Funcionamiento neurocognitivo y psicosocial de pacientes con trastorno bipolar en una unidad de salud mental

INTRODUCTION: There is evidence that patients suffering from bipolar disorder (BD), and even their healthy relatives, have characteristic patterns of involvement of certain neurocognitive domains that persist after clinical remission or eutimia period. The loss of psychosocial functionality of these patients is better predicted with the presence of cognitive alterations than with clinical or evolutionary variables. The clinician should know if there is impairment or impairment in the neurocognitive functions of their patients but in the daily care environment it is difficult to adequately evaluate cognitive functions and it is not customary to quantify the psychosocial functionality of TB patients. The main difficulties are the lack of training of professionals and the high time consumption of neuropsychological batteries. For this reason, the majority of publications worldwide on this subject have been carried out in third-level care centers or in superspecialized units, which usually study patients with greater clinical severity. It is possible that, at least part of the current knowledge about BD cognition and functionality, are not representative or extrapolated to the universe (or set) of people with this disease. We intend in this research to study a population "in the real world", not affected by biases that can be derived from samples from superspecialized units or from restrictive clinical trials. METHODOLOGY: The study aims to recruit all people with TB in psychiatric follow-up in a Mental Health Unit (USM) to assess the neurocognitive status and psychosocial functioning and quantify the consumption of health resources during the year prior to the evaluation. The scales chosen for their brevity and easy applicability to evaluate said operations are respectively the "Screen for Cognitive Impairment in Psychiatry" (SCIP-S) and the Brief Scale of Functioning or Functioning Assessment Short Test (FAST), in their Spanish versions. The main objective of the study is to characterize the neurocognitive and psychosocial functioning of the sample and secondary objectives are the analysis of the relationship between different clinical, evolutionary, diagnostic and treatment variables with cognitive and psychosocial functioning as well as its relationship with the consumption of resources. and to establish which part of the variance of psychosocial functioning is explained by the degree of cognitive impairment of BP patients. STUDY JUSTIFICATION: In addition to the interest of this study to be performed in a sample that aims to represent the "real world" by sticking to explore patients who come to the first basic point of psychiatric care in a Department of Health such as the USM, the innovation of correlating the cognitive and functional state with the use of healthcare resources is added, an aspect not yet reflected in the literature. RESULTS: The study corroborates previous findings in the relationship of certain clinical variables with cognitive and functional impairment, especially with the presence of subsyndromic depressive symptoms. It differs in the severity of the cognitive and functional affectation. There is no relationship between the consumption of health resources in the previous year and cognitive impairment, but there is a relationship with the functional one. The linear and logistic regression model to predict the variance of functional impairment confirms the initial hypothesis that cognitive impairment predicts it along with other clinical and therapeutic variables. DISCUSSION AND CONCLUSIONS: Our sample shows differences in its demographic and clinical characteristics with respect to other samples studied and this seems related to the results of cognitive, functional and consumption effects of health resources. The implications of these results and the importance of applying a neurocognitive and functional evaluation in the usual clinical practice of a USM are discussed