Avaliação da funcionalidade em pacientes com transtorno bipolar e em pacientes com esquizofrenia

Abstract

Introduction: Patients with Bipolar Disorder (BD) and patients with Schizophrenia (SCZ) have impaired functionality when compared to the general population. Few studies compare functionality between stable BD patients and stable SCZ patients. Additionally, there is a great functional heterogeneity, even among individuals with the same diagnosis, and it is not clear which factors determine better functionality. Therefore, this study aims to evaluate functionality in these two disorders. Methods: A cross-sectional study was conducted with 25 BD patients, 21 SCZ patients, and 21 individuals without a psychiatric disorder. Symptom assessment was performed using PANSS (for SCZ patients) and HAM-D and YOUNG (for BD patients), including only stable outpatients. Tests assessing cognition (BACS-SF), functionality (FAST), and functional capacity (UPSA-1-BR) were administered. Results: The BD and SCZ groups showed worse verbal memory (VM) compared to the control group (p < 0.001). The SCZ and BD groups exhibited worse functional capacity compared to the control group (p < 0.001), with no difference between them. The SCZ group showed worse functionality compared to the control group (p = 0.006). The BD group did not differ from the SCZ group or the control group in functionality as assessed by FAST. There was no correlation between functionality and functional capacity. In the multinomial model, controlled for years of study, evaluating the variables: age, VM, working memory, attention/processing speed, UPSA-1-BR, and FAST, we found that only VM, UPSA-1-BR, and FAST were significant in differentiating between the control group and the BD group (VM: OR = 0.87, p = 0.006; UPSA-1-BR: OR = 0.90, p = 0.049; FAST: OR = 1.11, p = 0.044) and between the control group and the SCZ group (VM: OR = 0.78, p < 0.001; UPSA-1-BR: OR = 0.86, p = 0.01; FAST: OR = 1.18, p = 0.006). Regarding differentiation between the BD and SCZ groups, only VM was significant (OR = 0.9, p = 0.007; BD as the reference group). Discussion: Stable BD patients show impairments in functionality and intermediate FC between the SCZ group and the control group, as they differ from the control group and the SCZ group in some measures and not in others. Stable SCZ patients exhibit worse functionality and FC when compared to control groups matched in education. The multinomial model showed that stable SCZ patients have worse VM compared to stable BD patients, with no difference in functionality and FC between the two groups.