0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Efficacy of Functional Remediation in Bipolar Disorder: A Multicenter Randomized Controlled Study
Carla Torrent, Ph.D.; Caterina del Mar Bonnin, Ph.D.; Anabel Martínez-Arán, Ph.D.; Jesús Valle, M.D., Ph.D.; Benedikt L. Amann, M.D., Ph.D.; Ana González-Pinto, M.D., Ph.D.; José Manuel Crespo, M.D., Ph.D.; Ángela Ibáñez, M.D., Ph.D.; Mari Paz Garcia-Portilla, M.D., Ph.D.; Rafael Tabarés-Seisdedos, M.D., Ph.D.; Celso Arango, M.D., Ph.D.; Francesc Colom, Ph.D.; Brisa Solé, Psy.D.; Isabella Pacchiarotti, M.D., Ph.D.; Adriane R. Rosa, Ph.D.; Jose Luis Ayuso-Mateos, M.D., Ph.D.; Celia Anaya, Ph.D.; Patricia Fernández, Ph.D.; Ramon Landín-Romero, Ph.D.; Silvia Alonso-Lana, M.Sc.; Jordi Ortiz-Gil, Ph.D.; Bàrbara Segura, Ph.D.; Sara Barbeito, Ph.D.; Patricia Vega, Psy.D.; Miryam Fernández, Ph.D.; Amaia Ugarte, Ph.D.; Marta Subirà, M.B.B.S., M.D.; Ester Cerrillo, M.B.B.S., M.D.; Núria Custal, M.D., Ph.D.; José Manuel Menchón, M.D., Ph.D.; Jerónimo Saiz-Ruiz, M.D., Ph.D.; Jose Maria Rodao, Ph.D.; Sandra Isella, Ph.D.; Analucía Alegría, M.Sc.; Susana Al-Halabi, Ph.D.; Julio Bobes, M.D., Ph.D.; Gonzalo Galván, Ph.D.; Pilar A. Saiz, M.D., Ph.D.; Vicent Balanzá-Martínez, M.D., Ph.D.; Gabriel Selva, M.D., Ph.D.; Inmaculada Fuentes-Durá, Ph.D.; Patricia Correa, Psy.D.; María Mayoral, Ph.D.; Guadalupe Chiclana, Ph.D.; Jessica Merchan-Naranjo, M.Sc.; Marta Rapado-Castro, Ph.D.; Manel Salamero, M.D., Ph.D.; Eduard Vieta, M.D., Ph.D.
Am J Psychiatry 2013;170:852-859. doi:10.1176/appi.ajp.2012.12070971
View Author and Article Information

Dr. Amann has served as a speaker for Bristol-Myers Squibb. Dr. González-Pinto has received grants from or served as consultant, adviser, or CME speaker for Almirall, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Merck, Novartis, Otsuka, Pfizer, Sanofi-Aventis, Schering-Plough, and the Spanish Ministry of Science and Innovation (CIBERSAM). Dr. Crespo has served as a consultant or speaker for AstraZeneca, Bristol-Myers Squibb, Janssen, Eli Lilly, GlaxoSmithKline, Lundbeck, Novartis, Otsuka, Pfizer, Sanofi-Sinthelabo, and Wyatt and has received grant support from FIS, Health Ministry, IDIBELL Foundation, and CIBERSAM. Dr. Arango has served as a consultant for or has received honoraria or grants from Abbott, AMGEN, AstraZeneca, Bristol-Myers Squibb, Caja Navarra, CIBERSAM, Alicia Koplowitz Foundation, Carlos III Health Institute, Janssen-Cilag, Lundbeck, Merck, Ministry of Science and Innovation, Ministry of Health, Ministry of Economy and Competitiveness, Mutua Madrileña, Otsuka, Pfizer, Roche, Servier, Takeda, and Schering-Plough. Dr. Colom has served as a speaker for Adamed, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Lundbeck, Otsuka, Pfizer, Sanofi-Aventis, and Tecnifar and as an adviser for MSD-Merck and Shire, and he has received copyright fees from Cambridge University Press, Solal Ed., Ars Médica, Giovani Fioriti Ed., Medipage, La Esfera de Los Libros, Morales i Torres Ed, Panamericana, Mayo Ed. & Columna. Dr. Ayuso-Mateos has provided expert testimony for Sanofi-Aventis. Dr. Menchon has received research grants from or served as a consultant or speaker for AGAUR, Almirall, AstraZeneca, Boehringer-Ingelheim, Eli Lilly, Janssen, Lundbeck, Medtronic, Novartis, Otsuka, Rovi, Servier, the Spanish Ministry of Health, the Spanish Ministry of Science and Innovation, and Wyeth. Dr. Rapado has received a Sara Borrell Health Research Fellowship from the Spanish Ministry of Economy and Competitiveness and an Alicia Koplowitz Grant for Short-Term Placements from the Alicia Koplowitz Foundation. Dr. Vieta has received grants, CME-related honoraria, or consulting fees from Alexza, Almirall, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Ferrer, Forest Research Institute, Gedeon Richter, GlaxoSmithKline, Janssen, Janssen-Cilag, Jazz, Johnson & Johnson, Lundbeck, Merck, Novartis, Organon, Otsuka, Pfizer, Pierre-Fabre, Qualigen, Roche, Sanofi-Aventis, Schering-Plough, Servier, Shire, Solvay, Takeda, Teva, CIBERSAM, the Seventh European Framework Programme (ENBREC), the Stanley Medical Research Institute, United Biosource Corporation, and Wyeth. The other authors report no financial relationships with commercial interests.

Supported by an ETS grant from the Spanish Ministry of Economy and Competitiveness (PI080180 and PI08/90825, PI08/90327, PI08/90675, PI08/90224, PI08/90654, PI08/90189, PI08/90916, PI08/90416, PI08/90094) PN 2008–2011, Carlos III Health Institute, General Subdepartment for Evaluation and Research Promotion; European Regional Fund, European Union, “Una manera de hacer Europa”; CIBERSAM; and the Commissioner for Universities and Research, Ministry of Innovation, Universities and Enterprise, Catalan Government (2009 SGR 1022 to the Bipolar Disorders Group).

Clinicaltrials.gov identification number: NCT 01370668.

From the Centers for Biomedical Research Network on Mental Health (CIBERSAM), Barcelona, Madrid, Vitoria, Oviedo, and Valencia, Spain; the Bipolar Disorder Program, Clinical Institute of Neuroscience, Hospital Clinic of Barcelona, University of Barcelona, Barcelona; the August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; the European Network of Bipolar Research Expert Centers (ENBREC), Barcelona; the Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de La Princesa, Madrid; FIDMAG Research Foundation, Barcelona; General Hospital of Granollers, Barcelona; Álava University Hospital, University of the Basque Country, Kronikgune, Vitoria, Spain; the Department of Psychiatry, University Hospital of Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Barcelona; the Department of Clinical Sciences, Bellvitge Campus, Barcelona University, Barcelona; the Department of Psychiatry, Ramon y Cajal Hospital, Ramon y Cajal Institute of Health Research (IRYCIS), University of Alcala, Madrid; the Department of Psychiatry, University of Oviedo, Oviedo; the Department of Medicine, University of Valencia, Valencia, Spain; and the Gregorio Marañón University General Hospital and Health Research Institute (IISGM), Madrid.

Address correspondence to Dr. Vieta (evieta@clinic.ub.es) and Dr. Martínez-Arán (amartiar@clinic.ub.es).

Copyright © 2013 by the American Psychiatric Association

Received July 25, 2012; Revised October 25, 2012; Accepted December 06, 2012.

Abstract

Objective  The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder.

Method  In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint.

Results  At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey’s post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation.

Conclusions  Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

FIGURE 1. Changes in Functional Impairment Scores Before and After Intervention in Patients With Bipolar Disordera

a Functional impairment is measured with the Functioning Assessment Short Test; higher scores indicate greater impairment. Change for the functional remediation group was significantly different from change for the treatment-as-usual group (Pillai’s Trace=0.065; F=6.51, p=0.002). Error bars indicate standard error of the mean.

FIGURE 2. Within-Group Effect Sizes in Functional Improvement, by Domain of the Functioning Assessment Short Test
Anchor for Jump
TABLE 1.Content of the Functional Remediation Program
Anchor for Jump
TABLE 2.Baseline Clinical and Sociodemographic Characteristics of Euthymic Patients With Bipolar Disorder and Moderate to Severe Functional Impairment Randomly Assigned to Functional Remediation, Psychoeducation, or Treatment as Usuala
Table Footer Note

a No significant differences between groups, except when illness duration was compared between the treatment-as-usual and psychoeducation groups (F=3.27; p=0.04).

+

References

Martínez-Arán  A;  Vieta  E;  Reinares  M;  Colom  F;  Torrent  C;  Sánchez-Moreno  J;  Benabarre  A;  Goikolea  JM;  Comes  M;  Salamero  M:  Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder.  Am J Psychiatry 2004; 161:262–270
[CrossRef] | [PubMed]
 
Martino  DJ;  Strejilevich  SA;  Scápola  M;  Igoa  A;  Marengo  E;  Ais  ED;  Perinot  L:  Heterogeneity in cognitive functioning among patients with bipolar disorder.  J Affect Disord 2008; 109:149–156
[CrossRef] | [PubMed]
 
Sanchez-Moreno  J;  Martinez-Aran  A;  Tabarés-Seisdedos  R;  Torrent  C;  Vieta  E;  Ayuso-Mateos  JL:  Functioning and disability in bipolar disorder: an extensive review.  Psychother Psychosom 2009; 78:285–297
[CrossRef] | [PubMed]
 
Depp  CA;  Mausbach  BT;  Harmell  AL;  Savla  GN;  Bowie  CR;  Harvey  PD;  Patterson  TL:  Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder.  Bipolar Disord 2012; 14:217–226
[CrossRef] | [PubMed]
 
Kessler  RC;  Akiskal  HS;  Ames  M;  Birnbaum  H;  Greenberg  P;  Hirschfeld  RM;  Jin  R;  Merikangas  KR;  Simon  GE;  Wang  PS:  Prevalence and effects of mood disorders on work performance in a nationally representative sample of US workers.  Am J Psychiatry 2006; 163:1561–1568
[CrossRef] | [PubMed]
 
Martinez-Aran  A;  Vieta  E;  Torrent  C;  Sanchez-Moreno  J;  Goikolea  JM;  Salamero  M;  Malhi  GS;  Gonzalez-Pinto  A;  Daban  C;  Alvarez-Grandi  S;  Fountoulakis  K;  Kaprinis  G;  Tabares-Seisdedos  R;  Ayuso-Mateos  JL:  Functional outcome in bipolar disorder: the role of clinical and cognitive factors.  Bipolar Disord 2007; 9:103–113
[CrossRef] | [PubMed]
 
Bonnín  CM;  Martínez-Arán  A;  Torrent  C;  Pacchiarotti  I;  Rosa  AR;  Franco  C;  Murru  A;  Sanchez-Moreno  J;  Vieta  E:  Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: a long-term follow-up study.  J Affect Disord 2010; 121:156–160
[CrossRef] | [PubMed]
 
Tabarés-Seisdedos  R;  Balanzá-Martínez  V;  Sánchez-Moreno  J;  Martinez-Aran  A;  Salazar-Fraile  J;  Selva-Vera  G;  Rubio  C;  Mata  I;  Gómez-Beneyto  M;  Vieta  E:  Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up.  J Affect Disord 2008; 109:286–299
[CrossRef] | [PubMed]
 
Martinez-Aran  A;  Torrent  C;  Sole  B;  Bonnin  CM;  Rosa  AR;  Sanchez-Moreno  J;  Vieta  E:  Functional remediation for bipolar disorder.  Clin Pract Epidemiol Ment Health 2011; 7:112–116
[CrossRef] | [PubMed]
 
Fuentes-Durá  I;  Balanzá-Martínez  V;  Ruiz-Ruiz  JC;  Martínez-Arán  A;  Girón  M;  Solé  B;  Sánchez-Moreno  J;  Gómez-Beneyto  M;  Vieta  E;  Tabarés-Seisdedos  R:  Neurocognitive training in patients with bipolar disorders: current status and perspectives.  Psychother Psychosom 2012; 81:250–252
[CrossRef] | [PubMed]
 
Wykes  T;  Huddy  V;  Cellard  C;  McGurk  SR;  Czobor  P:  A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes.  Am J Psychiatry 2011; 168:472–485
[CrossRef] | [PubMed]
 
Deckersbach  T;  Nierenberg  AA;  Kessler  R;  Lund  HG;  Ametrano  RM;  Sachs  G;  Rauch  SL;  Dougherty  D:  RESEARCH: Cognitive rehabilitation for bipolar disorder: an open trial for employed patients with residual depressive symptoms.  CNS Neurosci Ther 2010; 16:298–307
[CrossRef] | [PubMed]
 
Spaulding  WD;  Reed  D;  Sullivan  M;  Richardson  C;  Weiler  M:  Effects of cognitive treatment in psychiatric rehabilitation.  Schizophr Bull 1999; 25:657–676
[CrossRef] | [PubMed]
 
Naismith  SL;  Redoblado-Hodge  MA;  Lewis  SJ;  Scott  EM;  Hickie  IB:  Cognitive training in affective disorders improves memory: a preliminary study using the NEAR approach.  J Affect Disord 2010; 121:258–262
[CrossRef] | [PubMed]
 
Ueland  T;  Rund  BR:  A controlled randomized treatment study: the effects of a cognitive remediation program on adolescents with early onset psychosis.  Acta Psychiatr Scand 2004; 109:70–74
[CrossRef] | [PubMed]
 
Ueland  T;  Rund  BR:  Cognitive remediation for adolescents with early onset psychosis: a 1-year follow-up study.  Acta Psychiatr Scand 2005; 111:193–201
[CrossRef] | [PubMed]
 
McGurk  SR;  Mueser  KT;  Feldman  K;  Wolfe  R;  Pascaris  A:  Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial.  Am J Psychiatry 2007; 164:437–441
[CrossRef] | [PubMed]
 
Colom  F;  Vieta  E;  Martínez-Arán  A;  Garcia-Garcia  M;  Reinares  M;  Torrent  C;  Goikolea  JM;  Banús  S;  Salamero  M: [  Spanish version of a scale for the assessment of mania: validity and reliability of the Young Mania Rating Scale].  Med Clin (Barc) 2002; 119:366–371 (Spanish)
[CrossRef] | [PubMed]
 
Young  RC;  Biggs  JT;  Ziegler  VE;  Meyer  DA:  A rating scale for mania: reliability, validity, and sensitivity.  Br J Psychiatry 1978; 133:429–435
[CrossRef] | [PubMed]
 
Hamilton  M:  A rating scale for depression.  J Neurol Neurosurg Psychiatry 1960; 23:56–62
[CrossRef] | [PubMed]
 
Ramos-Brieva  JA;  Cordero Villafáfila  A:  [Validation of the Castillian version of the Hamilton Rating Scale for Depression].  Actas Luso Esp Neurol Psiquiatr Cienc Afines 1986; 14:324–334 (Spanish)
[PubMed]
 
Rosa  AR;  Sánchez-Moreno  J;  Martínez-Arán  A;  Salamero  M;  Torrent  C;  Reinares  M;  Comes  M;  Colom  F;  Van Riel  W;  Ayuso-Mateos  JL;  Kapczinski  F;  Vieta  E:  Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder.  Clin Pract Epidemiol Ment Health 2007; 3:5
[CrossRef] | [PubMed]
 
Colom  F;  Vieta  E:  Psychoeducation Manual for Bipolar Disorder .  Cambridge, UK,  Cambridge University Press, 2006
 
Colom  F;  Vieta  E;  Martinez-Aran  A;  Reinares  M;  Goikolea  JM;  Benabarre  A;  Torrent  C;  Comes  M;  Corbella  B;  Parramon  G;  Corominas  J:  A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission.  Arch Gen Psychiatry 2003; 60:402–407
[CrossRef] | [PubMed]
 
Spitzer  RL;  Williams  JBW;  Gibbon  M;  First  MB:  Structured Clinical Interview for DSM-IV (SCID) .  New York,  New York State Psychiatric Institute, Biometrics Research, 1995
 
Heaton  RK:  Wisconsin Card Sorting Test Manual .  Odessa, Fla,  Psychological Assessment Resources, 1981
 
Golden  CJ:  Stroop Color and Word Test .  Chicago,  Stoelting, 1978
 
Benton  AL;  Hamsher  K:  Multilingual Aphasia Examination .  Iowa City,  University of Iowa, 1976
 
Reitan  RM;  Wolfson  D:  The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation , 2nd ed.  Tucson, Ariz,  Neuropsychology Press, 1993
 
Rey  A:  Test de copia de una figura compleja.   Madrid,  TEA Ediciones, 1997
 
Rey  A:  L’examen clinique en psychologie .  Paris,  Presses Universitairies de France, 1958
 
Delis  DC;  Kramer  JH;  Kaplan  E;  Ober  B:  California Verbal Learning Test .  New York,  Psychological Corp, 1987
 
Weschler  D:  Weschler Memory Scale , 3rd ed.  San Antonio, Tex,  Psychological Corp, 1997
 
Conners  CK:  Conners’ Continuous Performance Test (CPT-II) Computer Program for Windows .  Tonawanda, NY,  Multi-Health Systems Inc, 2000
 
Rosa  AR;  Reinares  M;  Amann  B;  Popovic  D;  Franco  C;  Comes  M;  Torrent  C;  Bonnín  CM;  Solé  B;  Valentí  M;  Salamero  M;  Kapczinski  F;  Vieta  E:  Six-month functional outcome of a bipolar disorder cohort in the context of a specialized-care program.  Bipolar Disord 2011; 13:679–686
[CrossRef] | [PubMed]
 
Rosa  AR;  González-Ortega  I;  González-Pinto  A;  Echeburúa  E;  Comes  M;  Martínez-Àran  A;  Ugarte  A;  Fernández  M;  Vieta  E:  One-year psychosocial functioning in patients in the early vs late stage of bipolar disorder.  Acta Psychiatr Scand 2012; 125:335–341
[CrossRef] | [PubMed]
 
Penadés  R;  Boget  T;  Catalán  R;  Bernardo  M;  Gastó  C;  Salamero  M:  Cognitive mechanisms, psychosocial functioning, and neurocognitive rehabilitation in schizophrenia.  Schizophr Res 2003; 63:219–227
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 11

Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 54.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 19.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 18.  >
Textbook of Psychotherapeutic Treatments > Chapter 7.  >
Textbook of Psychotherapeutic Treatments > Chapter 24.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines
PubMed Articles