Patients with bipolar I disorder (BD I) without relapse after 1 year of first treatment had improved symptoms and neurocognition and showed improvements in global and occupational functioning, according to a study published in Bipolar Disorders.
The 42 first-treatment patients with BD I qualifying for the study were drawn consecutively from inpatient and outpatient psychiatric units in major hospitals in Oslo, Norway. Patients completed clinical and neurocognitive assessments at both baseline and 1-year follow up. During the 1-year follow-up period, 24 patients (57.1%) experienced a relapse, defined as 1 or more episodes of either manic or depressive moods; 18 patients (42.9%) did not experience a mood relapse. Overall neurocognitive functioning improvements in the no-relapse group reached a level similar to that in the healthy controls. The patients who experienced 1 or more relapses during that year did not show as much improvement.
The no-relapse patients improved more than patients who relapsed and controls in overall neurocognitive functioning and in 2 subcategories: verbal learning and memory and attention and working memory. During the same 1-year follow-up period, the relapse group had decreased executive functioning ability compared with the control group, while the rest of their cognitive domain abilities remained about the same. The majority of the relapse episodes were depressive.
The researchers found no correlations between the course of neurocognitive functioning and changes in clinical symptoms or functional outcome in the BD I relapse group. However, in the no-relapse BD I patients, the researchers did find a significant correlation between the course of overall neurocognitive functioning and changes in Positive and Negative Syndrome Scale (PANSS) in PANSS Positive (r = –.525, P=.025), Inventory of Depressive Symptomatology score (r = –.560; P=.019), and Global Assessment of Functioning, Functioning only (GAF-F) score (r = .537; P =.026).
The researchers also assessed whether overall neurocognitive functioning was associated with depressive symptoms and psychotic symptoms and with verbal learning and memory. They found that all improved in the no-relapse group along with a reduction in general symptoms, including depressive, manic, and psychotic symptoms. The absence of acute or residual symptoms in the no-relapse group might in part explain their gain in neurocognitive performance. Similarly, the lack of improvement in the group that experienced a relapse could be caused by their symptoms of depression and mania at follow up.
The researchers note that a larger percentage of patients who did not relapse were taken off antipsychotic medication during the follow-up period compared with the percentage of patients who did relapse. A significantly greater percentage of the no-relapse group also were employed or in school at the time of the 1-year follow up.
The researchers note the relatively small sample size and the attrition rate as a limitation of their study. They advocate for future studies with larger sample sizes and longer follow-up periods to elucidate the effects of multiple relapse episodes and heightened symptoms levels on neurocognitive function and functional outcome.
Demmo C, Lagerberg TV, Kvitland LR, et al. Neurocognitive functioning, clinical course and functional outcome in first-treatment bipolar I disorder patients with and without clinical relapse: A 1-year follow-up study [published online November 9, 2017]. Bipolar Disorder. doi:10.1111/bdi.12569