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

Lookup NU author(s): Emeritus Professor Jan Scott


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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.

Publication metadata

Author(s): Lee RSC, Hermens DF, Naismith SL, Lagopoulos J, Jones A, Scott J, Chitty KM, White D, Robillard R, Scott EM, Hickie IB

Publication type: Article

Publication status: Published

Journal: Translational Psychiatry

Year: 2015

Volume: 5

Online publication date: 28/04/2015

Acceptance date: 09/03/2015

ISSN (electronic): 2158-3188

Publisher: Nature Publishing Group


DOI: 10.1038/tp.2015.50


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Funder referenceFunder name
NSW Health Mental Health and Drug and Alcohol Office
Fonds de la recherche en sante du Quebec
1008117National Health and Medical Research Council Clinical Development Award
1061043National Health and Medical Research Council Centre of Research Excellence in Optimising Early Interventions for Young People with Emerging Mood Disorders
464914Australian Fellowship
566529National Health and Medical Research Council Program