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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    • "Prospective longitudinal studies have indicated that patients experience mood symptoms around half of the time they have the disorder, but while the characteristic feature of the disorder is (hypo)mania, it is depressive symptoms that are far more prevalent (Judd et al., 2002, 2003). Its etiology is unknown and a large amount of work in recent years has been undertaken to characterize the functional, cognitive and social deficits associated with the illness (Bonnín et al., 2010; Fagiolini et al., 2005; Goetz, Tohen, Reed, Lorenzo, & Vieta, 2007; Green, Cahill, & Malhi, 2007; MacQueen, Young, & Joffe, 2001; Van Rheenen & Rossell, 2014b). Emotion processing in BD has received increasing attention in an attempt to understand whether some element of dysfunction in the processing of emotional stimuli plays a part in clinical mood symptoms (Van Rheenen & Rossell, 2013). "
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    ABSTRACT: Previous studies of facial emotion processing in bipolar disorder (BD) have reported conflicting findings. In independently conducted studies, we investigate facial emotion labeling in euthymic and depressed BD patients using tasks with static and dynamically morphed images of different emotions displayed at different intensities. Study 1 included 38 euthymic BD patients and 28 controls. Participants completed two tasks: labeling of static images of basic facial emotions (anger, disgust, fear, happy, sad) shown at different expression intensities; the Eyes Test (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001), which involves recognition of complex emotions using only the eye region of the face. Study 2 included 53 depressed BD patients and 47 controls. Participants completed two tasks: labeling of “dynamic” facial expressions of the same five basic emotions; the Emotional Hexagon test (Young, Perret, Calder, Sprengelmeyer, & Ekman, 2002). There were no significant group differences on any measures of emotion perception/labeling, compared to controls. A significant group by intensity interaction was observed in both emotion labeling tasks (euthymia and depression), although this effect did not survive the addition of measures of executive function/psychomotor speed as covariates. Only 2.6–15.8% of euthymic patients and 7.8–13.7% of depressed patients scored below the 10th percentile of the controls for total emotion recognition accuracy. There was no evidence of specific deficits in facial emotion labeling in euthymic or depressed BD patients. Methodological variations—including mood state, sample size, and the cognitive demands of the tasks—may contribute significantly to the variability in findings between studies.
    Journal of the International Neuropsychological Society 10/2015; 21(9):709-721. DOI:10.1017/s1355617715000909 · 2.96 Impact Factor
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    • "Although 97.5% of BD patients are in remission from affective symptoms in the 24 months after the start of treatment, only 37.6% recuperate to a comparable functionality (Tohen et al., 2000). Among the factors associated with functionality, neurocognitive impairment has been described as one of the best long-term predictors (Jaeger et al., 2007; Bonnin et al., 2010). There is increasing evidence that indicates BD is associated with cognitive impairment (Martínez- Arán et al., 2000; Torres et al., 2007). "
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    ABSTRACT: Background: The aim of choosing a mood-stabilizing drug (lithium or anticonvulsants) or a combination of them with minimal neurocognitive effects is to stimulate the development of criteria for a therapeutic adequacy, particularly in Bipolar Disorder (BD) patients who are clinically stabilized. Method: Three groups of BD patients were established according to their treatment: i) lithium monotherapy (n = 29); ii) lithium together with one or more anticonvulsants (n = 28); and iii) one or more anticonvulsants (n = 16). A group of healthy controls served as the control (n = 25). The following tests were applied: Wechsler Adult Intelligence Scale, Trail Making Test, Wechsler Memory Scale, Rey Complex Figure Test, Stroop color-word test, Wisconsin Card Sorting Test, Tower of Hanoi, Frontal Assessment Battery, and Reading the Mind in the Eyes Test. Results. Relative to healthy controls, BD patients showed the following: i) those on lithium monotherapy, but not other BD groups, had preserved short-term auditory memory, long-term memory, and attention; ii) those who took only anticonvulsants showed worse findings in short-term visual memory, working memory, and several executive functions; and iii) all BD patients showed worse performance in processing speed, resistance to interference, and emotion recognition. Limitations: Medication alone cannot explain why all BD patients showed common cognitive deficits despite different pharmacological treatment. Conclusion: The impairment on some executive functions and emotion recognition is an inherent trait in BD patients, regardless of their pharmacological treatment. However, while memory, attention, and most of the executive functions are preserved in long-term stable BD patients, these cognitive functions are impaired in those who take anticonvulsants.
    Journal of Affective Disorders 10/2015; DOI:10.1016/j.jad.2015.10.008 · 3.38 Impact Factor
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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
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