Neuropsychological and socio-occupational functioning in young psychiatric outpatients: a longitudinal investigation

Clinical 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-...

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Veröffentlicht in:PloS one 2013-03, Vol.8 (3), p.e58176-e58176
Hauptverfasser: Lee, Rico S C, Hermens, Daniel F, Redoblado-Hodge, M Antoinette, Naismith, Sharon L, Porter, Melanie A, Kaur, Manreena, White, Django, Scott, Elizabeth M, Hickie, Ian B
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container_issue 3
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container_title PloS one
container_volume 8
creator Lee, Rico S C
Hermens, Daniel F
Redoblado-Hodge, M Antoinette
Naismith, Sharon L
Porter, Melanie A
Kaur, Manreena
White, Django
Scott, Elizabeth M
Hickie, Ian B
description Clinical 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. At 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. Good 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. Neuropsychological 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.
doi_str_mv 10.1371/journal.pone.0058176
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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. At 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. Good socio-occupational functioning at follow-up was associated with better quality of life, less disability, current employment and being in a romantic relationship. 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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. At 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. Good 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. Neuropsychological 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23469268</pmid><doi>10.1371/journal.pone.0058176</doi><tpages>e58176</tpages><oa>free_for_read</oa></addata></record>
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subjects Achievement tests
Adolescent
Adult
Analysis
Behavior disorders
Biology
Bipolar disorder
Bipolar Disorder - physiopathology
Bipolar Disorder - psychology
Bipolar Disorder - therapy
Brain research
Care and treatment
Classification systems
Cognitive ability
Cognitive Behavioral Therapy
Cognitive therapy
Depressive Disorder, Major - physiopathology
Depressive Disorder, Major - psychology
Depressive Disorder, Major - therapy
Ethics
Female
Humans
Investigations
Longitudinal Studies
Male
Mathematical models
Medical diagnosis
Medicine
Memory, Short-Term - drug effects
Mental Competency - psychology
Mental depression
Mental disorders
Mental health
Models, Psychological
Neuropsychological Tests
Neuropsychology
Outpatients
Patient outcomes
Prognosis
Psychiatric Status Rating Scales
Psychiatry
Psychology
Psychosis
Psychotic Disorders - physiopathology
Psychotic Disorders - psychology
Psychotic Disorders - therapy
Psychotropic Drugs - therapeutic use
Quality of Life
Schizophrenia
Short term memory
Social and Behavioral Sciences
Structure-function relationships
Studies
Treatment Outcome
title Neuropsychological and socio-occupational functioning in young psychiatric outpatients: a longitudinal investigation
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