Subjective Experiences of Bipolar Patients in The Residual or Remitted Phase
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 14, Issue 5
Abstract
Aim: Patients with bipolar disorder often experience subtle impairment in residual or remitted phase although they do not show florid mood or psychotic symptom any more. This study investigated subjective experiences of bipolar patients during residual or remitted state. Methods: Sixty patients (29 males, 31 females) who were determined to be in remission or residual state from the acute phase were included in this study. All patients were assessed in two dimensions: subjective experiences and objective experiences. Subjective experiences were measured with the Korean version of the Frankfurter Beschwerde-Fragebogen (K-FBF) and Symptom Check List 90-R (SCL-90-R). Objective psychopathology was measured with the Positive and Negative Symptoms Scale (PANSS), Young Mania Rating Scale (YMRS), and Montgomery Asberg Depression Rating Scale (MADRS). We then examined the relationship between subjective experiences and objective psychopathology. Results: A longer period of hospitalization was significantly correlated with lower K-FBF and SCL-90-R total scores. The K-FBF total score was not correlated with YMRS and PANSS scores. However, the SCL-90-R total score was significantly correlated with almost all objective psychopathology measures. Multiple regression analysis revealed that the subjective expereince \as measured by the total K-FBF score was predicted by the number of previous episodes. Conclusion: It is suggested that subjective experience of cognitive impairment is more trait dependent than state dependent in bipolar disorder. It is also suggested that subjective experiences are aggravated with the number of episodes, and hence it might be related to brain damage as the illness progresses. Traditionally, objective psychopathology has been considered more valid than self-reported assessments, and so subjective experience has received little attention [1,2]. Although there is some concern about methodological problems of subjective experience [3], there is evidence that even patients with poor insight can recognize their symptoms and report truthfully [4]. Especially bipolar patients usually obtain good insight once the acute phase is remited, so evaluation of subjective experience is considered to be relia ble in the detection of cognitive impairment. Subjective experience is sensitive to measure the subtle cognitive impairments that are not yet psychotic [5]. Although it contributes to the improvement of inter-rater reliability, the diagnostic system used currently – based on objective pathology – does not offer new perspective on etiology and psychopathology. We therefore need to pay careful attention to areas that are difficult to evaluate using objective measurements. There have been reports that subjective experience exists even before distinct objective psychopathology has occurred [6,7], and some authors have suggested subjective experience as a marker of vulnerability that is related to organic brain abnormality [8-10]. In summary, it is expected that the investigation of subjective cognitive impairment in bipolar disorder would be helpful in elucidating the pathophysiology and etiology of bipolar disorder. Several instruments have been used to evaluate subjective experiences: Subjective Deficit Syndrome Scale2, Subclinical Symptoms Scale [11], Bonn Scale for the Assessment of Basic symptoms [12] and Frankfurter Beschwerde Fragebogen (FBF) [13]. Among these, the FBF is one of the most representative tools and is the most widely used in Europe. FBF measures subjective complaint of cognitive impairment in psychotic disorder. Unlike the Symptom Check List 90-R (SCL-90-R), which covers general subjective symptoms, FBF points to cognitive impairment specifically. In spite of some concerns of the validity of self-reported assessments3, FBF is known to be a reliable measure of subjective cognitive impairment [8,10]. Specifically, FBF evaluates residual symptoms and the remission period well [1,14], and hence can be an effective instrument for investigating subjective cognitive impairment during the residual and remitted phases. This study investigated the implication of cognitive impairment of bipolar patients by measuring FBF in the residual and remitted phases. We also examined the relationship between clinical characteristics, objective psychopathology, general subjective dysfunction, and subjective experience. To exclude the influence of acute symptoms on cognitive function, we performed evaluations when the acute symptoms were judged to be either remitted or only residual.
Authors and Affiliations
Soo Hyun Joe
Keywords
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- EP ID EP594751
- DOI 10.26717/BJSTR.2019.14.002602
- Views 114
- Downloads 0
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