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Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study

  • Jacob J. Crouse (a1), Kate M. Chitty (a2), Frank Iorfino (a3), Joanne S. Carpenter (a1), Django White (a4), Alissa Nichles (a1), Natalia Zmicerevska (a1), Ashleigh M. Tickell (a1), Rico S.C. Lee (a5), Sharon L. Naismith (a6), Elizabeth M. Scott (a7), Jan Scott (a8), Daniel F. Hermens (a9) and Ian B. Hickie (a1)...

Abstract

Background

Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries.

Aims

To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course.

Method

Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder.

Results

Cluster analysis of neurocognitive test scores derived three subgroups described as ‘normal range’ (n = 243, 38.6%), ‘intermediate impairment’ (n = 252, 40.1%), and ‘global impairment’ (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI −0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI −0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time.

Conclusions

Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Jacob Crouse. Email: jacob.crouse@sydney.edu.au

Footnotes

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This work was presented as a poster at the International Congress of the Royal College of Psychiatrists, UK (4 July 2019).

Footnotes

References

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Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study

  • Jacob J. Crouse (a1), Kate M. Chitty (a2), Frank Iorfino (a3), Joanne S. Carpenter (a1), Django White (a4), Alissa Nichles (a1), Natalia Zmicerevska (a1), Ashleigh M. Tickell (a1), Rico S.C. Lee (a5), Sharon L. Naismith (a6), Elizabeth M. Scott (a7), Jan Scott (a8), Daniel F. Hermens (a9) and Ian B. Hickie (a1)...

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Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study

  • Jacob J. Crouse (a1), Kate M. Chitty (a2), Frank Iorfino (a3), Joanne S. Carpenter (a1), Django White (a4), Alissa Nichles (a1), Natalia Zmicerevska (a1), Ashleigh M. Tickell (a1), Rico S.C. Lee (a5), Sharon L. Naismith (a6), Elizabeth M. Scott (a7), Jan Scott (a8), Daniel F. Hermens (a9) and Ian B. Hickie (a1)...
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