title: Effects of functional remediation on neurocognitively impaired bipolar patients: enhancement of verbal memory.
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.
  
  
  METHODS
  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 [F 2,158 = 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 (F 2,158 = 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.
authors.affiliation: Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain.
authors.forename: C M
authors.initials: CM
authors.lastname: Bonnin
authors.affiliation: Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain.
authors.forename: M
authors.initials: M
authors.lastname: Reinares
authors.affiliation: Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain.
authors.forename: A
authors.initials: A
authors.lastname: Martínez-Arán
authors.affiliation: Department of Medicine,University of Valencia,CIBERSAM,Valencia,Spain.
authors.forename: V
authors.initials: V
authors.lastname: Balanzá-Martínez
authors.affiliation: Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain.
authors.forename: B
authors.initials: B
authors.lastname: Sole
authors.affiliation: Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain.
authors.forename: C
authors.initials: C
authors.lastname: Torrent
authors.affiliation: Department of Medicine,University of Valencia,CIBERSAM,Valencia,Spain.
authors.forename: R
authors.initials: R
authors.lastname: Tabarés-Seisdedos
authors.affiliation: Department of Psychiatry,University of Oviedo,CIBERSAM,Oviedo,Spain.
authors.forename: M P
authors.initials: MP
authors.lastname: García-Portilla
authors.affiliation: Department of Psychiatry,Ramon y Cajal University Hospital, University of Alcala,IRYCIS,CIBERSAM,Madrid,Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ibáñez
authors.affiliation: FIDMAG Hermanas Hospitalarias Research Foundation,CIBERSAM,Barcelona,Spain.
authors.forename: B L
authors.initials: BL
authors.lastname: Amann
authors.affiliation: Child and Adolescent Psychiatry Department,Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense,IiSGM,CIBERSAM,Madrid,Spain.
authors.forename: C
authors.initials: C
authors.lastname: Arango
authors.affiliation: Department of Psychiatry,Universidad Autonoma de Madrid,IIS-IP,CIBERSAM,Madrid,Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.affiliation: Department of Psychiatry,University Hospital of Bellvitge,Bellvitge Biomedical Research Institute (IDIBELL),CIBERSAM,Barcelona,Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Crespo
authors.affiliation: Álava University Hospital,CIBERSAM,University of the Basque Country,Kronikgune,Vitoria,Spain.
authors.forename: A
authors.initials: A
authors.lastname: González-Pinto
authors.affiliation: Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain.
authors.forename: F
authors.initials: F
authors.lastname: Colom
authors.affiliation: Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D011939:Mental Recall; D008875:Middle Aged; D009483:Neuropsychological Tests; D010353:Patient Education as Topic; D000067250:Psychiatric Rehabilitation / Q000379:methods*; D014706:Verbal Learning
keywords: Bipolar disorder; clinical trials; functional remediation; neuropsychology; verbal memory