Memory best predicts socio-occupational outcome in early psychiatric illness
medwireNews: Assessment of neuropsychological functioning is better than psychiatric symptoms at predicting later socio-occupational functioning in young psychiatric outpatients, researchers say.
"Baseline verbal and visuospatial memory, spatial working memory, and attention switching were instrumental to socio-occupational functioning 6 to 48 months later," note Rico Lee (University of Sydney, Australia) and co-workers in PLoS One.
"In contrast, baseline depressive and negative symptoms did not directly predict later functional outcome," they report.
The findings suggest that cognitive remediation strategies may be most effective early on in the course of psychiatric illness.
The study involved 93 young psychiatric outpatients who were seen twice for the assessment and treatment of depression, a psychotic syndrome, or both. The mean age of participants was 21.6 years, ranging from 12 to 34 years.
The primary diagnosis was major depressive disorder (MDD) in 34 participants, 29 had bipolar disorder, and 30 had a diagnosis of psychosis.
Using the Social and Occupational Functioning Scale (SOFAS), 53 participants were categorized as having a "good outcome" and 40 as having a "poor outcome" at re-assessment an average of 21.6 months after baseline evaluation.
Patients in the good outcome group had better quality of life, as assessed using the World Health Organization Quality of Life BREF instrument, than those in the poor outcome group.
Patients in the good outcome group were also more likely than those in the poor outcome group to have better scores on the Disability Assessment Scale II and less likely to be on a disability support pension (13.5 vs 45.0%). Furthermore, patients in the good outcome group were more likely to be employed (56.5 vs 15.0%) and in a romantic relationship (43.4 vs 17.5%).
Patients in the poor outcome group performed significantly worse than those in the good outcome group on the following neuropsychological tests at baseline: Spatial Scan Length, which measures working memory; Learning Test 20-Minute Percentage Retention, which indicates the degree of verbal memory retention; Paired Associates Learning adjusted errors, which assesses visual memory capabilities; and the Trail Making Test part B, which can help determine the level of attention switching.
"The longer-term outcome of young patients presenting to mental health services with a range of disorders is best predicted by their initial level of neuropsychological functioning," Lee and colleagues report.
They speculate that the impact of these memory and executive function deficits may wane over time, as the chronicity of psychiatric illness takes hold.
"Compared with more chronic stages, neuropsychological functioning may be a more robust predictor of later functioning in the early stages of psychiatric illness," Lee et al speculate.
They therefore conclude: "Cognitive remediation strategies may be most efficacious in effecting functional changes in this early 'critical period.'"
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By Sara Freeman, medwireNews Reporter