Perhaps not surprisingly, many patients with bipolar disorder have poor quality of life, including health-related quality of life. A survey of bipolar patients during euthymia showed that quality of life was similar or worse than that of patients with long-term medical conditions.31 Another study showed that a woman who has bipolar disorder with an onset at 25 years of age loses 9 years of life, 12 years of normal health, and 14 years of effective functioning.32 Ten-year follow-up of a group of patients with bipolar disorder showed that about 50% had sustained improvement, whereas 30% to 40% declined functionally over time.33
A recent review evaluated health-related quality of life, work impairment, and healthcare costs and utilization among patients with bipolar disorder. The analysis showed that bipolar disorder substantially decreases a person's health-related quality of life and increases costs associated with medical care and work impairment. Patients with bipolar disorder had higher rates of healthcare resources compared with patients with depression or long-term medical conditions.11 Another review found that patients with bipolar disorder have lower quality of life than patients with schizophrenia.34
A recent study investigated changes in health-related quality of life in patients with bipolar I or II disorder who were given quetiapine monotherapy during an 8-week, double-blind, placebo-controlled trial. Using the 16-item short form of the Quality of Life Enjoyment and Satisfaction Questionnaire, significant improvement was noted in the quetiapine treatment groups compared with placebo groups.35
This supplement to The American Journal of Managed Care examines 2 key issues in the diagnosis, evaluation, and management of bipolar disorder: misdiagnosis and quality of life. As suggested above, both issues make major contributions to the burdens associated with bipolar disorder.
Roy H. Perlis, MD, explores the magnitude of the problem of misdiagnosis, factors underlying misdiagnosis of bipolar disorder, and some of the consequences of misdiagnosis. Dr Perlis also discusses how to improve the diagnosis of bipolar disorder. The article emphasizes that careful screening for current and past symptoms and close clinical follow-up provide the foundation for accurate diagnosis and more effective management of bipolar disorder.
Lana A. Vornik, MSc, and Robert M. A. Hirschfeld, MD, examine the impact of bipolar disorder on patients' quality of life. They review findings from studies that have included quality-of-life assessment in the evaluation and management of patients with bipolar disorder. They also discuss findings obtained with specific quality-of-life assessment instruments. Finally, they review data related to the impact of treatment on the quality of life of patients with bipolar disorder, particularly the effects of atypical antipsychotics. In general, symptomatic improvement has been associated with improved quality of life in patients with bipolar disorder.
The following articles address highly relevant, contemporary issues in the diagnosis, evaluation, and treatment of bipolar disorder. The information provides insight into topics and principles that have clear applicability to the managed care environment.
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