Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: A long-term, follow-up study

Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Journal of Affective Disorders (Impact Factor: 3.38). 07/2009; 121(1-2):156-60. DOI: 10.1016/j.jad.2009.05.014
Source: PubMed


To identify clinical and neurocognitive predictors of long-term functional outcome in patients with bipolar disorder
A total of 32 subjects who met criteria for bipolar I or II disorder were recruited from the Barcelona Bipolar Disorder Program and were assessed clinically and neuropsychologically at baseline. After an average 4-year follow-up, they were interviewed with the Functioning Assessment Short Test (FAST) to assess functional outcome. Multivariate analyses were applied to identify clinical and neurocognitive predictors of functional outcome.
The main regression model for predictors of overall psychosocial functioning identified subclinical depressive symptoms (beta=0.516, t=3.51, p=0.002), and free delayed recall in a verbal memory task (beta=-0.314, t=-2.144, p=0.041), accounting for 36% of the variance. Specific predictors of occupational functioning were, again, subthreshold depression (beta=0.435, t=2.8, p=0.009) and a measure of executive function, digits backwards (beta=-0.347, t=-2.23, p=0.034). This model explained around 28% of the variance (corrected R(2)=0.28; F=6.38, gl=2, p=0.004).
Subdepressive symptomatology together with neurocognitive impairments related to verbal memory and executive functions are predictor variables of long-term functional outcome in bipolar disorder.

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    • "Regarding the present results, it is worth mentioning that the changes in delayed free recall were not correlated with changes in functional outcome. This was an unexpected result, since it has been consistently found that verbal memory impairment is related to worse functional outcome (Martínez-Arán et al. 2007; Martino et al. 2009; Bonnin et al. 2010). Even though these are preliminary results, we have different hypotheses that may explain this lack of relationship between the two variables: first, it might be attributed to the loss of statistical power due to small sample size in the functional remediation group. "
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    ABSTRACT: Background: Functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. Method: A total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. Results: Patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). Conclusions: Functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation.
    Psychological Medicine 09/2015; DOI:10.1017/S0033291715001713 · 5.94 Impact Factor
    • "A defi cit in verbal memory (VM), in particular , has been consistently identifi ed as a trait neuropsychological impairment persisting in all mood states (Martinez-Aran et al. 2004; Schretlen et al. 2007; Torres et al. 2007; Sanchez-Morla et al. 2009). VM has been associated with functional outcome (Sanchez-Morla et al. 2009; Burdick et al. 2010; Torres et al. 2011) and may be more strongly associated with psychosocial and occupational functioning than clinical variables such as illness duration and number of mood episodes (Martinez- Aran et al. 2004; Bonnin et al. 2010). "
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    ABSTRACT: Objectives. Verbal memory (VM) impairment is a trait feature of bipolar I disorder (BDI) that is present at illness onset and associated with functional outcome. However, little is known about the morphological abnormalities underlying this deficit early in the disease course. This study examined the neurobiological correlates of VM impairment in euthymic newly diagnosed patients, with attention to frontal and medial temporal (MT) structures known to contribute to VM. Methods. Euthymic patients with BDI recently recovered from their first episode of mania (n = 42) were compared with healthy subjects (n = 37) using measures of the California Verbal Learning Test (CVLT-II) associated with frontal and MT functioning. A subset of participants had 3T MRI scan (n = 31 patient group, n = 30 healthy subject group). Hippocampal and prefrontal volumes were analyzed using FreeSurfer 5.1 and correlated with their corresponding CVLT-II subscores. Results. Patients showed decreased performance in total learning as well as short and long delay verbal recall. Consistent with MT dysfunction, they also showed deficits in recognition discriminability and learning slope. In the patient group only, left hippocampal volumes were negatively correlated with these measures. Conclusions. These results suggest that anomalous MT functioning is involved with VM impairment early in the course of BDI.
    The World Journal of Biological Psychiatry 02/2015; 16(4):1-12. DOI:10.3109/15622975.2014.1000373 · 4.18 Impact Factor
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    • "Based on the studies published to date, the hypotheses pertaining to the validity of the WHODAS 2.0 are: (1) dimensional structure will adjust to that proposed by the creators of the instrument, assuming six disability factors (World Health Organization, 2000); (2) WHODAS 2.0 scores will be significantly related to levels of depression (Baron et al., 2008; Chwastiak and Von Korff, 2003; McKibbin et al., 2004), illness severity (Bottlender et al., 2013; Luciano et al., 2010a; Pösl et al., 2007), social and occupational functioning (Hudson et al., 2008; Lee et al., 2013; Pösl et al., 2007) and health-related quality of life (Chávez et al., 2005; Luciano et al., 2010b; Quintas et al., 2012; Raggi et al., 2011); (3) patients who are working or studying will present a lesser degree of disability than those who are not working (De Wolf et al., 2012; Garin et al., 2010); and (4) patients in euthymic phase will show a lesser degree of disability compared to those who are not in said phase of the disease (Bonnín et al., 2012; Garin et al., 2010). "
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    ABSTRACT: The WHODAS 2.0 is an ICF-based multidimensional instrument developed for measuring disability. The present study analyzes the utility of the 36-item interviewer-administered version in a sample of patients with bipolar disorder. There is no study to date that analyses how the scale works in a sample that only comprises such patients. A total of 291 patients with bipolar disorder (42.6% males) according to DSM-IV-TR criteria from a cross-sectional study conducted in outpatient psychiatric clinics were enrolled. In addition to the WHODAS 2.0, patients completed a comprehensive assessment battery including measures on psychopathology, functionality and quality of life. Analyses were centered on providing evidence on the validity and utility of the Spanish version of the WHODAS 2.0 in bipolar patients. Participation domain had the highest percentage of missing data (2.7%). Confirmatory factorial analysis was used to test three models formulated in the literature: six primary correlated factors, six primary factors with a single second-order factor, and six primary factors with two second-order factors. The three models were plausible, although the one formed by six correlated factors produced the best fit. Cronbach's alpha values ranged between .73 for the Self-care domain and .92 for Life activities, and the internal consistency of the total score was .96. Relationships between the WHODAS 2.0 and measures of psychopathology, functionality and quality of life were in the expected direction, and the scale was found to be able to differentiate among patients with different intensity of clinical symptoms and work situation. The percentage of euthymic patients was considerable. However, the assessment of euthymic patients is less influenced by mood. Some psychometric properties have not been studied, such as score stability and sensitivity to change. The Spanish version of the 36-item WHODAS 2.0 has suitable psychometric properties in terms of reliability and validity when applied to patients with bipolar disorder. Disability in bipolar patients is especially prominent in Cognition, Getting along, Life activities, and Participation domains, so functional remediation interventions should emphasize these areas in order to improve the daily living activities of these patients. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 12/2014; 174C:353-360. DOI:10.1016/j.jad.2014.12.028 · 3.38 Impact Factor
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