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Psychosocial function in schizophrenia and bipolar disorder: Relationship to neurocognition and clinical symptoms

Published online by Cambridge University Press:  28 May 2010

CARMEN SIMONSEN*
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway Department of Psychology, University of Oslo, Oslo, Norway
KJETIL SUNDET
Affiliation:
Department of Psychology, University of Oslo, Oslo, Norway
ANJA VASKINN
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway
TORILL UELAND
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
KRISTIN LIE ROMM
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
TONE HELLVIN
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
INGRID MELLE
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
SVEIN FRIIS
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
OLE A. ANDREASSEN
Affiliation:
Psychosis Research Section, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
*
*Correspondence and reprint requests to: Carmen Simonsen, Psychosis Research Section - TOP, Building 49, Oslo University Hospital, Kirkeveien 166, 0407 Oslo, Norway. E-mail: c.e.simonsen@medisin.uio.no

Abstract

In line with a dimensional approach to psychopathology, we examined whether psychosocial function and its relationship to neurocognition and clinical symptoms differ across schizophrenia and bipolar disorder subgroups with and without a history of affective or psychotic episodes. From the TOP study, a heterogeneous sample of individuals with schizophrenia spectrum disorders without (n = 60) and with a history of affective episodes (n = 54); individuals with bipolar spectrum disorders with (n = 64) and without a history of psychosis (n = 56) and healthy controls (n = 268) participated. Psychosocial functioning was measured with the Social Functioning Scale (self-rated) and the Global Assessment of Functioning Scale (clinician-rated), neurocognition with a comprehensive neuropsychological test battery, and symptoms with Inventory of Depressive Symptomatology, Young Mania Rating Scale, and Positive and Negative Syndrome Scale. Clinician-rated functioning was poorer in schizophrenia groups than in bipolar groups, but self-rated functioning was similar across all clinical groups and poorer than in controls. Neurocognition and current clinical symptoms were associated with psychosocial function in bivariate analyses, but current symptoms had a greater independent contribution to functioning than neurocognition across clinical groups in multivariate analyses. Despite differences in neurocognition and psychosocial function, groups showed the same pattern in prediction of functioning irrespective of DSM-IV or clinical definition. (JINS, 2010, 16, 771–783.)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2010

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References

REFERENCES

Altshuler, L.L., Bearden, C.E., Green, M.F., van Gorp, W., & Mintz, J. (2008). A relationship between neurocognitive impairment and functional impairment in bipolar disorder: A pilot study. Psychiatry Research, 157, 289293.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1994). Diagnostic and Statistical manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association.Google Scholar
Arts, B., Jabben, N., Krabbendam, L., & van Os, J. (2008). Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychological Medicine, 38, 771785.CrossRefGoogle ScholarPubMed
Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake, S. (1990). The social functioning scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157, 853859.CrossRefGoogle ScholarPubMed
Bonnin, C.M., Martinez-Aran, A., Torrent, C., Pacchiarotti, I., Rosa, A.R., Franco, C., et al. (2009). Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: A long-term, follow-up study. Journal of Affective Disorders. 121, 156160.CrossRefGoogle ScholarPubMed
Bora, E., Vahip, S., Akdeniz, F., Gonul, A.S., Eryavuz, A., Ogut, M., et al. (2007). The effect of previous psychotic mood episodes on cognitive impairment in euthymic bipolar patients. Bipolar Disorders, 9, 468477.CrossRefGoogle ScholarPubMed
Bora, E., Yucel, M., Fornito, A., Berk, M., & Pantelis, C. (2008). Major psychoses with mixed psychotic and mood symptoms: Are mixed psychoses associated with different neurobiological markers? Acta Psychiatrica Scandinavica, 118, 172187.CrossRefGoogle ScholarPubMed
Bowie, C.R., Reichenberg, A., Patterson, T.L., Heaton, R.K., & Harvey, P.D. (2006). Determinants of real-world functional performance in schizophrenia subjects: Correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry, 163, 418425.CrossRefGoogle Scholar
Bozikas, V.P., Kosmidis, M.H., Kafantari, A., Gamvrula, K., Vasiliadou, E., Petrikis, P., et al. (2006). Community dysfunction in schizophrenia: Rate-limiting factors. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 30, 463470.CrossRefGoogle ScholarPubMed
Burns, T., & Patrick, D. (2007). Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatrica Scandinavica, 116, 403418.CrossRefGoogle ScholarPubMed
Cohen, A.S., Brown, L.A., & Minor, K.S. (2009). The psychiatric symptomatology of deficit schizophrenia: A meta-analysis. Schizophrenia Research, 118, 122127.CrossRefGoogle ScholarPubMed
Cohen, A.S., Saperstein, A.M., Gold, J.M., Kirkpatrick, B., Carpenter, W.T. Jr., & Buchanan, R.W. (2007). Neuropsychology of the deficit syndrome: New data and meta-analysis of findings to date. Schizophrenia Bulletin, 33, 12011212.CrossRefGoogle ScholarPubMed
Craddock, N., & Owen, M.J. (2007). Rethinking psychosis: The disadvantages of a dichotomous classification now outweigh the advantages. World Psychiatry, 6, 8491.Google ScholarPubMed
Delis, D.C., Kaplan, E., & Kramer, J.H. (2005). The Delis-Kaplan Executive Function System (D-KEFS). Norwegian manual. Stockholm: Pearson Assessment.Google Scholar
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (2004). California Verbal Learning Test (CVLT-II). Norwegian manual supplement. Stockholm: Pearson Assessment.Google Scholar
Dickerson, F.B., Boronow, J.J., Stallings, C.R., Origoni, A.E., Cole, S., & Yolken, R.H. (2004). Association between cognitive functioning and employment status of persons with bipolar disorder. Psychiatric Services, 55, 5458.CrossRefGoogle ScholarPubMed
Dickerson, F.B., Sommerville, J., Origoni, A.E., Ringel, N.B., & Parente, F. (2001). Outpatients with schizophrenia and bipolar I disorder: Do they differ in their cognitive and social functioning? Psychiatry Research, 102, 2127.CrossRefGoogle ScholarPubMed
Dickinson, D., & Coursey, R.D. (2002). Independence and overlap among neurocognitive correlates of community functioning in schizophrenia. Schizophrenia Research, 56, 161170.CrossRefGoogle Scholar
Drake, R.E., Mueser, K.T., & McHugo, G.J. (1996). Clinician rating scales. In Sederer, L., & Dickey, I.B. (Eds.), Outcomes assessment in clinical practice (pp. 113116). Baltimore, MD: Williams & Wilkins.Google Scholar
Evans, J.D., Heaton, R.K., Paulsen, J.S., McAdams, L.A., Heaton, S.C., & Jeste, D.V. (1999). Schizoaffective disorder: A form of schizophrenia or affective disorder? Journal of Clinical Psychiatry, 60, 874882.CrossRefGoogle ScholarPubMed
First, M., Spitzer, R., Gibbon, M., & Williams, J.B.W. (1995). Structured clinical interview for DSM-IV Axis I disorders: Patient edition (SCID-P), Version 2. New York, NY: New York State Psychiatric Institute, Biometrics Research.Google Scholar
Glahn, D.C., Bearden, C.E., Barguil, M., Barrett, J., Reichenberg, A., Bowden, C.L., et al. (2007). The neurocognitive signature of psychotic bipolar disorder. Biological Psychiatry, 62, 910916.CrossRefGoogle ScholarPubMed
Glahn, D.C., Bearden, C.E., Cakir, S., Barrett, J.A., Najt, P., Serap, M.E., et al. (2006). Differential working memory impairment in bipolar disorder and schizophrenia: Effects of lifetime history of psychosis. Bipolar Disorders, 8, 117123.CrossRefGoogle ScholarPubMed
Gold, J.M. (2004). Cognitive deficits as treatment targets in schizophrenia. Schizophrenia Research, 72, 2128.CrossRefGoogle Scholar
Green, M.F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153, 321330.Google Scholar
Green, M.F. (2006). Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. Journal of Clininical Psychiatry, 67(Suppl. 9), 38.Google ScholarPubMed
Green, M.F., Kern, R.S., Braff, D.L., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the “right stuff”? Schizophrenia Bulletin, 26, 119136.CrossRefGoogle ScholarPubMed
Green, M.F., Kern, R.S., & Heaton, R.K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: Implications for MATRICS. Schizophrenia Research, 72, 4151.CrossRefGoogle ScholarPubMed
Haatveit, B., Sundet, K., Hugdahl, K., Ueland, T., Melle, I., & Andreassen, O. (2010). The validity of d prime as a working memory index: Results from the “Bergen n-back task”. Journal of Clinical and Experimental Neuropsychology, [Epub ahead of print].CrossRefGoogle Scholar
Heinrichs, R.W., Ammari, N., McDermid, V.S., & Miles, A.A. (2008). Are schizophrenia and schizoaffective disorder neuropsychologically distinguishable? Schizophrenia Research, 99, 149154.CrossRefGoogle ScholarPubMed
Hellvin, T., Sundet, K., Vaskinn, A., Simonsen, C., Ueland, T., Andreassen, O., et al. (2010). Social functioning in severe mental disorders: A validation of the social functioning scale for patients with bipolar disorder. (Submitted).Google Scholar
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, 93102.CrossRefGoogle ScholarPubMed
Kauer-Sant’anna, M., Bond, D.J., Lam, R.W., & Yatham, L.N. (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, 18.CrossRefGoogle ScholarPubMed
Kay, S.R., Fiszbein, A., & Opler, L.A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276.CrossRefGoogle Scholar
Keck, P.E., McElroy, S.L., Havens, J.R., Altshuler, L.L., Nolen, W.A., Frye, M.A., et al. (2003). Psychosis in bipolar disorder: Phenomenology and impact on morbidity and course of illness. Comprehensive Psychiatry, 44, 263269.CrossRefGoogle ScholarPubMed
Kirkpatrick, B., Buchanan, R.W., Breier, A., & Carpenter, W.T. Jr. (1994). Depressive symptoms and the deficit syndrome of schizophrenia. Journal of Nervous and Mental Disease, 182, 452455.CrossRefGoogle ScholarPubMed
Kirkpatrick, B., Buchanan, R.W., Ross, D.E., & Carpenter, W.T. Jr. (2001). A separate disease within the syndrome of schizophrenia. Archives of General Psychiatry, 58, 165171.CrossRefGoogle ScholarPubMed
Kurtz, M.M. (2006). Symptoms versus neurocognitive skills as correlates of everyday functioning in severe mental illness. Expert Review of Neurotherapeutics, 6, 4756.CrossRefGoogle ScholarPubMed
Kurtz, M.M., Moberg, P.J., Ragland, J.D., Gur, R.C., & Gur, R.E. (2005). Symptoms versus neurocognitive test performance as predictors of psychosocial status in schizophrenia: A 1- and 4-year prospective study. Schizophrenia Bulletin, 31, 167174.CrossRefGoogle ScholarPubMed
Laes, J.R., & Sponheim, S.R. (2006). Does cognition predict community function only in schizophrenia?: A study of schizophrenia patients, bipolar affective disorder patients, and community control subjects. Schizophrenia Research, 84, 121131.CrossRefGoogle ScholarPubMed
Leifker, F.R., Bowie, C.R., & Harvey, P.D. (2009). Determinants of everyday outcomes in schizophrenia: The influences of cognitive impairment, functional capacity, and symptoms. Schizophrenia Research, 115, 8287.CrossRefGoogle Scholar
Martinez-Aran, A., Penades, R., Vieta, E., Colom, F., Reinares, M., Benabarre, A., et al. (2002). Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome. Psychotherapy and Psychosomatics, 71, 3946.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Torrent, C., Tabares-Seisdedos, R., Salamero, M., Daban, C., Balanza-Martinez, V., et al. (2008). Neurocognitive impairment in bipolar patients with and without history of psychosis. Journal of Clinical Psychiatry, 69, 233239.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Vieta, E., Torrent, C., Sanchez-Moreno, J., Goikolea, J.M., Salamero, M., et al. (2007). Functional outcome in bipolar disorder: The role of clinical and cognitive factors. Bipolar Disorders, 9, 103113.CrossRefGoogle ScholarPubMed
Martino, D.J., Marengo, E., Igoa, A., Scapola, M., Ais, E.D., Perinot, L., et al. (2009). Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: A prospective 1 year follow-up study. Journal of Affective Disorder, 161, 3742.CrossRefGoogle Scholar
Mohamed, S., Rosenheck, R., Swartz, M., Stroup, S., Lieberman, J.A., & Keefe, R.S. (2008). Relationship of cognition and psychopathology to functional impairment in schizophrenia. American Journal of Psychiatry, 165, 978987.CrossRefGoogle Scholar
Mur, M., Portella, M.J., Martinez-Aran, A., Pifarre, J., & Vieta, E. (2009). Influence of clinical and neuropsychological variables on the psychosocial and occupational outcome of remitted bipolar patients. Psychopathology, 42, 148156.CrossRefGoogle ScholarPubMed
Nuechterlein, K.H., Green, M.F., Kern, R.S., Baade, L.E., Barch, D.M., Cohen, J.D., et al. (2008). The MATRICS Consensus Cognitive Battery, part 1: Test selection, reliability, and validity. American Journal of Psychiatry, 165, 203213.CrossRefGoogle ScholarPubMed
Pedersen, G., Hagtvet, K.A., & Karterud, S. (2007). Generalizability studies of the Global Assessment of Functioning-Split version. Comprehensive Psychiatry, 48, 8894.CrossRefGoogle ScholarPubMed
Perlick, D.A., Rosenheck, R.A., Kaczynski, R., Bingham, S., & Collins, J. (2008). Association of symptomatology and cognitive deficits to functional capacity in schizophrenia. Schizophrenia Research, 99, 192199.CrossRefGoogle Scholar
Pijnenborg, G.H., Withaar, F.K., Evans, J.J., van den Bosch, R.J., Timmerman, M.E., & Brouwer, W.H. (2009). The predictive value of measures of social cognition for community functioning in schizophrenia: Implications for neuropsychological assessment. Journal of the International Neuropsychological Society, 15, 239247.CrossRefGoogle ScholarPubMed
Romm, K.L., Rossberg, J.I., Berg, A.O., Barrett, E.A., Faerden, A., Agartz, I., et al. (2010). Depression and depressive symptoms in first episode psychosis. Journal of Nervous and Mental Disease, 198, 6771.CrossRefGoogle ScholarPubMed
Root, J.C., Robbins, R.N., Chang, L., & VAN Gorp, W.G. (2006). Detection of inadequate effort on the California Verbal Learning Test-Second edition: Forced choice recognition and critical item analysis. Journal of the International Neuropsychological Society, 12, 688696.CrossRefGoogle ScholarPubMed
Rosa, A.R., Reinares, M., Franco, C., Comes, M., Torrent, C., Sanchez-Moreno, J., et al. (2009). Clinical predictors of functional outcome of bipolar patients in remission. Bipolar Disorders, 11, 401409.CrossRefGoogle ScholarPubMed
Rosen, L.N., Rosenthal, N.E., Dunner, D.L., & Fieve, R.R. (1983). Social outcome compared in psychotic and nonpsychotic bipolar I patients. Journal of Nervous and Mental Disease, 171, 272275.CrossRefGoogle ScholarPubMed
Rush, A.J., Gullion, C.M., Basco, M.R., Jarrett, R.B., & Trivedi, M.H. (1996). The Inventory of Depressive Symptomatology (IDS): Psychometric properties. Psychological Medicine, 26, 477486.CrossRefGoogle ScholarPubMed
Sanchez-Moreno, J., Martinez-Aran, A., Tabares-Seisdedos, R., Torrent, C., Vieta, E., & Ayuso-Mateos, J.L. (2009). Functioning and disability in bipolar disorder: An extensive review. Psychotherapy and Psychosomatics, 78, 285297.CrossRefGoogle Scholar
Schultz, S.K., & Andreasen, N.C. (1999). Schizophrenia. Lancet, 353, 14251430.CrossRefGoogle ScholarPubMed
Simonsen, C., Sundet, K., Vaskinn, A., Birkenaes, A.B., Engh, J.A., Faerden, A., et al. (2009). Neurocognitive dysfunction in bipolar and schizophrenia spectrum disorders depends on history of psychosis rather than diagnostic group. Schizophrenia Bulletin, [Epub ahead of print].Google ScholarPubMed
Smith, M.J., Barch, D.M., & Csernansky, J.G. (2009). Bridging the gap between schizophrenia and psychotic mood disorders: Relating neurocognitive deficits to psychopathology. Schizophrenia Research, 107, 6975.CrossRefGoogle ScholarPubMed
Spitzer, R.L., Williams, J.B., Kroenke, K., Linzer, M., deGruy, F.V. III, Hahn, S.R., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. Journal of the American Medical Association, 272, 17491756.CrossRefGoogle ScholarPubMed
Tabares-Seisdedos, R., Balanza-Martinez, V., Sanchez-Moreno, J., Martinez-Aran, A., Salazar-Fraile, J., Selva-Vera, G., et al. (2008). Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up. Journal of Affective Disorder, 109, 286299.CrossRefGoogle ScholarPubMed
van Os, J., & Kapur, S. (2009). Schizophrenia. Lancet, 374, 635645.CrossRefGoogle ScholarPubMed
Vaskinn, A., Sundet, K., Friis, S., Simonsen, C., Birkenaes, A.B., Jonsdottir, H., et al. (2008). Emotion perception and learning potential: Mediators between neurocognition and social problem-solving in schizophrenia? Journal of International Neuropsychological Society, 14, 279288.CrossRefGoogle Scholar
Velligan, D.I., Alphs, L., Lancaster, S., Morlock, R., & Mintz, J. (2009). Association between changes on the Negative Symptom Assessment scale (NSA-16) and measures of functional outcome in schizophrenia. Psychiatry Research, 169, 97100.CrossRefGoogle Scholar
Ventura, J., Hellemann, G.S., Thames, A.D., Koellner, V., & Nuechterlein, K.H. (2009). Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: A meta-analysis. Schizophrenia Research, 113, 189199.CrossRefGoogle ScholarPubMed
Vieta, E., & Phillips, M.L. (2007). Deconstructing bipolar disorder: A critical review of its diagnostic validity and a proposal for DSM-V and ICD-11. Schizophrenia Bulletin, 33, 886892.CrossRefGoogle Scholar
Wechsler, D. (2007a). Wechsler Abbreviated Scale of Intelligence (WASI). Norwegian manual supplement. Stockholm: Pearson Assessment.Google Scholar
Wechsler, D. (2007b). Wechsler Memory Scale - third edition (WMS-III). Norwegian manual. Stockholm: Pearson Assessment.Google Scholar
Wechsler, D. (2003). Wechsler Adult Intelligence Scale - third edition (WAIS-III). Norwegian manual. Stockholm: Pearson Assessment.Google Scholar
Wingo, A.P., Harvey, P.D., & Baldessarini, R.J. (2009). Neurocognitive impairment in bipolar disorder patients: Functional implications. Bipolar Disorders, 11, 113125.CrossRefGoogle ScholarPubMed
Young, R.C., Biggs, J.T., Ziegler, V.E., & Meyer, D.A. (1978). A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429435.CrossRefGoogle ScholarPubMed
Zarate, C.A., Tohen, M., Land, M., & Cavanagh, S. (2000). Functional impairment and cognition in bipolar disorder. Psychiatric Quarterly, 71, 309329.CrossRefGoogle ScholarPubMed
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