Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study

R S Lee; Daniel F Hermens; S L Naismith; Jim Lagopoulos; A Jones; Jan Scott; K M Chitty; D White; R Robillard; E M Scott; I B Hickie

doi:10.1038/tp.2015.50

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Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study

Journal article

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Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study

R S Lee, Daniel F Hermens, S L Naismith, Jim Lagopoulos, A Jones, Jan Scott, K M Chitty, D White, R Robillard, E M Scott, …

Translational Psychiatry, Vol.5, e555

2015

DOI: https://doi.org/10.1038/tp.2015.50

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Abstract

Psychology

Clinical Sciences

Public Health and Health Services

Functional disability is the lead contributor to burden of mental illness. Cognitive deficits frequently limit functional recovery, although whether changes in cognition and disability are longitudinally associated in recent-onset individuals remains unclear. Using a prospective, cohort design, 311 patients were recruited and assessed at baseline. One hundred and sixty-seven patients met eligibility criteria (M=21.5 years old, s.d.=4.8) and returned for follow-up (M=20.6 months later, s.d.=7.8). Two-hundred and thirty participants were included in the final analysis, comprising clinically stable patients with major depression (n=71), bipolar disorder (BD; n=61), schizophrenia-spectrum disorders (n=35) and 63 healthy controls. Neuropsychological functioning and self-rated functional disability were examined using mixed-design, repeated-measures analysis, across diagnoses and cognitive clusters, covarying for relevant confounds. Clinical, neuropsychological and functional changes did not differ between diagnoses (all P>0.05). Three reliable neuropsychological subgroups emerged through cluster analysis, characterized by psychomotor slowing, improved sustained attention, and improved verbal memory. Controlling for diagnosis and changes in residual symptoms, clusters with improved neuropsychological functioning observed greater reductions in functional disability than the psychomotor slowing cluster, which instead demonstrated a worsening in disability (P < 0.01). Improved sustained attention was independently associated with greater likelihood of follow-up employment (P < 0.01). Diagnosis of BD uniquely predicted both follow-up employment and independent living. Neuropsychological course appears to be independently predictive of subjective and objective functional outcomes. Importantly, cognitive phenotypes may reflect distinct pathophysiologies shared across major psychiatric conditions, and be ideal targets for personalized early intervention.

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Title: Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study
Authors: R S Lee (Author) - University of Sydney
Daniel F Hermens (Author) - University of Sydney
S L Naismith (Author) - University of Sydney
Jim Lagopoulos (Author) - University of Sydney
A Jones (Author) - University of Sydney
Jan Scott (Author) - University of Newcastle
K M Chitty (Author) - University of Sydney
D White (Author) - University of Sydney
R Robillard (Author) - University of Sydney
E M Scott (Author) - University of Sydney
I B Hickie (Author) - University of Sydney
Publication details: Translational Psychiatry, Vol.5, e555
Publisher: Nature Publishing Group
Date published: 2015
DOI: 10.1038/tp.2015.50
ISSN: 2158-3188
Copyright note: Copyright © 2015 The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Organisation Unit: University of the Sunshine Coast, Queensland; Thompson Institute
Language: English
Record Identifier: 99449217402621
Output Type: Journal article

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