Brief reportClinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: A long-term, follow-up study
Introduction
Bipolar disorder (BD) is a severe mental illness that affects nearly 4.4% of the population (Merikangas et al., 2007). According to the World Health Organisation (WHO), bipolar disorder is the 6th cause of disability among all other diseases (Murray and Lopez, 1996). There is a gap between clinical remission and functional outcome (Huxley and Baldessarini, 2007, Goetz et al., 2007, Rosa et al., 2008) and it is known that after a relapse, only 40% of the patients achieve premorbid functional outcome during euthymia (Delbello et al., 2007). Therefore, it is necessary to identify which factors contribute to this disability.
Clinical course may impact on functional outcome. In fact, a recent study described clinical predictors of disability during euthymia: previous number of mixed episodes, current subdepressive symptomatolgy, previous number of hospitalizations and older age were the variables that best predicted poor functional outcome (Rosa et al., 2009).
Cognition is also thought to play an important role in psychosocial functioning (Ferrier et al., 1999, Mur et al., 2007, Torrent et al., 2007). Several cross-sectional studies have already pointed out that there may be a link between cognitive impairment and disability (Dickerson et al., 2004, Martinez-Aran et al., 2004a, Martinez-Aran et al., 2004b, Martinez-Aran et al., 2007) but there is limited evidence that this is really the case from longitudinal studies. As far as we know, only three studies analyzed this relationship longitudinally (Jaeger et al., 2007, Martino et al., 2009, Tabares-Seisdedos et al., 2008a).
Our main aim was to assess which clinical and neurocognitive variables would best predict the functional outcome of euthymic bipolar patients in the 4-year follow up study. Our hypothesis was that verbal memory and executive functions would be critical when it comes to predict disability and long-term psychosocial functional outcome.
Section snippets
Subjects
Thirty two patients with BD were recruited from the Barcelona Bipolar Disorder Program, with the following inclusion criteria: 1) BD diagnosis (Type I or II) according to DSM-IV criteria; 2) euthymia, defined by HRDS ≤ 8 [Hamilton Rating Scale for Depression (Hamilton, 1960, Ramos-Brieva and Cordero, 1986)] and YMRS ≤ 6 [Young–Mania Rating Scale (Young et al., 1978, Colom et al., 2002)] at least 6 months at baseline, and 3 months at follow-up; 3) Age between 18–65 years old. Exclusion criteria
Results
Baseline description of demographic, clinical and neuropsychological data of the sample is provided in Table 1.
Discussion
The main finding of the present study is that some cognitive factors like free delayed recall (verbal memory), as well as subdepressive symptomatology are significant predictors of long-term functional outcome in bipolar patients. This study, therefore, prospectively confirms the predictive value of neurocognitive performance and subthreshold symptoms even when using a specific functioning scale (FAST). Other studies from our group suggested a cross-sectional link between verbal memory and poor
Role of funding source
This work was partly supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, CIBERSAM and IDIBAPS.
Conflict of interest
Caterina del Mar Bonnin has no conflict of interests.
Dr. Anabel Martinez-Aran has no conflict of interests.
Carla Torrent has no conflict of interests.
Isabella Pacchiarotti has no conflict of interests.
Adriane R. Rosa has no conflict of interests.
Carolina Franco has no conflict of interests.
Andrea Murru has no conflict of interests.
Jose Sanchez-Moreno has no conflict of interests.
Professor Eduard Vieta has served as consultant, advisor or speaker for the following companies: Almirall,
Acknowledgments
The authors of this report would like to thank the support of the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, CIBERSAM and IDIBAPS.
References (43)
- et al.
Neurocognitive endophenotypes (endophenocognitypes) from studies of relatives of bipolar disorder subjects: a systematic review
Neurosci. Biobehav. Rev.
(2008) - et al.
Spanish version of a scale for the assessment of mania: validity and reliability of the Young Mania Rating Scale
Med. Clin. (Barc.)
(2002) - et al.
Cognitive functioning in schizophrenia and bipolar disorder: comparison of performance on the Repeatable Battery for the Assessment of Neuropsychological Status
Psychiatry Res.
(2004) - et al.
Allostatic load in bipolar disorder: implications for pathophysiology and treatment
Neurosci. Biobehav. Rev.
(2008) - et al.
Variations in genes regulating neuronal migration predict reduced prefrontal cognition in schizophrenia and bipolar subjects from Mediterranean Spain: a preliminary study
Neuroscience
(2006) - et al.
Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up
J. Affect. Disord.
(2008) - et al.
Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: results of a large, multisite study
J. Clin. Psychiatry
(2006) Diagnostic and Statistical Manual of Mental Disorders
(1994)- et al.
Multilingual Aphasia Examination
(1976) - Bora, E., Vahip, S., Akdeniz, F., Ilerisoy, H., Aldemir, E., Alkan, M., 2008. Executive and verbal working memory...
A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission
Arch. Gen. Psychiatry
Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial
Br. J. Psychiatry
Twelve-month outcome of adolescents with bipolar disorder following first hospitalization for a manic or mixed episode
Am. J. Psychiatry
California Verbal Learning Test
Neuropsychological function in euthymic patients with bipolar disorder
Br. J. Psychiatry
Neurocognitive function in unaffected first-degree relatives of patients with bipolar disorder: a preliminary report
Bipolar Disord.
Treatment of bipolar disorder: a systematic review of available data and clinical perspectives
Int. J. Neuropsychopharmacol.
Functional impairment in patients with mania: baseline results of the EMBLEM study
Bipolar Disord.
Stroop Colour and Word Test Stoelting
A rating scale for depression
J. Neurol. Neurosurg. Psychiatry
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