title: Cognitive change in the year after a first manic episode: association between clinical outcome and cognitive performance early in the course of bipolar I disorder.
abstract: OBJECTIVE
  Cognitive impairments are present immediately following recovery from a first episode of mania, although at a lesser severity than those seen in more chronic patients with bipolar I disorder. Little is known about how deficits evolve over the course of illness, however, and whether these changes are associated with disease progression.
  
  
  METHODS
  Patients with bipolar I disorder (DSM-IV-TR) receiving naturalistic clinical follow-up from the Systematic Treatment Optimization Program for Early Mania (STOP-EM) from July 2004 to May 2013 completed a comprehensive cognitive battery following recovery from their first manic episode and again 1 year later. Performance was compared between patients who experienced a recurrence of a mood episode (BDrecur) (n = 26) versus those that maintained remission (BDwell) (n = 27) over follow-up, as well as healthy comparison subjects (HS) (n = 31).
  
  
  RESULTS
  While both BDrecur and BDwell had impairments in overall cognitive performance relative to HS at baseline (mean difference = -0.59, P < .001; mean difference = -0.43, P < .05, respectively), at follow-up BDrecur showed deficits compared to both HS (mean difference = -0.62, P = .001) and BDwell (mean difference = -0.41, P = .05), with BDwell cognition similar to that in HS (mean difference = -0.21, P > .4). BDwell showed larger improvements over follow-up relative to both other groups (P < .05). While changes in BDrecur did not differ from HS, in this group more days in a manic or hypomanic episode was associated with performance declines (r = -0.40, P < .05).
  
  
  CONCLUSIONS
  While cognitive function improves in patients who sustain remission in the year following a first manic episode, those who experience a recurrence remain impaired, with performance declines being most apparent in those who experienced longer manic or hypomanic episodes.
authors.affiliation: Department of Psychiatry, University of British Columbia, Room 2C7-2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1 yatham@mail.ubc.ca.
authors.forename: Jan-Marie
authors.initials: JM
authors.lastname: Kozicky
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Torres
authors.forename: Leonardo E
authors.initials: LE
authors.lastname: Silveira
authors.forename: David J
authors.initials: DJ
authors.lastname: Bond
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D001955:British Columbia; D003072:Cognition Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011379:Prognosis; D011594:Psychometrics; D012008:Recurrence; D014635:Valproic Acid / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D018020:Lithium Compounds; D014635:Valproic Acid