Abstract
BackgroundClinical 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.MethodsAt 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.ResultsGood 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.ConclusionsNeuropsychological 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.
Highlights
In mental health, there has been a strong emphasis on defining recovery in terms of symptom resolution
Patients were assessed by a psychiatrist according to DSM-IV TR [American Psychiatric Association, 25] criteria at two time points, and underwent a comprehensive clinical and neuropsychological assessment by clinical neuropsychologists or trained research psychologists at baseline
183 patients diagnosed with major depressive disorder (n = 66), bipolar disorder (n = 52) and psychosis (n = 65) were assessed at baseline
Summary
In mental health, there has been a strong emphasis on defining recovery in terms of symptom resolution. There is increasing recognition that defining remission solely on the basis of clinical symptoms is inadequate These ‘remitted’ patients with diagnoses of major depression [1], bipolar disorder [2] or psychosis [3] remain functionally impaired. Zimmerman et al [1] demonstrated that half of patients with major depression who were classified as remitted based on rating scale criteria did not consider themselves to be in remission These individuals were significantly more impaired in their work performance and social relationships. Cognitive vulnerabilities may contribute to persisting disability given evidence that neuropsychological dysfunction predicts later socio-occupational functioning, over and above symptom levels, as observed in depression [5], bipolar disorder [6], and schizophrenia [7]. 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
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