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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 4J2 Canada. (Email: [email protected])
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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

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