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Impairment in functional outcome is commonly observed even when patients are euthymic and includes multiple areas of functioning. Many factors such as sociodemographic, clinical, pharmacological, and neurocognitive variables have been associated with functional impairment. The term ‘functional remediation’ has been coined to define an innovative strategy aimed at targeting the critical factors for full psychosocial adjustment and functional recovery in the context of psychoses and more specifically bipolar disorders. Functional remediation involves not only neurocognitive techniques and training but also psychoeducation on cognition-related issues and problem-solving within an ecological framework. The inclusion of context processing, performance monitoring, encoding, and manipulation of the information as well as fostering compensatory strategies must be included in the functional remediation intervention. In this regard, real-world problems affecting daily functioning are used for bipolar disorder to be transferred to daily practice.

Bipolar disorder (BD) is a chronic mental disorder that affects 1-3% of the population, and is characterized by affective episodes that alternate with periods of euthymia. Although traditionally patients were thought to return to premorbid functioning levels during the inter-episode periods, recent evidence suggests that cognitive deficits persist even during periods of euthymia, and may impair patients working and functioning status.The present study aimed to characterize the neurocognitive and psychosocial functioning in a sample of Portuguese bipolar type I patients.Sixty-five BD type I patients were compared to 50 healthy controls with an extensive neuropsychological battery to assess to assess attention and mental control, speed of processing, executive functions, and verbal memory. Mood symptoms were assessed with the Hamilton Depression Rating Scale and with the Young Mania Rating Scale, and psychosocial functioning was assessed with the Global Assessment of Functioning (GAF).BD patients performed overall significantly worse on neurocognitive tests as compared to healthy controls, but especially on verbal memory and executive functions, even after controlling for educational level and mood symptomatology, showing moderate to large effect sizes on these domains. BD patients scored significantly lower on the GAF as compared to healthy controls, and psychosocial functioning was significantly correlated with performance on all neurocognitive tests. Although there were less BD patients active and working, and more patients inactive and/or retired, working status did not correlate significantly with neurocognitive performance.The results of our study support the hypothesis that BD type I patients present global cognitive deficits even whilst in euthymia, especially in the domains of verbal memory and executive functions. These cognitive deficits correlate with the functional difficulties that many patients present in the course of the disease, but their impact on working status is still not clear.

This prospective open-label study assessed the impact of add-on quetiapine in the treatment of rapid cycling bipolar patients.Fourteen rapid cycling bipolar patients were treated with quetiapine, which was added to their ongoing medication regimen for 112 +/- 33 days. At the beginning of the study, five were manic, three were in a mixed state, three were depressed, two hypomanic and one was euthymic. Patients were assessed prospectively with a modified version of the Clinical Global Impression Scale for Bipolars (CGI-BP), the Young Scale for mania (YMRS) and the Hamilton Scale for Depression (HDRS).A significant reduction of the following scale scores was observed: a 1.8 point reduction for the general CGI-BP (p = 0.013), a -1.3 point for the mania subscale (p = 0.016), a -1.01 point for the YMRS (p = 0.025). Improvement in depressive symptoms was not significant, neither in the CGI-BP (-1 point, p = 0.074) nor in the HDRS (-5.2 points, p = NS). The most common side-effect was sedation (n = 6, 43%). Doses of quetiapine were significantly reduced by the end of the study (443 +/- 235 mg/day versus 268 +/- 190 mg/day, p = 0.008) and they also differed according to the initial episode to be treated (720 +/- 84 mg/day for mania, and 183 +/- 29 mg/day for depression, p = 0.023).Quetiapine could possibly be an effective treatment for rapid cycling bipolar patients. Adequate doses for acute episodes could significantly differ according to the episode polarity and the length of treatment.