater illness severity at baseline than employed participants (P values <.05). Over the study duration, employed participants reported greater improvements in physical health and quality of life in leisure activities than both unemployed and disabled participants (P values <.05). Individuals who saw greater improvement in functioning and quality of life tended to show greater improvements in depressive and anxiety symptoms (P values ≥.0001), as well as overall illness severity (P values <.001). Early (8 weeks) and very early (4 weeks) clinical changes in mood symptoms predicted changes in functioning and quality of life at 6 months (P values <.001). Conclusions: Prior disability status was associated with a worse treatment response and prospective illness course. Results implicate functioning and employment status as important markers of illness severity and likelihood of recovery in bipolar disorder, suggesting that interventions that target functional impairment may improve outcomes. Trial Registration: ClinicalTrials.gov identifier for the Bipolar CHOICE study: NCT01331304.

AB - Objective: To examine the effects of treatment on functioning impairments and quality of life and assess baseline functioning and employment status as predictors of treatment response in symptomatic individuals from the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (Bipolar CHOICE) study. Method: Bipolar CHOICE was an 11-site, 6-month randomized effectiveness study comparing lithium to quetiapine, each with adjunctive personalized treatments (APTs). We examined post hoc (1) the effects of treatment on functioning, (2) how changes in functioning differed between treatment responders and nonresponders, and (3) whether functioning and employment status mediated treatment response in 482 participants with DSM-IV-TR bipolar I or II disorder from September 2010 to September 2013. Results: Treatment was associated with significant improvements in functioning and quality of life, regardless of treatment group (P values <.0001). Responders showed greater improvements in quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire P values <.05) and functioning (Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool P values <.05) than nonresponders. Unemployed or disabled participants at baseline had significantly greater illness severity at baseline than employed participants (P values <.05). Over the study duration, employed participants reported greater improvements in physical health and quality of life in leisure activities than both unemployed and disabled participants (P values <.05). Individuals who saw greater improvement in functioning and quality of life tended to show greater improvements in depressive and anxiety symptoms (P values ≥.0001), as well as overall illness severity (P values <.001). Early (8 weeks) and very early (4 weeks) clinical changes in mood symptoms predicted changes in functioning and quality of life at 6 months (P values <.001). Conclusions: Prior disability status was associated with a worse treatment response and prospective illness course. Results implicate functioning and employment status as important markers of illness severity and likelihood of recovery in bipolar disorder, suggesting that interventions that target functional impairment may improve outcomes. Trial Registration: ClinicalTrials.gov identifier for the Bipolar CHOICE study: NCT01331304.

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Baseline disability and poor functioning in Bipolar disorder predict worse outcomes: Results from the Bipolar CHOICE study

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