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Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

Published online by Cambridge University Press:  31 August 2012

E. Mora ,
M. J. Portella ,
I. Forcada ,
E. Vieta  and
M. Mur
E. Mora
Affiliation:
Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain
M. J. Portella
Affiliation:
Psychiatric Service, Research Institute, Hospital de Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
I. Forcada
Affiliation:
Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain
E. Vieta
Affiliation:
Bipolar Disorders Program, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
M. Mur*
Affiliation:
Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain
*
*Address for correspondence: M. Mur, M.D., Ph.D., Servei de Psiquiatria, Hospital Santa Maria, C/Rovira Roure, 44, 25198 Lleida, Catalunya, Spain. (Email: mmur@gss.scs.es)
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Abstract

Background

Previous cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome.

Method

A total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.

Results

Repeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).

Conclusions

Executive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

Keywords

Bipolar disordercognitionfollow-up studylithium treatmentpsychosocial functioning
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 6 , June 2013 , pp. 1187 - 1196
Copyright
Copyright © Cambridge University Press 2012 

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