Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-16T07:25:02.170Z Has data issue: false hasContentIssue false
  • English
  • Français

Relationship between cognitive functioning and 6-month clinical and functional outcome in patients with first manic episode bipolar I disorder

Published online by Cambridge University Press:  01 September 2010

I. J. Torres ,
C. M. DeFreitas ,
V. G. DeFreitas ,
D. J. Bond ,
M. Kunz ,
W. G. Honer ,
R. W. Lam  and
L. N. Yatham
I. J. Torres*
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada Research Department, Riverview Hospital, British Columbia Mental Health and Addictions Services, Coquitlam, BC, Canada
C. M. DeFreitas
Affiliation:
Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
V. G. DeFreitas
Affiliation:
Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
D. J. Bond
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
M. Kunz
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
W. G. Honer
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada Research Department, Riverview Hospital, British Columbia Mental Health and Addictions Services, Coquitlam, BC, Canada
R. W. Lam
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
L. N. Yatham
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
*
*Address for correspondence: I. J. Torres, Ph.D., Clinical Associate Professor, Department of Psychiatry, University of British Columbia; Research Scientist, Riverview Hospital, BC Mental Health and Addiction Services, 106 Administration Building, 2601 Lougheed Highway, Coquitlam, BC V3C 4J2Canada. (Email: itorres@bcmhs.bc.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although cognitive deficits in bipolar disorder have been associated with diminished functional outcome, this relationship has been studied primarily through cross-sectional designs, and has not been studied in patients early in the course of illness. The purpose of this study was to evaluate the impact of cognitive functioning on longitudinal 6-month functional and clinical outcome in recently diagnosed clinically stable patients with bipolar disorder.

Method

A total of 53 recently diagnosed patients with DSM-IV bipolar disorder type I were assessed within 3 months of their first manic episode using a neuropsychological battery measuring verbal/pre-morbid intellectual functioning, learning/memory, spatial/non-verbal reasoning, attention/processing speed and executive function. Functional outcome was assessed at baseline and 6 months using the Multidimensional Scale of Independent Functioning (MSIF) and DSM-IV Global Assessment of Functioning Scale (GAF). Clinical outcome was assessed with symptom ratings and by monitoring onset of new mood episodes.

Results

Memory, particularly verbal learning/memory, was robustly associated with 6-month functional outcome on the MSIF, even after partialling out the influence of mood symptoms and substance abuse co-morbidity. Depression ratings at 6 months, but not cognitive variables, were associated with 6-month GAF scores. Cognitive functioning was not associated with 6-month clinical outcome.

Conclusions

Memory was associated with 6-month longitudinal functional but not clinical outcome in recently diagnosed patients with bipolar disorder. These data further support the distinction between clinical and functional outcome, and emphasize the need for identification of, and development of treatments for, cognitive impairments early in the course of bipolar disorder.

Keywords

Bipolar disorderfunctional outcomememoryneurocognitionneuropsychology
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 5 , May 2011 , pp. 971 - 982
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Benton, AL, Sivan, AB, deS. Hamsher, K, Varney, NR, Spreen, O (1994). Contributions to Neuropsychological Assessment: A Clinical Manual, 2nd edn. Oxford University Press: New York, NY.Google Scholar
Berk, M, Ng, F, Wang, WV, Calabrese, JR, Mitchell, PB, Malhi, GS, Tohen, M (2008). The empirical redefinition of the psychometric criteria for remission in bipolar disorder. Journal of Affective Disorders 106, 153–158.CrossRefGoogle ScholarPubMed
Berns, S, Uzelac, S, Gonzalez, C, Jaeger, J (2007). Methodological considerations of measuring disability in bipolar disorder: Validity of the multidimensional scale of independent functioning. Bipolar Disorders 9, 3–10.CrossRefGoogle ScholarPubMed
Blair, JR, Spreen, O (1989). Predicting premorbid IQ: a revision of the National Adult Reading Test. Clinical Neuropsychologist 3, 129–136.CrossRefGoogle Scholar
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders 113, 1–20.CrossRefGoogle ScholarPubMed
Chapman, LJ, Chapman, JP (1973). Problems in the measurement of cognitive deficit. Psychological Bulletin 79, 380–385.CrossRefGoogle ScholarPubMed
Conus, P, Cotton, S, Abdel-Baki, A, Lambert, M, Berk, M, McGorry, PD (2006). Symptomatic and functional outcome 12 months after a first episode of psychotic mania: barriers to recovery in a catchment area sample. Bipolar Disorders 8, 221–231.CrossRefGoogle Scholar
Coryell, W, Scheftner, W, Keller, M, Endicott, J, Maser, J, Klerman, GL (1993). The enduring psychosocial consequences of mania and depression. American Journal of Psychiatry 150, 720–727.Google ScholarPubMed
Delis, DC, Kramer, JH, Kaplan, E, Ober, BA (2000). California Verbal Learning Test, 2nd edn. The Psychological Corporation: San Antonio, TX.Google Scholar
Dickerson, FB, Boronow, JJ, Stallings, CR, Origoni, AE, Cole, S, Yolken, RH (2004). Association between cognitive functioning and employment status of persons with bipolar disorder. Psychiatric Services 55, 54–58.CrossRefGoogle ScholarPubMed
Donders, J (2008). A confirmatory factor analysis of the California Verbal Learning Test-Second Edition (CVLT-II) in the standardization sample. Assessment 15, 123–131.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J (1976). The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766–771.CrossRefGoogle Scholar
Golden, JC (1978). Stroop Color and Word Test. Stoelting: Chicago, IL.Google Scholar
Gruber, SA, Rosso, IM, Yurgelun-Todd, D (2008). Neuropsychological performance predicts clinical recovery in bipolar patients. Journal of Affective Disorders 105, 253–260.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Jaeger, J, Berns, S, Loftus, S, Gonzalez, C, Czobor, P (2007). Neurocognitive test performance predicts functional recovery from acute exacerbation leading to hospitalization in bipolar disorder. Bipolar Disorders 9, 93–102.CrossRefGoogle ScholarPubMed
Jaeger, J, Berns, SM, Czobor, P (2003). The multidimensional scale of independent functioning: a new instrument for measuring functional disability in psychiatric populations. Schizophrenia Bulletin 29, 153–168.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Leon, AC, Solomon, DA, Coryell, W, Maser, JD, Keller, MB (2005). Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Archives of General Psychiatry 62, 1322–1330.CrossRefGoogle ScholarPubMed
Kauer-Sant'Anna, M, Bond, DJ, Lam, RW, Yatham, LN (2009). Functional outcomes in first-episode patients with bipolar disorder: a prospective study from the systematic treatment optimization program for early mania project. Comprehensive Psychiatry 50, 1–8.CrossRefGoogle ScholarPubMed
Kaufman, AS, Kaufman, NL (1990). Kaufman Brief Intelligence Test Manual. American Guidance Service: Circle Pines, MN.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Lee, TMC, Cheung, PPY (2005). The relationship between visual-perception and attention in Chinese with schizophrenia. Schizophrenia Research 72, 185–193.CrossRefGoogle ScholarPubMed
Lezak, MD, Howeison, DB, Loring, DW (2004). Neuropsychological Assessment, 4th edn. Oxford University Press: New York, NY.Google Scholar
MacQueen, GM, Young, LT, Joffe, RT (2001). A review of psychosocial outcome in patients with bipolar disorder. Acta Psychiatrica Scandinavica 103, 163–170.CrossRefGoogle ScholarPubMed
Martínez-Arán, A, Vieta, E, Colom, F, Torrent, C, Sánchez-Moreno, J, Reinares, M, Benabarre, A, Goikolea, JM, Brugué, E, Daban, C, Salamero, M (2004). Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disorders 6, 224–232.CrossRefGoogle ScholarPubMed
Martino, DJ, Marengo, E, Igoa, A, Scápola, M, Ais, ED, Perinot, L, Strejilevich, SA (2009). Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: a prospective 1 year follow-up study. Journal of Affective Disorders 116, 37–42.CrossRefGoogle ScholarPubMed
McIntyre, RS, Fallu, A, Konarski, JZ (2006). Measurable outcomes in psychiatric disorders: remission as a marker of wellness. Clinical Therapeutics 28, 1882–1891.CrossRefGoogle ScholarPubMed
Miyake, A, Friedman, NP, Emerson, MJ, Witzki, AH, Howerter, A, Wager, TD (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cognitive Psychology 41, 49–100.CrossRefGoogle ScholarPubMed
Nehra, R, Chakrabarti, S, Pradhan, BK, Khehra, N (2006). Comparison of cognitive functions between first- and multi-episode bipolar affective disorders. Journal of Affective Disorders 93, 185–192.CrossRefGoogle ScholarPubMed
Reitan, R, Wolfson, D (1993). The Halstead–Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Neuropsychology Press: Tucson, AZ.Google Scholar
Robbins, TW, James, M, Owen, AM, Sahakian, BJ, McInnes, L, Rabbitt, P (1994). Cambridge neuropsychological test automated battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 5, 266–281.Google ScholarPubMed
Robinson, LJ, Ferrier, IN (2006). Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disorders 8, 103–116.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 22–33.Google ScholarPubMed
Stefanopoulou, E, Manoharan, A, Landau, S, Geddes, JR, Goodwin, G, Frangou, S (2009). Cognitive functioning in patients with affective disorders and schizophrenia: a meta-analysis. International Review of Psychiatry 21, 336–356.CrossRefGoogle ScholarPubMed
Strauss, E, Sherman, EMS, Spreen, O (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary, 3rd edn. Oxford University Press: New York.Google Scholar
Stuss, DT, Levine, B (2002). Adult clinical neuropsychology: lessons from studies of the frontal lobes. Annual Review of Psychology 53, 401–433.CrossRefGoogle ScholarPubMed
Tabachnick, BG, Fidell, LS (2007). Using Multivariate Statistics, 5th edn. Allyn and Bacon: Boston, MA.Google Scholar
Tabares-Seisdedos, R, Balanza-Martinez, V, Sanchez-Moreno, J, Martinez-Aran, A, Salazar-Fraile, J, Selva-Vera, G, Rubio, C, Mata, I, Gomez-Beneyto, M, Vieta, E (2008). Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up. Journal of Affective Disorders 109, 286–299.CrossRefGoogle ScholarPubMed
Tohen, M, Hennen, J, Zarate, CM Jr., Baldessarini, RJ, Strakowski, SM, Stoll, AL, Faedda, GL, Suppes, T, Gebre-Medhin, P, Cohen, BM (2000). Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. American Journal of Psychiatry 157, 220–228.CrossRefGoogle ScholarPubMed
Torres, IJ, Boudreau, VG, Yatham, LN (2007). Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatrica Scandinavica Supplementum 116 (Suppl. 434), 17–26.CrossRefGoogle Scholar
Torres, IJ, DeFreitas, CM, Yatham, LN (2008). Cognition and functional outcome in bipolar disorder. In Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians (ed. Goldberg, J. F. and Burdick, K. E.), pp. 217–234. American Psychiatric Press: Washington, DC.Google Scholar
Torres, IJ, DeFreitas, VG, DeFreitas, CM, Kauer-Sant'Anna, M, Bond, DJ, Honer, WG, Lam, RW, Yatham, LN (2010). Neurocognitive functioning in bipolar I patients recently recovered from a first manic episode. Journal of Clinical Psychiatry. Published online: 23 March 2010. doi:10.4088/JCP.08m04997yel.CrossRefGoogle ScholarPubMed
Wechsler, D (1997). The Wechsler Memory Scale, 3rd edn. The Psychological Corporation: San Antonio, TX.Google Scholar
Wingo, AP, Harvey, PD, Baldessarini, RJ (2009). Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disorders 11, 113–125.CrossRefGoogle ScholarPubMed
Yatham, LN, Kauer-Sant'Anna, M, Bond, DJ, Lam, RW, Torres, I (2009 a). Course and outcome after the first manic episode in patients with bipolar disorder: prospective 12-month data from the systematic treatment optimization program for early mania project. Canadian Journal of Psychiatry 54, 105–112.CrossRefGoogle ScholarPubMed
Yatham, LN, Kennedy, SH, Schaffer, A, Parikh, SV, Beaulieu, S, O'Donovan, C, MacQueen, G, McIntyre, RS, Sharma, V, Ravindran, A, Young, LT, Young, AH, Alda, M, Milev, R, Vieta, E, Calabrese, JR, Berk, M, Ha, K, Kapczinski, F (2009 b). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disorders 11, 225–255.CrossRefGoogle Scholar
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed
Zarate, CA Jr, Tohen, M, Land, M, Cavanagh, S (2000). Functional impairment and cognition in bipolar disorder. Psychiatric Quarterly 71, 309–329.CrossRefGoogle ScholarPubMed