Impairment and Psychosocial Functioning in Bipolar Disorder

Researchers have been investigating whether cognitive impairments in bipolar disorder are the result of psychotropic medication or the illness itself. Results indicated deficits involving memory, processing rewards, and sensitivity to negative feedback. All of these limitations present difficulties for bipolar patients in making decisions and adapting to situations which contribute to high-risk behaviors. The data indicated that these deficits represent an effect of the illness itself and are not due to mood-stabilizing medication. This clarification should reassure patients to continue utilizing the benefits of mood-stabilizing medication without concern over harmful cognitive side effects. Optimal treatment involves monitoring and managing symptoms by a psychologist who is trained in the treatment of bipolar disorder and clinical psychopharmacology. One type of specialized psychological treatment of Bipolar disorder is Interpersonal Social Rhythm Therapy (IPSRT). IPSRT is an intervention designed specifically for bipolar patients which involves teaching them how to prevent manic and depressive episodes by stabilizing their sleep/wake cycles and daily routines. Current interpersonal problem areas are also identified in IPSRT and addressed to provide additional stability. In addition to IPSRT, neuropsychological assessment and cognitive retraining also can assist in reducing the effects of neurocognitive impairments on overall functioning.

Some patients with bipolar disorder also have demonstrated poor psychosocial adjustment, for example unemployment and a lack of reliable friends and quality leisure activities. Poor psychosocial adjustment is associated with low quality of life and increased risk of suicide. Psychologists continue examine this crucial area of psychological functioning to improve patient care.

Insight on Psychosocial Functioning in Bipolar Disorder

Executive functioning involves abilities to generate strategic approaches to problems, monitor and planning behaviors, and revise strategies to behaviors that are no longer appropriate. Executive functioning and insight are strongly related to psychosocial adjustment and are often impaired in patients with bipolar disorder.

Insight involves awareness of current psychiatric symptoms, awareness of the presence of psychiatric disorders, and awareness of the achieved effect of treatment. In bipolar disorder, the relationship between poor insight and poorer psychosocial adjustment is likely accounted for by neurocognitive deficits. These deficits are exacerbated by multiple manic and depressive episodes. Thus, managing episodes through medication and psychotherapy is critical in preventing future neurocognitive deterioration.

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