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Predictors of Remission in Adults

Predictors of functional remission/recovery include onset in adulthood, absence of a family history of BD, absence of comorbid disorders, and presentation with manic symptoms.18,31,34 Conversely, those who had longer periods before remission and shorter periods before relapse were more likely to have a history of child psychopathology, greater symptom severity during index hospital visit, and an index depressive mood episode.13,27,29 The effect of polarity and recurrence was inconsistent across studies, with some showing better course for manic episodes,19,32 and others finding that depressive index episodes were associated with better course.14,17 Treatment adherence and response are also predictors of remission in both adults13 and youth.35,36

Functional Outcome in Adults

Whereas syndromic recovery is quite common, there is a large gap between clinical remission and functional outcomes in BD. Several of the first-episode studies systematically tracked quality of life and adjustment in occupational and social spheres. For example, Tohen and colleagues18 found that people with BD had work impairment for more than 30% of a 4-year follow-up period. Several other studies also demonstrated the importance of occupational and social functioning as both a predictor and outcome of BD.14,19 One explanation for the gap between symptomatic recovery and functional impairment could be attributable to risk factors such as lower socioeconomic status (SES), limited social support, and poor psychosocial adjustment prior to the index mood episode that may be more chronic in nature and not ameliorated by pharmacologic treatment.2731 Nonremitting comorbid physical disorders may also explain residual impairment in those who have responded to treatment.19 In addition, neurocognitive deficits that tend to persist despite symptomatic remission in BP may also contribute to impairment and disability.27,31 For example, MacQueen37 found a direct association between the number of episodes and decline in cognitive function and well-being. These findings underscore the urgent need to expand clinical trials and systematic studies of treatment to inclusion of functional impairment that could reduce the burden of this illness.

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