Skip to main content
×
×
Home

Effects of functional remediation on neurocognitively impaired bipolar patients: enhancement of verbal memory

  • C. M. Bonnin (a1), M. Reinares (a1), A. Martínez-Arán (a1), V. Balanzá-Martínez (a2) (a3), B. Sole (a1), C. Torrent (a1), R. Tabarés-Seisdedos (a2), M. P. García-Portilla (a4), A. Ibáñez (a5), B. L. Amann (a6), C. Arango (a7), J. L. Ayuso-Mateos (a8), J. M. Crespo (a9), A. González-Pinto (a10), F. Colom (a1), E. Vieta (a1) and The CIBERSAM Functional Remediation Group...
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.

Copyright
Corresponding author
* Address for correspondence: A. Martínez-Arán, Bipolar Disorders Programme, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, Villarroel 170 08036-Barcelona, Spain. (Email: amartiar@clinic.ub.es)
References
Hide All
Altshuler, LL, Ventura, J, van Gorp, WG, Green, MF, Theberge, DC, Mintz, J (2004). Neurocognitive function in clinically stable men with bipolar I disorder or schizophrenia and normal control subjects. Biological Psychiatry 56, 560569.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). APA: Arlington, VA.
Benton, AL, Hamsher, K (1976). Multilingual Aphasia Examination. University of Iowa: Iowa City, IA.
Binder, LM, Iverson, GL, Brooks, BL (2009). To err is human: ‘abnormal’ neuropsychological scores and variability are common in healthy adults. Archives of Clinical Neuropsychology 24, 3146.
Bonnin, CM, Martinez-Aran, A, Torrent, C, Pacchiarotti, I, Rosa, AR, Franco, C, Murru, A, Sanchez-Moreno, J, Vieta, E (2010). Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: a long-term, follow-up study. Journal of Affective Disorders 121, 156160.
Bonnin, CM, Sanchez-Moreno, J, Martinez-Aran, A, Sole, B, Reinares, M, Rosa, AR, Goikolea, JM, Benabarre, A, Ayuso-Mateos, JL, Ferrer, M, Vieta, E, Torrent, C (2012). Subthreshold symptoms in bipolar disorder: impact on neurocognition, quality of life and disability. Journal of Affective Disorders 136, 650659.
Bonnín, CM, Torrent, C, Arango, C, Amann, BL, Solé, B, González-Pinto, A, Crespo, JM, Tabarés-Seisdedos, R, Reinares, M, Ayuso-Mateos, JL, García Portilla, MP, Ibáñez, A, Salamero, M, Vieta, E, Martínez-Arán, A, the CIBERSAM Functional Remediation Group (in press). Functional remediation in bipolar disorder: 1-year follow-up of neurocognitive and functional outcome. British Journal of Psychiatry 207, doi:10.1192/bjp.bp.114.162123.
Bonnin, CM, Torrent, C, Vieta, E, Martínez-Arán, A (2014). Restoring functioning in bipolar disorder: functional remediation. Harvard Review of Psychiatry 22, 326330.
Bourne, C, Aydemir, O, Balanza-Martinez, V, Bora, E, Brissos, S, Cavanagh, JT, Clark, L, Cubukcuoglu, Z, Dias, VV, Dittmann, S, Ferrier, IN, Fleck, DE, Frangou, S, Gallagher, P, Jones, L, Kieseppa, T, Martinez-Aran, A, Melle, I, Moore, PB, Mur, M, Pfennig, A, Raust, A, Senturk, V, Simonsen, C, Smith, DJ, Bio, DS, Soeiro-de-Souza, MG, Stoddart, SD, Sundet, K, Szoke, A, Thompson, JM, Torrent, C, Zalla, T, Craddock, N, Andreassen, OA, Leboyer, M, Vieta, E, Bauer, M, Worhunsky, PD, Tzagarakis, C, Rogers, RD, Geddes, JR, Goodwin, GM (2013). Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis. Acta Psychiatrica Scandinavica 128, 149162.
Burdick, KE, Russo, M, Frangou, S, Mahon, K, Braga, RJ, Shanahan, M, Malhotra, AK (2014). Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: clinical implications. Psychological Medicine 44, 30833096.
Colom, F, Vieta, E (2006). Psychoeducation Manual for Bipolar Disorder. Cambridge University Press: Cambridge, UK.
Colom, F, Vieta, E, Martinez-Aran, A, Garcia-Garcia, M, Reinares, M, Torrent, C, Goikolea, JM, Banus, S, Salamero, M (2002). Spanish version of a scale for the assessment of mania: validity and reliability of the Young Mania Rating Scale. Medicina Clinica (Barcelona) 119, 366371.
Colom, F, Vieta, E, Martinez-Aran, A, Reinares, M, Goikolea, JM, Benabarre, A, Torrent, C, Comes, M, Corbella, B, Parramon, G, Corominas, J (2003). A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Archives of General Psychiatry 60, 402407.
Conners, CK (2000). Conner's Continuous Performance Test II (CPT-II V.5). Multi-Health Systems: North Tonawanda, NY.
Deckersbach, T, Nierenberg, AA, Kessler, R, Lund, HG, Ametrano, RM, Sachs, G, Rauch, SL, Dougherty, D (2010). RESEARCH: cognitive rehabilitation for bipolar disorder: an open trial for employed patients with residual depressive symptoms. CNS. Neurosciences and Therapeutics 16, 298307.
Delis, DC, Kramer, JH, Kaplan, E, Ober, B (1987). California Verbal Learning Test. Psychological Corporation: New York.
Depp, CA, Mausbach, BT, Harmell, AL, Savla, GN, Bowie, CR, Harvey, PD, Patterson, TL (2012). Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disorders 14, 217226.
Fuentes-Dura, I, Balanza-Martinez, V, Ruiz-Ruiz, JC, Martinez-Aran, A, Giron, M, Sole, B, Sanchez-Moreno, J, Gomez-Beneyto, M, Vieta, E, Tabares-Seisdedos, R (2012). Neurocognitive training in patients with bipolar disorders: current status and perspectives. Psychotherapy and Psychosomatics 81, 250252.
Golden, CJ (1978). Stroop Color and Word Test. Stoelting: Chicago, IL.
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.
Heaton, RK (1981). Wisconsin Card Sorting Test Manual. Psychological Assessment Resources: Odessa, FL.
Hellvin, T, Sundet, K, Simonsen, C, Aminoff, SR, Lagerberg, TV, Andreassen, OA, Melle, I (2012). Neurocognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disorders 14, 227238.
Iverson, GL, Brooks, BL, Langenecker, SA, Young, AH (2011). Identifying a cognitive impairment subgroup in adults with mood disorders. Journal of Affective Disorders 132, 360367.
Lopez-Jaramillo, C, Lopera-Vasquez, J, Gallo, A, Ospina-Duque, J, Bell, V, Torrent, C, Martinez-Aran, A, Vieta, E (2010). Effects of recurrence on the cognitive performance of patients with bipolar I disorder: implications for relapse prevention and treatment adherence. Bipolar Disorders 12, 557567.
Martínez-Arán, A, Torrent, C, Solé, B, Bonnín, CM, Rosa, AR, Sánchez-Moreno, J, Vieta, E (2011). Functional remediation for bipolar disorder. Clinical Practice and Epidemiology in Mental Health 7, 112116.
Martinez-Aran, A, Vieta, E, Torrent, C, Sanchez-Moreno, J, Goikolea, JM, Salamero, M, Malhi, GS, Gonzalez-Pinto, A, Daban, C, Alvarez-Grandi, S, Fountoulakis, K, Kaprinis, G, Tabares-Seisdedos, R, Ayuso-Mateos, JL (2007). Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disorders 9, 103113.
Martino, DJ, Marengo, E, Igoa, A, Scapola, 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, 3742.
Martino, DJ, Strejilevich, SA, Marengo, E, Ibáñez, A, Scápola, M, Igoa, A (2014). Toward the identification of neurocognitive subtypes in euthymic patients with bipolar disorder. Journal of Affective Disorders 167, 118124.
Martino, DJ, Strejilevich, SA, Scapola, M, Igoa, A, Marengo, E, Ais, ED, Perinot, L (2008). Heterogeneity in cognitive functioning among patients with bipolar disorder. Journal of Affective Disorders 109, 149156.
Ramos-Brieva, JA, Cordero-Villafáfila, A (1986). Validation of the Castillian version of the Hamilton Rating Scale for Depression [article in Spanish]. Actas luso-españolas de Neurología, Psiquiatría y Ciencias Afines 14, 324334.
Reichenberg, A, Harvey, PD, Bowie, CR, Mojtabai, R, Rabinowitz, J, Heaton, RK, Bromet, E (2009). Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. Schizophrenia Bulletin 35, 10221029.
Reinares, M, Sanchez-Moreno, J, Fountoulakis, KN (2014). Psychosocial interventions in bipolar disorder: what, for whom, and when. Journal of Affective Disorders 156, 4655.
Reitan, RM (1958). Validity of the Trailmaking Test as a indication of organic brain damage. Perceptual and Motor Skills 8, 271276.
Rey, A (1997). Test de copia de la figura compleja (The Rey–Osterrieth Complex Figure). TEA ediciones: Madrid.
Rosa, AR, Sanchez-Moreno, J, Martinez-Aran, A, Salamero, M, Torrent, C, Reinares, M, Comes, M, Colom, F, Van, RW, Ayuso-Mateos, JL, Kapczinski, F, Vieta, E (2007). Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice and Epidemology in Mental Health 3, 5.
Sole, B, Martinez-Aran, A, Torrent, C, Bonnin, CM, Reinares, M, Popovic, D, Sanchez-Moreno, J, Vieta, E (2011). Are bipolar II patients cognitively impaired? A systematic review. Psychological Medicine 41, 17911803.
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, 286299.
Torrent, C, Bonnin, CM, Martinez-Aran, A, Valle, J, Amann, BL, Gonzalez-Pinto, A, Crespo, JM, Ibanez, A, Garcia-Portilla, MP, Tabares-Seisdedos, R, Arango, C, Colom, F, Sole, B, Pacchiarotti, I, Rosa, AR, Ayuso-Mateos, JL, Anaya, C, Fernandez, P, Landin-Romero, R, Alonso-Lana, S, Ortiz-Gil, J, Segura, B, Barbeito, S, Vega, P, Fernandez, M, Ugarte, A, Subira, M, Cerrillo, E, Custal, N, Menchon, JM, Saiz-Ruiz, J, Rodao, JM, Isella, S, Alegria, A, Al-Halabi, S, Bobes, J, Galvan, G, Saiz, PA, Balanza-Martinez, V, Selva, G, Fuentes-Dura, I, Correa, P., Mayoral, M., Chiclana, G., Merchan-Naranjo, J., Rapado-Castro, M, Salamero, M, Vieta, E (2013). Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. American Journal of Psychiatry 170, 852859.
Torrent, C, Martinez-Aran, A, del Mar, BC, Reinares, M, Daban, C, Sole, B, Rosa, AR, Tabares-Seisdedos, R, Popovic, D, Salamero, M, Vieta, E (2012). Long-term outcome of cognitive impairment in bipolar disorder. Journal of Clinical Psychiatry 73, e899e905.
van der Werf-Eldering, MJ, Burger, H, Holthausen, EA, Aleman, A, Nolen, WA (2010). Cognitive functioning in patients with bipolar disorder: association withdepressive symptoms and alcohol use. PLoS ONE 28, 5.
Vieta, E (2014). The bipolar maze: a roadmap through translational psychopathology. Acta Psychiatrica Scandinavica 129, 323327.
Vieta, E, Torrent, C, Martinez-Aran, A (2014). Functional Remediation for Bipolar Disorder. Cambridge University Press, Cambridge, UK.
Volkert, J, Kopf, J, Kazmaier, J, Glaser, F, Zierhut, KC, Schiele, MA, Kittel-Schneider, S, Reif, A (2015). Evidence for cognitive subgroups in bipolar disorder and the influence of subclinical depression and sleep disturbances. European Neuropsychopharmacology 25, 192202.
Wechsler, D (1997 a). The Wechsler Adult Intelligence Scale – III (WAIS-III). Psychological Corporation, San Antonio, TX.
Wechsler, D (1997 b). Wechsler Memory Scale, 3rd edn. Psychological Corporation, San Antonio, TX.
Yatham, LN, Torres, IJ, Malhi, GS, Frangou, S, Glahn, DC, Bearden, CE, Burdick, KE, Martinez-Aran, A, Dittmann, S, Goldberg, JF, Ozerdem, A, Aydemir, O, Chengappa, KN (2010). The International Society for Bipolar Disorders-Battery for Assessment of Neurocognition (ISBD-BANC). Bipolar Disorders 12, 351363.
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429435.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 5
Total number of PDF views: 102 *
Loading metrics...

Abstract views

Total abstract views: 487 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th August 2018. This data will be updated every 24 hours.