The Relationship Between Antipsychotic Use and Functionality in Patients with Bipolar Disorder: A Naturalistic Observational Study

Aim: The aim of this study is to investigate the impact of antipsychotic use on functioning and medication adherence in patients with bipolar disorder (BD) in remission. Material and Method: The study included 142 patients with BD who were diagnosed with remission according to DSM-5 criteria. The patients were administered various scales, including the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS), Bipolar Disorder Functioning Scale, and Morisky Medication Adherence Scale. Study participants had a HAM-D score of less than 7, a YMRS score of less than 4, and no manic, depressive, or hypomanic symptoms in the past 6 months. Results: 50.7% of study participants were female. The results showed that those not taking antipsychotics were more likely to live with someone, while those taking antipsychotics were more likely to be alone and have lower incomes. No important difference was found when patients and controls were examined in terms of gender, employment status or disease-related parameters. Antipsychotic users had higher scores in emotional functioning, whereas non-users had higher scores in family and friendships, social activities, and general functioning. Medication adherence correlated positively with social relationships but negatively with emotional, intellectual, and sexual functioning. Female gender and antipsychotic use were identified as significant predictors of overall functioning. Conclusion: This study highlights that while antipsychotics are beneficial during the acute phase of BD, their long-term impact on functioning during remission should not be ignored. The results demonstrate the importance of an individualized treatment strategy that balances symptom management with quality of life and regularly reassesses the need for antipsychotic treatment in long-term care.