Impacto das comorbidades clínicas na funcionalidade em pacientes com o diagnóstico de transtorno afetivo bipolar

Abstract

The presence of clinical comorbidities in bipolar disorder (BD), especially cardiometabolic diseases, is relatively common and has been associated with functional impairment. The functional status of an individual must be understood in two dimensions: competence and performance. Functioning refers to an individual's ability to fulfil their social roles. Functional capacity is defined as the individual's ability to perform activities related to daily life autonomously and independently. Thus, it is important to understand the relationship between BD, clinical comorbidities and functional outcomes, aiming at the development of therapies that focus on functional recovery of these patients. A cross-sectional study was carried out, evaluating 35 euthymic bipolar patients and 20 matched community controls. The semi-standardized anamnesis and physical examination were followed by the assessment of mood symptoms and the FAST and UPSA-1-BR scales. Laboratory data of blood glucose, glycated haemoglobin, lipid profile and serum lithium level were acquired from the patients' medical records. Cognitive assessment was performed using BAC-A and MMSE. 65.71% of the bipolar patients presented functional impairment by FAST and 42.86% presented alteration in functional capacity by UPSA-1-BR. Patients with BD presented lower functional capacity when compared to controls (p<0.001). Of the clinical comorbidities analysed, only dyslipidemia was associated with functional capacity (Z=57.5, p=0.004). Regarding the FAST scale, patients with dyslipidemia showed worse functional performance only in the domains of autonomy (Z=70; p=0.02) and leisure time (Z=70.5; p=0.02). Concerning sociodemographic factors, UPSA was positively correlated with education (rho=0.411, p=0.01). There was no correlation between the total FAST score and sociodemographic characteristics. In cognitive evaluation, functional capacity was positively correlated with neurocognitive domains (r=0.488; p=0.025) of the BAC-A. There was no correlation between functioning and BAC-A (r=- 0.148 p=0.52); or with MMSE (r=- 0.192 p=0.41). The UPSA showed medium to high accuracy to determine functional capacity in patients with BD in relation to functioning measured by FAST (ROC = 0.625 CI 95% 0.42 - 0.87). There was a relationship between functioning and functional capacity alterations (McNemar test: p=0.06). However, the scales have low agreement (Kappa=0.2), indicating that many patients have functional alterations in only one of the assessments. It was noticed that with the increase in the mean values of the difference between the scores on the scales, the greater was the distance between methods. To our knowledge, this is the first study to assess the presence of clinical comorbidities in BD and its association with functional outcomes. When used together, FAST and UPSA are important tools to identify functional outcomes in patients with BD. Other cross-sectional and longitudinal studies should be carried out to better understand the interaction between these factors in patients with BD.