New research in bipolar disorder (BPD) has uncovered various factors that may account for the enduring functional impairment observed in people who experience the disorder. Neuroimaging studies point to abnormal reductions in brain volume related to age and illness duration. Consistent with these findings, studies employing neuropsychological measures reveal that cognitive dysfunction in BPD increases with a more severe course of illness. For many people with BPD, cognitive deficits linger into periods of euthymia, and correlate with psychosocial impairment. These studies collectively support a neurodegenerative model in which repeated exposure to mood disturbance leads to neurological impairment, cognitive decline and functional difficulties. In this respect, they highlight the importance of preventive care for preserving functional adjustment in BPD. Effective prevention will probably involve significant reductions in psychosocial stress, which remains among the strongest predictors of symptom recurrence in BPD. This process may be leveraged by actively removing distressing social barriers to functioning, such as stigma and discrimination. This paper discusses implications for disability policy.
Keywords: bipolar disorder, cognitive deficits, disability policy