title: Neuropsychological and socio-occupational functioning in young psychiatric outpatients: a longitudinal investigation.
abstract: BACKGROUND
  Clinical symptoms and neuropsychological deficits are longitudinally associated with functional outcome in chronic psychiatric cohorts. The current study extended these findings to young and early-course psychiatric outpatients, with the aim of identifying cognitive markers that predict later socio-occupational functioning.
  
  
  METHODS
  At baseline, 183 young psychiatric outpatients were assessed. Ninety-three returned for follow-up (M = 21.6 years old; SD = 4.5) with an average re-assessment interval of 21.6 months (SD = 7.0), and primary diagnoses of major depressive disorder (n = 34), bipolar disorder (n = 29), or psychosis (n = 30). The primary outcome measure was cross-validated with various other functional measures and structural equation modelling was used to map out the interrelationships between predictors and later functional outcome.
  
  
  RESULTS
  Good socio-occupational functioning at follow-up was associated with better quality of life, less disability, current employment and being in a romantic relationship. The final structural equation model explained 47.5% of the variability in functional outcome at follow-up, with baseline neuropsychological functioning (a composite of memory, working memory and attentional switching) the best independent predictor of later functional outcome. Notably, depressive and negative symptoms were only associated with functioning cross-sectionally. Diagnosis at follow-up was not associated with functional outcome.
  
  
  CONCLUSIONS
  Neuropsychological functioning was the single best predictor of later socio-occupational outcome among young psychiatric outpatients. Therefore, framing psychiatric disorders along a neuropsychological continuum is likely to be more useful in predicting functional trajectory than traditional symptom-based classification systems. The current findings also have implications for early intervention utilising cognitive remediation approaches.
authors.affiliation: Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Rico S C
authors.initials: RS
authors.lastname: Lee
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hermens
authors.forename: M Antoinette
authors.initials: MA
authors.lastname: Redoblado-Hodge
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Naismith
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Porter
authors.forename: Manreena
authors.initials: M
authors.lastname: Kaur
authors.forename: Django
authors.initials: D
authors.lastname: White
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Scott
authors.forename: Ian B
authors.initials: IB
authors.lastname: Hickie
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D016743:Mental Competency / Q000523:psychology*; D008960:Models, Psychological; D009483:Neuropsychological Tests; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs