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INTRODUCTION: Bipolar disorder, in its classic description, is a serious psychiatric disease characterized by depressive, manic or hypomanic stages that involves a high risk of mortality and morbidity in almost every aspect of functionality. In the past, the prevalence of the disease was assumed to be around 1% of the population, but nowadays it is estimated at 5% when we consider it as a spectrum disorder. It is a very important health issue leading to serious social and economic consequences. In every patient, the form and timing of the onset, progress, and response to the treatment differ, and these differences have been assumed to be effected by multi-dimensional, not fully understood processes, causing uncertainty, which leads us to the conclusion that it might me more appropriate to accept the disease as a heterogeneous spectrum disorder rather than a homogenous disease as in the classical description. It is thought that patients are totally normal between episodes or with minimal symptom levels, but this view is changing dramatically towards an opinion that it is actually a more continuous disease than it seemed before. In the past, it was thought that functionality loss (which was related to disorders like schizophrenia and depression back then) have not been seen in euthymic stages, but this idea has been changing rapidly for the last 30 years with studies about the disorder. Today, it is consistently reported that functionality impairment is a continuous problem that can be seen even in the euthymic stages. The degree of functionality impair is hard to determine in bipolar disorder due to its nature. Other than its unpredictable natural course, aspects like comorbid substance abuse, personality traits, low premorbid functionality levels, psychotic symptoms, drug side effects, and the number, severity, and onset of previous episodes are also parts of the reasons of this difficulties.
METHODS: In this study, we included 80 bipolar disorder-diagnosed patients who applied to Rize Education and Research Hospital, Psychiatry Clinic between the dates of 01.02.2013 and 01.01.2014 and had the capability of accomplishing the interviews and questionnaires, matching study inclusion criteria and having therapeutic levels of mood stabilizer drug blood levels. Before the study, an approval from Recep Tayyip Erdogan University School of Medicine Clinical Research Ethics Committee had been received. All patients had been informed and signed a written approval form. Patients having an active episode, psychosis, dementia, mental retardations, Parkinson disease, degenerative diseases or neurologic diseases like multiple sclerosis, Systemic Lupus Erythematosus, chronic renal diseases or any other chronic physical diseases were excluded. Remission phase is defined as not having active episodes for at least 3 months. We applied inventories such as Young Mania Rating Scale, Hamilton Depression Rating Scale, Eysenck Personality Questionnaire, Bipolar Disorder Functionality scale (BDFS), SCID I and SCID II.
RESULTS: Out of 80 patients included in the study, 57 (71.3%) were women and 23 (28.7%) men. Their age was in the range of 18-74 and the average age was 40.51+14.2. The average age for women was 40.91+13.75, for men 39.52+15.74. 38 of them were in the age range 18-36, 30 between 37 and 56 and 12 of them were 56 and above. 25% of the patients were university graduates. Most of the patients were housewives (52.5%) and 93.8% of them had health insurance. 50% of them were married and 68.75% of them were living with their family. When we analyzed the sample regarding socio-economic levels, we found that 16 of them belonged to the lower class, 38 were lower midle class, 26 were upper middle class. There was no patient who defined himself as a member of the upper class. 51 (63.8%) of them lived in cities, 23 (28.8%) in towns and 6 (7.55%) in villages. After psychiatric evaluations by psychometric questionnaires, 67 (83.75%) of the patients were diagnosed as bipolar disorder type I and 13 (16.25%) diagnosed as bipolar type 2. The average illness time was 13.8+9.1 years; in women 14.63±9.4, in men 11.87±8.2. Onset age was 26.28±4.1 for women and 27.65±3.9 for men. Average manic episode number was 3.7+5.8, depressive episodes were 4.5+7.7, mixed episodes were 1.2+2.1 and hypomanic were 1.1+4.1. There was no significant statistical difference between those. When we evaluated the long-term course of the disease, we found that there was complete or almost complete functionality in 38 (47.5%) patients, significant functionality loss in 36 (45%) and very poor functionality in 6 (7.5%). By gender, 31.3% of women have complete or almost complete functionality, 32.5% of them have impaired functionality and 7.5% have bad functionality. For men, those numbers were 16.3% for complete functionality and, 12.5% for impaired functionality. When we analyze the course between the episodes, 34 (42.5%) of them were symptom-free, 27 (33.8%) of them had light symptoms, 14 (17.5%) had moderate symptoms and 3 (3.8%) of them had severe symptoms chronically. 31 (38.8%) of them showed seasonal changes. 11 (13.8%) had a rapid cycling history and 40 (50%) of them had a psychotic symptoms history. As the result of the Eysenck Personality Questionnaire - revised short version, average points of sub-scales have been found as 3.14+.3 for the neuroticism subscale, 1.84+1.6 for the extraversion subscale, and 1.59+1.2 for the psychoticism subscale. The average point BDFS for men was 101.65±15.6, average point BDFS for women was 93.35±18.2 (p= 0.6). For the Bipolar 1 disorder-diagnosed group, the average point was 97.91±17.7, for Bipolar 2 it was 84.54±14.7 (p= 0.01). In our study, the lowest scores for BDFS subscales were “taking initiative”, “fulfilling potential” and “introversion”. The highest average subscale points are for “joining social activities”, “participating in house works”, “daily activities” and “hobbies”. We found a significant but weak negative correlation between psychoticism and functionality. There was no significant relationship between the other Eysenck Personality Questionnaire subscales with functionality.
CONCLUSION: In our study, when we evaluate the long-term course of the disorder, it is found that 36 (45%) patients have partly impaired functionality and 6 (7.5%) have poor functionality. In the study, BDFC subscale points are lowest in the taking initiative, fulfilling potential and introversion sections. The highest scores were in the social activities, daily activities and hobbies sections. The only subscale that showed a significant relationship with functionality was psychoticism. In our sample, it seems that the higher the psychoticism subscale points get, the lower functionality scores become. In bipolar disorder, it is important to determine the functionality of patients. In this context, more research about the determining role of personality traits is required.