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29-07-2013 | Mental health | Article

Cognitive tests predict employability in bipolar disorder


Free abstract

medwireNews: Patients with bipolar disorder who are not employed despite being in euthymia have poorer neurocognition than those who are in a job, report researchers.

“The current findings add to the few studies indicating that cognitive dysfunction may negatively impact the specific area of employment,” says the team from the University of Michigan in Ann Arbor, USA, led by Kelly Ryan.

They found that 33 unemployed bipolar disorder patients performed worse than 123 employed patients in tasks related to emotion processing, verbal fluency and processing speed, and processing speed with interference resolution.

“Treatment for [bipolar disorder] generally focuses on clinical remission, but our results indicate that treatments should target areas of cognitive functioning as contributing factors to improve overall functional recovery, such as employability,” Ryan et al write in Psychiatry Research.

The patients undertook a battery of neurocognitive tests, the results of which were used to create scores relating to various cognitive factors. When age and number of mood episodes were used as covariates, the employed patients also outperformed the unemployed patients on fine motor skills, but not on auditory memory, visual memory, conceptual reasoning and set-shifting, and inhibitory control.

Combined with age and number of mood episodes, these neurocognitive variables accurately distinguished 75.7% of employed and unemployed patients, correctly classifying 96.2% of the employed patients.

The researchers stress that their cross-sectional study cannot determine whether continued cognitive defects hamper patients’ employment prospects or whether employment itself has cognitive benefits.

But they note that “the strength of our findings is linked to having a comparison, nonworking control group, such that effects of unemployment in the [bipolar disorder] group can be dissociated from the effects related to greater impact of illness.”

The nonworking control group consisted of 18 people who were mentally healthy but unemployed. These people had similar neurocognitive test results to 125 mentally healthy employed people, and in fact had higher scores for visual memory. They outperformed unemployed bipolar disorder patients in fine motor skills, verbal fluency processing speed, and inhibitory control.

“A multidisciplinary approach to management of [bipolar disorder] which integrates medication, psychosocial interventions and cognition would enhance functional recovery,” the researchers suggest.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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