Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-27T22:43:24.018Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 September 2015

C. M. Bonnin ,
M. Reinares ,
A. Martínez-Arán ,
V. Balanzá-Martínez ,
B. Sole ,
C. Torrent ,
R. Tabarés-Seisdedos ,
M. P. García-Portilla ,
A. Ibáñez  and
B. L. Amann
...Show all authors
C. M. Bonnin
Affiliation:
Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
M. Reinares
Affiliation:
Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
A. Martínez-Arán*
Affiliation:
Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
V. Balanzá-Martínez
Affiliation:
Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain La Fe University Polytechnic Hospital, Valencia, Spain
B. Sole
Affiliation:
Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
C. Torrent
Affiliation:
Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
R. Tabarés-Seisdedos
Affiliation:
Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
M. P. García-Portilla
Affiliation:
Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
A. Ibáñez
Affiliation:
Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid, Spain
B. L. Amann
Affiliation:
FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona, Spain
C. Arango
Affiliation:
Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
J. L. Ayuso-Mateos
Affiliation:
Department of Psychiatry, Universidad Autonoma de Madrid, IIS-IP, CIBERSAM, Madrid, Spain
J. M. Crespo
Affiliation:
Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona, Spain
A. González-Pinto
Affiliation:
Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria, Spain
F. Colom
Affiliation:
Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
E. Vieta
Affiliation:
Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
*
* 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)
Get access Rights & Permissions [Opens in a new window]

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 [F2,158 = 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 (F2,158 = 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.

Keywords

Bipolar disorderclinical trialsfunctional remediationneuropsychologyverbal memory
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 2 , January 2016 , pp. 291 - 301
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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, 560–569.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). APA: Arlington, VA.Google Scholar
Benton, AL, Hamsher, K (1976). Multilingual Aphasia Examination. University of Iowa: Iowa City, IA.Google Scholar
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, 31–46.Google Scholar
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, 156–160.Google Scholar
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, 650–659.Google Scholar
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. Google Scholar
Bonnin, CM, Torrent, C, Vieta, E, Martínez-Arán, A (2014). Restoring functioning in bipolar disorder: functional remediation. Harvard Review of Psychiatry 22, 326–330.Google Scholar
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, 149–162.CrossRefGoogle ScholarPubMed
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, 3083–3096.CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E (2006). Psychoeducation Manual for Bipolar Disorder. Cambridge University Press: Cambridge, UK.Google Scholar
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, 366–371.Google Scholar
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, 402–407.Google Scholar
Conners, CK (2000). Conner's Continuous Performance Test II (CPT-II V.5). Multi-Health Systems: North Tonawanda, NY.Google Scholar
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, 298–307.Google Scholar
Delis, DC, Kramer, JH, Kaplan, E, Ober, B (1987). California Verbal Learning Test. Psychological Corporation: New York.Google Scholar
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, 217–226.Google Scholar
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, 250–252.Google Scholar
Golden, CJ (1978). Stroop Color and Word Test. Stoelting: Chicago, IL.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.Google Scholar
Heaton, RK (1981). Wisconsin Card Sorting Test Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
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, 227–238.Google Scholar
Iverson, GL, Brooks, BL, Langenecker, SA, Young, AH (2011). Identifying a cognitive impairment subgroup in adults with mood disorders. Journal of Affective Disorders 132, 360–367.CrossRefGoogle ScholarPubMed
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, 557–567.CrossRefGoogle ScholarPubMed
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, 112–116.Google Scholar
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, 103–113.Google Scholar
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, 37–42.Google Scholar
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, 118–124.Google Scholar
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, 149–156.CrossRefGoogle ScholarPubMed
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, 324–334.Google ScholarPubMed
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, 1022–1029.Google Scholar
Reinares, M, Sanchez-Moreno, J, Fountoulakis, KN (2014). Psychosocial interventions in bipolar disorder: what, for whom, and when. Journal of Affective Disorders 156, 46–55.Google Scholar
Reitan, RM (1958). Validity of the Trailmaking Test as a indication of organic brain damage. Perceptual and Motor Skills 8, 271–276.Google Scholar
Rey, A (1997). Test de copia de la figura compleja (The Rey–Osterrieth Complex Figure). TEA ediciones: Madrid.Google Scholar
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.CrossRefGoogle ScholarPubMed
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, 1791–1803.Google Scholar
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, 286–299.Google Scholar
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, 852–859.CrossRefGoogle ScholarPubMed
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, e899–e905.CrossRefGoogle ScholarPubMed
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.Google Scholar
Vieta, E (2014). The bipolar maze: a roadmap through translational psychopathology. Acta Psychiatrica Scandinavica 129, 323–327.Google Scholar
Vieta, E, Torrent, C, Martinez-Aran, A (2014). Functional Remediation for Bipolar Disorder. Cambridge University Press, Cambridge, UK.CrossRefGoogle Scholar
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, 192–202.CrossRefGoogle ScholarPubMed
Wechsler, D (1997 a). The Wechsler Adult Intelligence Scale – III (WAIS-III). Psychological Corporation, San Antonio, TX.Google Scholar
Wechsler, D (1997 b). Wechsler Memory Scale, 3rd edn. Psychological Corporation, San Antonio, TX.Google Scholar
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, 351–363.Google Scholar
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed