Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study.
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.
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Lee
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Hermens
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Naismith
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Lagopoulos
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Jones
1] Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK [2] Centre for Affective Disorders, Institute of Psychiatry, London, UK.
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Scott
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Chitty
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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White
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Robillard
1] Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia [2] St Vincent's Hospital, University of Notre Dame, Sydney, NSW, Australia.
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Scott
Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Hickie
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D016022:Case-Control Studies; D016000:Cluster Analysis; D003072:Cognition Disorders / Q000523:psychology*; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011596:Psychomotor Disorders; D020127:Recovery of Function; D012559:Schizophrenia / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D055815:Young Adult