There is a compelling need for innovative intervention strategies for patients with affective disorders, given their increasing global prevalence and significant associated disability and impaired functioning. This study aimed to investigate whether a comprehensive multimodule individualized intervention (AWARE), targeting known mediators of functioning, improves functioning in affective disorders.

AWARE was a randomized, controlled, rater-blind clinical trial conducted at two centers in the Capital Region of Denmark (Clinicaltrials.gov, NCT 04701827). Participants were adults with bipolar disorder or major depressive disorder and impaired functioning. Participants were randomized to the six-month AWARE intervention or treatment as usual (TAU). The AWARE intervention is based on the International Classification of Functioning, Disability and Health (ICF) Brief Core Set for Bipolar and Unipolar Disorder.

The primary outcome was observation-based functioning using the Assessment of Motor and Process Skills (AMPS). Secondary outcomes were functioning, QoL, stress, and cognition.

Between February 2021 and January 2023, 103 patients were enrolled; 50 allocated to AWARE treatment and 53 to TAU (96 included in the full analysis set). There was no statistically significant differential change over time between groups in the primary outcome (AMPS), however, both groups showed a statistically significant improvement at endpoint. The AWARE intervention had a statistically significant effect compared with TAU on secondary outcomes of patient-reported functioning, stress and cognition.

Compared with TAU, the AWARE intervention was ineffective at improving overall functioning on the primary outcome, presumably due to the short duration of the intervention. Further development of effective treatments targeting functioning is needed.

Alleviation of symptom severity for major depressive disorder (MDD) is known to be associated with a lagged improvement of functioning. Pharmacotherapy guidelines support algorithms for MDD treatment. However, it is currently unclear whether concordance with guidelines influences functional recovery. A guideline concordance algorithm (GCA-8) was used to measure this pathway in a naturalistic clinical setting.

Data from 1403 adults (67% female, 84% non-Hispanic/Latino White, mean age of 43 years) with nonpsychotic MDD from the Penn State Psychiatry Clinical Assessment and Rating Evaluation System registry (visits from 02/01/2015 to 04/13/2021) were evaluated. Multivariable linear regression measured associations between GCA-8 and World Health Organization Disability Assessment Schedule 2.0 (WHODAS) scores. Mediation by MDD symptom severity using the Patient Health Questionnaire depression module (PHQ-9) was also evaluated.

This study found a statistically significant improvement in WHODAS scores (functioning) between baseline and final measures (−2 points, P < .001) within one year. A one standard deviation increase in the GCA-8 score was associated with a 0.48-point reduction in mean disability score (total effect; P = .02) with significant mediation by the change in MDD symptom severity (coefficient = −0.51, P < .001) and a nonsignificant natural direct effect of the GCA-8 independent of PHQ-9 change (coefficient = −0.02, P = .92).

Higher pharmacotherapy guideline concordance is associated with better functioning for MDD patients; this association likely occurs through improvement in MDD symptom severity rather than directly.

Healthcare workers (HCWs) were considered a population at risk for developing psychiatric symptoms during the COVID-19 pandemic, such as anxiety, depression, and post-traumatic stress disorder (PTSD). Peritraumatic distress is associated with post-traumatic psychopathological symptoms; however, little is known about how it may affect functioning. The study aimed at evaluating the level of peritraumatic distress in a sample of HCWs during the first wave of the COVID-19 pandemic and at examining the relationship between peritraumatic distress, mental health symptoms, and functioning impairment.

A sample of 554 frontline HCWs were consecutively enrolled in major university hospitals and community services in Italy. The PDI, IES-R, PHQ-9, and GAD-7 were used to assess peritraumatic distress, symptoms of PTSD, depression, and anxiety, respectively, and the WSAS to investigate functioning impairment. PDI scores were higher among females, community services, physicians, and nurses. Furthermore, the PDI correlated significantly with the GAD-7, PHQ-9, IES-R, and WSAS.

In a mediation analysis, the direct effect of PDI on WSAS and the indirect effects through the PHQ-9 and IES-R were statistically significant (P < .001).

Peritraumatic distress reported by HCWs was associated with symptoms of PTSD, depression, and anxiety, but the association with reduced functioning may be only partially mediated through symptoms of depression and PTSD.

The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare.

Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) ‘initial network’, that shows the conditional dependencies between factors at first presentation, and a (2) ‘transition network’, how factors are dependent longitudinally.

The ‘initial network’ identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The ‘transition network’ identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59–1.99) and self-harm (RR, 1.32; CI, 1.22–1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69–2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28–5.43) and self-harm (RR, 2.78; CI, 2.55–3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time.

This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.

The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by a ‘need for care’.

Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34 653), the current study examined variation in functioning, symptomology and aetiological risk across the psychosis phenotype [i.e. variation from (i) no PEs, ‘No PEs’ to (ii) non-distressing PEs, ‘PE-Experienced Only’ to (iii) distressing PEs, ‘PE-Impaired’ to (iv) clinically defined psychotic disorder, ‘Diagnosed’].

A graded trend was present such that, compared to those with no PEs, the Diagnosed group had the poorest functioning, followed by the PE-Impaired then PE-Experienced Only groups. In relation to symptom expression, the PE-Impaired group were more likely than the PE-Experienced Only and the Diagnosed groups to endorse most PEs. Predictors of group membership tended to vary quantitatively rather than qualitatively. Trauma, current mental health diagnoses (anxiety and depression) and drug use variables differentiated between all levels of the continuum, with the exception of the extreme end (PE-Impaired v. Diagnosed). Only a few variables distinguished groups at the upper end of the continuum: female sex, older age, unemployment, parental mental health hospitalisation and lower likelihood of having experienced physical assault.

The findings highlight the importance of continuum-based interpretations of the psychosis phenotype and afford valuable opportunities to consider if and how impairment, symptom expression and risk change along the continuum.

Patients with remitted psychosis face a dilemma between the wish to discontinue antipsychotics and the risk of relapse. We test if an operationalized guided-dose-reduction algorithm can help reach a lower effective dose without increased risks of relapse.

A 2-year open-label randomized prospective comparative cohort trial from Aug 2017 to Sep 2022. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomized 2:1 into guided dose reduction group (GDR) v. maintenance treatment group (MT1), together with a group of naturalistic maintenance controls (MT2). We observed if the relapse rates would be different between 3 groups, to what extent the dose could be reduced, and if GDR patients could have improved functioning and quality of life.

A total of 96 patients, comprised 51, 24, and 21 patients in GDR, MT1, and MT2 groups, respectively. During follow-up, 14 patients (14.6%) relapsed, including 6, 4, and 4 from GDR, MT1, and MT2, statistically no difference between groups. In total, 74.5% of GDR patients could stay well under a lower dose, including 18 patients (35.3%) conducting 4 consecutive dose-tapering and staying well after reducing 58.5% of their baseline dose. The GDR group exhibited improved clinical outcomes and endorsed better quality of life.

GDR is a feasible approach as the majority of patients had a chance to taper antipsychotics to certain extents. Still, 25.5% of GDR patients could not successfully decrease any dose, including 11.8% experienced relapse, a risk comparable to their maintenance counterparts.

Self-stigma is widespread in patients with bipolar disorder, with many consequences for family, social and occupational functioning, as well as treatment adherence.

The aim of this study was to evaluate self-stigma in remitted patients with bipolar disorder and to investigate its impact upon functioning.

We conducted a cross-sectional, descriptive, and analytical study of 61 patients with bipolar disorder. Euthymia was verified using the Hamilton scale for depression and the Young scale for mania. We used the Internalized Stigma of Mental Illness (ISMI) to evaluate self-stigma, the Functioning Assessment Short Test (FAST) to assess functioning.

The mean age of patients was 43.4 years. The sex ratio was 2.4. The mean score on the ISMI was 2.36. More than half of our patients (59%) were self-stigmatized. Regarding functioning, a global impairment was noted in more than two thirds of the patients (71%). Occupational functioning was the most affected area (82%). Patients with higher self-stigma scores had significantly more impaired functioning (p<10-3). To decompose the relationship between stigma and functioning into more specific spheres, we found that all scores on the different domains of functioning were associated with a significantly higher mean self-stigma score.

The relationship between self-stigma and functioning seems to be bidirectional. Therefore, improved social functioning could reduce self-stigma and improve self-esteem.

No significant relationships.

Despite youth’s high Global Burden of Disease there is a substantial service delivery gap between this population’s urgent needs and their access to health services. Because attention has remained under-prioritized (Babatunde et al., 2019), youth typically do not receive the treatment they require, i.e., they present an unmet need (Barwick et al., 2013). This is particularly problematic given that untreated mental disorders (MD) are associated with short-term and long-term functional deterioration.

To determine the level of functioning of children who receive mental healthcare in the selected psychiatric hospitals of Mexico.

A cross-sectional study was conducted during 2018-2020. Sample of children who received mental healthcare at the time of the study. Questionnaire for the evaluation of disability WHODAS 2.0 (World Health Organization-Disability Assessment Schedule) was applied. T test and analysis of variance were applied to know the differences of means of the variables and indicators.

Sample (n= 397), 63% were boys. Mean (SD) for Age: 12 (3.6) and schooling: 5.8 (3.6). 51% (n =202) of children reported having a generic diagnosis for hyperkinetic disorders and 34% depressive disorder. WHODAS scores: significant differences in the functioning domains (Do). Mean and (SD) for Do5 Life activities domestic: 45 (26.7); Do6 Social participation:37 (20.6); and Do1 cognition: 36.6 (19.3). Figure 1.

The children with MD are more vulnerable due to the associated disability and it requires specific heath interventions adapted to their mental health care needs. References: 1) Babatunde et al. (2021). Glob.Soc.Welfare 8, 29–46. 2) Barwick et al. (2013). J.evid.based.soc.work, 10(4), 338–352.

No significant relationships.

Bipolar disorder is related with functional impairment in euthymia. The contribution of biological functions such as sleep, sexual functioning; or the presence of obesity on this loss remain understudied.

The aim of this work was to study the influence of biological determinants in context with clinical and demographical determinants of functioning in a 3-year cohort of euthymic BD patients.

In this multicentric study 67 euthymic adult bipolar outpatients were followed during three years. Functioning was assessed with FAST, insomnia severity with Oviedo Sleep Questionnaire (OSQ) and, sexual functioning with Changes on Sexual Functioning Questionnaire (CSFQ-14) and obesity was expressed as body mass index (BMI). The basal effect of sleep, sexual functioning and obesity (Time 0) on FAST (Time 3) was analyzed with a mixed ordinal regression model including time effect, age, sex, number of manic and depressive episodes, euthymia length, and comorbidity with personality disorder. Change in functioning (Time 3 to 0) was analyzed in another mixed model also considering the difference in biological determinants (Time 3 to 0) and the presence of mood episodes during the period.

A basal worse sexual functioning, a higher severity of insomnia and a higher BMI predicted a worse functioning at three years (p=0.005, p=0.043, p=0.05 respectively). Regarding FAST difference from Time0 to 3, only having a manic episode related to an impairment on functioning (p=0.027).

Sexual functioning, quality of sleep and BMI are predictors of functioning in euthymia in BD. Manic episodes in the following contribute to impairments on functioning more than depressive episodes.

No significant relationships.

In bipolar disorder, cognitive deficits persist across mood episodes and euthymia. Despite recent advances, cognitive impairment in bipolar disorder remains poorly understood. The presentation will focus on recent work where different approaches are used to clarify the role of cognitive deficits in bipolar disorder.

First, we have examined the clinical relevance of cognitive impairments and examined if cognitive abilities differ between bipolar disorder subtypes and healthy controls. Second, we examined if cognitive abilities differ between individuals with bipolar disorder with and without attention-deficit hyperactivity disorder. Third, we examined the relationship between cognitive functioning and occupational functioning. Lastly, we examined if long-term changes in cognitive functioning in bipolar disorder patients differ from normal aging.

The St. Göran Bipolar Project is an interdisciplinary, prospective, naturalistic study of bipolar disorder. Patients were recruited and followed-up at two specialized out-patient clinics in Stockholm and Gothenburg, Sweden.

We showed that there is evidence for significant cognitive heterogeneity in bipolar disorder. Comorbid ADHD could not explain this heterogeneity. Moreover, we showed that excutive functioning is a powerful predictor of occupational functioning. The cognitive trajectory over a 6-year period did not differ between bipolar disorder patients and healthy controls.

There is no conclusive cognitive profile characterizing bipolar disorder. However, cognitive functioning is of great importance in understanding occupational functioning in bipolar disorder. Contrary to the assumption that cognitive impairments may be progressive we show that changes in cognitive functioning over time do not differ between patients and healthy controls.

No significant relationships.

Schizophrenia is often associated with impaired functioning abilities due to its disabling symptoms.

to determine the clinical factors that impact the functioning in stabilized patients withschizophrenia and schizoaffective disorder.

We conducted a cross-sectional, descriptive and analytical study. It was carried out on an outpatient population with schizophrenia or schizoaffective disorder diagnosis. We used the Functional Assessment Staging Scale (FAST) to measure the functional capacity, the PANSS to assess psychosis symptom severity and the Calgary scale to screen for comorbid depression.

Seventy-five patients were included with 61 males (81.3%).The mean age was 39.81 ± 9.96 years. The mean sore of the Fast scale was 33 ± 14.95. 90% of our patients scored higher than 11 on the FAST scale revealing a functioning deficiency. 18.7% scored higher than 6 on the Calgary scale revealing a comorbid depression .No significant correlations were found between the FAST score and the age of patient, the gender,the age of onset of psychosis, the duration of untreated psychosis and the number of life-time episodes. Scores of PANSS were significantly higher among patients with a functioning deficiency (p<0.00).No significant correlation was found between the FAST score and the Calgary score.

Our study suggests that the severity of residual positive and negative symptoms affects negatively the functioning of patients with schizophrenia or schizoaffective disorder. Thus, targeting those symptoms in the treatment may have significant functional benefits.

No significant relationships.

Exposure to severe childhood trauma has been associated with the onset and the severity of bipolar disorder in adults.

The aim of this study was to examine the relationship between childhood trauma and functioning of patients suffering from bipolar disorder.

We conducted a cross-sectional, descriptive, and analytical study, including sixty-one remitted patients with BD. We used the Childhood Trauma Questionnaire (CTQ-SF) to measure history of traumatic childhood experiences and the Functioning Assessment Short Test (FAST) to assess functioning.

The mean age of patients was 43.4. The sex ratio was 2.4. Almost two-thirds of patients (64%) had experienced at least one type of childhood trauma. An overall functional impairment was found in 70.5% of participants. The CTQ total score was significantly associated with low educational level (p=0.001), low socio-economic status (P=0.034), a family history of psychosis (P=0.022), the number of mood episodes (P=0.001), the number of hospitalizations (P=0.04), the number of relapses with psychotic features (p=0.002) and that of depressive relapses (P<0.001), rapid cycling (P=0.012), higher rates of suicide attempts (P=0.04) and poor functioning (P<0.001).The logistic regression analyses showed a significant association of childhood trauma with low educational level (p=0.001), high number of depressive episodes (p=0.013) and poor functioning (p<0.001).

Our findings demonstrate that childhood abuse and neglect are risk factors associated with worsening clinical course of bipolar disorder and higher functional impairment. These findings press the urgency for preventive practices and early intervention strategies to diminish the prevalence of childhood trauma and minimize their impact.

No significant relationships.