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Long-term outcome predictors after functional remediation in patients with bipolar disorder

Published online by Cambridge University Press:  16 June 2020

B. Solé
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
C. M. Bonnín
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
J. Radua
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
L. Montejo
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
B. Hogg
Affiliation:
Centre Fórum Research Unit, Parc de Salut Mar, Barcelona, Spain Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
E. Jimenez
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
M. Reinares
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
E. Valls
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
C. Varo
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
I. Pacchiarotti
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
M. Valentí
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
M. Garriga
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
I. Torres
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
A. Martínez-Arán*
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
E. Vieta*
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
C. Torrent
Affiliation:
Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
*
Author for correspondence: A. Martínez-Arán, E-mail: [email protected]; E. Vieta, E-mail: [email protected]
Author for correspondence: A. Martínez-Arán, E-mail: [email protected]; E. Vieta, E-mail: [email protected]

Abstract

Background

Improving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD.

Methods

A total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature.

Results

The regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model.

Conclusions

Results suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

This article has been updated since its original publication. A notice detailing this update can be found here: https://doi.org/10.1017/S0033291723001538

References

Benton, A., & Hamsher, K. (1976). Multilingual aphasia examination. Iowa City: University of Iowa.Google Scholar
Bonnin, C. M., Reinares, M., Martinez-Aran, A., Balanza-Martinez, V., Sole, B., Torrent, C., … CIBERSAM Functional Remediation Group (2016a). Effects of functional remediation on neurocognitively impaired bipolar patients: Enhancement of verbal memory. Psychological Medicine, 46, 291301. doi: 10.1017/S0033291715001713CrossRefGoogle ScholarPubMed
Bonnin, C. M., Torrent, C., Arango, C., Amann, B. L., Sole, B., Gonzalez-Pinto, A., … Martinez-Aran, A. (2016b). Functional remediation in bipolar disorder: 1-year follow-up of neurocognitive and functional outcome. British Journal of Psychiatry, 208, 8793. doi: 10.1192/bjp.bp.114.162123CrossRefGoogle ScholarPubMed
Bonnín, C. M., Martínez-Arán, A., Torrent, C., Pacchiarotti, I., Rosa, A. R., Franco, C., … Vieta, E. (2010). Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: A long-term, follow-up study. Journal of Affective Disorders, 121, 156160. doi: 10.1016/j.jad.2009.05.014CrossRefGoogle ScholarPubMed
Bourne, C., Aydemir, O., Balanza-Martinez, V., Bora, E., Brissos, S., Cavanagh, J. T. O., … Goodwin, G. M. (2013). Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: An individual patient data meta-analysis. Acta Psychiatrica Scandinavica, 128, 149162. doi: 10.1111/acps.12133CrossRefGoogle ScholarPubMed
Brissos, S., Dias, V. V., & Kapczinski, F. (2008). Cognitive performance and quality of life in bipolar disorder. Canadian Journal of Psychiatry, 53, 517524.CrossRefGoogle ScholarPubMed
Burdick, K. E., Russo, M., Frangou, S., Mahon, K., Braga, R. J., Shanahan, M., & Malhotra, A. K. (2014). Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: Clinical implications. Psychological Medicine, 44, 30833096. 10.1017/S0033291714000439.CrossRefGoogle ScholarPubMed
Colom, F., Vieta, E., Martínez-Arán, A., Garcia-Garcia, M., Reinares, M., Torrent, C., … Salamero, M. (2002). Spanish version of a scale for the assessment of mania: Validity and reliability of the young mania rating scale. Medicina Clinica, 119, 366371.CrossRefGoogle ScholarPubMed
Conners, C. (2000). Conner's continuous performances test for Windows (CPT-II). Toronto, ON: Multi-Health Systems.Google Scholar
Delis, D., Kramer, J., Kaplan, E., & Ober, B.. (1987). California Verbal Learning Test. New York: Psychological Corporation.Google Scholar
Demant, K. M., Vinberg, M., Kessing, L. V., & Miskowiak, K. W. (2015). Effects of short-term cognitive remediation on cognitive dysfunction in partially or fully remitted individuals with bipolar disorder: Results of a randomised controlled trial. PloS One, 10, e0127955. doi: 10.1371/journal.pone.0127955. eCollection 2015CrossRefGoogle ScholarPubMed
Depp, C., & Mausbach, B. (2012). Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disorder, 14, 217226. doi: 10.1111/j.1399-5618.2012.01011.xCrossRefGoogle ScholarPubMed
Ehrminger, M., Brunet-Gouet, E., Cannavo, A. S., Aouizerate, B., Cussac, I., Azorin, J. M., … Roux, P. (2019). Longitudinal relationships between cognition and functioning over 2 years in euthymic patients with bipolar disorder: A cross-lagged panel model approach with the FACE-BD cohort. The British Journal of Psychiatry, 13, 18. doi: 10.1192/bjp.2019.180Google Scholar
Farreny, A., Aguado, J., Corbera, S., Ochoa, S., Huerta-Ramos, E., & Usall, J. (2016). Baseline predictors for success following strategy-based cognitive remediation group training in schizophrenia. Journal of Nervous and Mental Disease, 204, 585589. doi: 10.1097/NMD.0000000000000509CrossRefGoogle ScholarPubMed
First, M. B., & Spitzer, R, & Gibbon, M. (1997). Structured clinical interview for DSM-IV axis I disorders (Biometrics Research Department.). Washington DC: American Psychiatric Press Inc.Google Scholar
Fiszdon, J. M., Cardenas, A. S., Bryson, G. J., & Bell, M. D. (2005). Predictors of remediation success on a trained memory task. Journal of Nervous and Mental Disease, 193, 602608.CrossRefGoogle ScholarPubMed
Forcada, I., Mur, M., Mora, E., Vieta, E., Bartrés-Faz, D., & Portella, M. J. (2015). The influence of cognitive reserve on psychosocial and neuropsychological functioning in bipolar disorder. European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology, 25, 214222. doi: 10.1016/j.euroneuro.2014.07.018CrossRefGoogle ScholarPubMed
Fu, D. J., Turkoz, I., Simonson, R. B., Walling, D. P., Schooler, N. R., Lindenmayer, J. P., … Alphs, L. (2015). Paliperidone palmitate once-monthly reduces risk of relapse of psychotic, depressive, and manic symptoms and maintains functioning in a double-blind, randomized study of schizoaffective disorder. Journal of Clinical Psychiatry, 76, 253262. doi: 10.4088/JCP.14m09416CrossRefGoogle Scholar
Golden, C. J. (1978). Stroop color and word test: A manual for clinical and experimental uses. Chicago: Stoelting.Google Scholar
Grande, I., Sanchez-Moreno, J., Sole, B., Jimenez, E., Torrent, C., Bonnin, C. M., … Martinez-Aran, A. (2017). High cognitive reserve in bipolar disorders as a moderator of neurocognitive impairment. Journal of Affective Disorders, 208, 621627. doi: 10.1016/j.jad.2016.10.012CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of neurology, neurosurgery, and psychiatry, 23, 5662.CrossRefGoogle ScholarPubMed
Heaton, R. K., & Staff, P. A.R. (2003). Wisconsin card sorting test: Computer version 4.. Lutz, FL: Psychological Assessment Resources.Google Scholar
Iosifescu, D. V. (2012). The relation between mood, cognition and psychosocial functioning in psychiatric disorders. European Neuropsychopharmacology, 22, S499S504.CrossRefGoogle ScholarPubMed
Jimenez, E., Arias, B., Castellvi, P., Goikolea, J. M., Rosa, A. R., Fananas, L., … Benabarre, A. (2012). Impulsivity and functional impairment in bipolar disorder. Journal of Affective Disorders, 136, 491497. doi: 10.1016/j.jad.2011.10.044CrossRefGoogle ScholarPubMed
Kahn, R. S., Sommer, I. E., Murray, R. M., Meyer-Lindenberg, A., Weinberger, D. R., Cannon, T. D., … Insel, T. R. (2015). Schizophrenia. Nature Reviews. Disease primers, 1, 15067. doi: 10.1038/nrdp.2015.67CrossRefGoogle ScholarPubMed
Kozicky, J.-M., Torres, I. J., Silveira, L. E., Bond, D. J., Lam, R. W., & Yatham, L. N. (2014). Cognitive change in the year after a first manic episode: Association between clinical outcome and cognitive performance early in the course of bipolar I disorder. The Journal of Clinical Psychiatry, 75, e587e593. doi: 10.4088/JCP.13m08928CrossRefGoogle ScholarPubMed
Kurtz, M. M. (2012). Cognitive remediation for schizophrenia: Current status, biological correlates and predictors of response. Expert Review of Neurotherapeutics, 12, 813821. doi: 10.1586/ern.12.71CrossRefGoogle ScholarPubMed
Kurtz, M. M., Seltzer, J. C., Fujimoto, M., Shagan, D. S., & Wexler, B. E. (2009). Predictors of change in life skills in schizophrenia after cognitive remediation. Schizophrenia Research, 107, 267274. doi: 10.1016/j.schres.2008.10.014CrossRefGoogle ScholarPubMed
Lewandowski, K. E., Sperry, S. H., Cohen, B. M., Norris, L. A., Fitzmaurice, G. M., Ongur, D., & Keshavan, M. S. (2017). Treatment to enhance cognition in bipolar disorder (TREC-BD): Efficacy of a randomized controlled trial of cognitive remediation versus active control. Journal of Clinical Psychiatry, 78, e1242e1249. doi: 10.4088/JCP.17m11476CrossRefGoogle ScholarPubMed
Lindenmayer, J. P., Ozog, V. A., Khan, A., Ljuri, I., Fregenti, S., & McGurk, S. R. (2017). Predictors of response to cognitive remediation in service recipients with severe mental illness. Psychiatric Rehabilitation Journal, 40, 6169. doi: 10.1037/prj0000252CrossRefGoogle ScholarPubMed
Mackala, S. A., Torres, I. J., Kozicky, J., Michalak, E. E., & Yatham, L. N. (2014). Cognitive performance and quality of life early in the course of bipolar disorder. Journal of Affective Disorders, 168, 119124. doi: 10.1016/j.jad.2014.06.045CrossRefGoogle ScholarPubMed
Martino, D. J., Marengo, E., Igoa, A., Scápola, M., Ais, E. D., Perinot, L., & Strejilevich, S. A. (2009). Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: A prospective 1 year follow-up study. Journal of Affective Disorders, 116, 3742. doi: 10.1016/j.jad.2008.10.023CrossRefGoogle ScholarPubMed
Martínez-Arán, A., Torrent, C., Solé, B., Bonnín, C. M., Rosa, A. R., Sánchez-Moreno, J., & Vieta, E. (2011). Functional remediation for bipolar disorder. Clinical Practice & Epidemiology in Mental Health, 7, 112116. doi: 10.2174/1745017901107010112CrossRefGoogle ScholarPubMed
Martínez-Arán, A., Vieta, E., Reinares, M., Colom, F., Torrent, C., Sánchez-Moreno, J., … Salamero, M. (2004). Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. The American Journal of Psychiatry, 161, 262270.CrossRefGoogle ScholarPubMed
Medalia, A., & Richardson, R. (2005). What predicts a good response to cognitive remediation interventions? Schizophrenia Bulletin, 31, 942953.CrossRefGoogle ScholarPubMed
Miskowiak, K. W., Carvalho, A. F., Vieta, E., & Kessing, L. V. (2016a). Cognitive enhancement treatments for bipolar disorder: A systematic review and methodological recommendations. European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology, 26, 15411561. doi: 10.1016/j.euroneuro.2016.08.011CrossRefGoogle ScholarPubMed
Miskowiak, K. W., Petersen, J. Z., Ott, C. V., Knorr, U., Kessing, L. V., Gallagher, P., & Robinson, L. (2016b). Predictors of the discrepancy between objective and subjective cognition in bipolar disorder: A novel methodology. Acta Psychiatrica Scandinavica, 134, 511521. doi: 10.1111/acps.12649CrossRefGoogle ScholarPubMed
Mora, E., Portella, M. J., Forcada, I., Vieta, E., & Mur, M. (2013). Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: A 6-year follow-up study. Psychological Medicine, 43, 11871196. doi: 10.1017/S0033291712001948CrossRefGoogle ScholarPubMed
Nakagami, E., Xie, B., Hoe, M., & Brekke, J. S. (2008). Intrinsic motivation, neurocognition and psychosocial functioning in schizophrenia: Testing mediator and moderator effects. Schizophrenia Research, 105, 95104. doi: 10.1016/j.schres.2008.06.015CrossRefGoogle ScholarPubMed
Newman, A. L., & Meyer, T. D. (2014). Impulsivity: Present during euthymia in bipolar disorder? - a systematic review. International Journal of Bipolar Disorders, 2, 2. doi: 10.1186/2194-7511-2-2. eCollection 2014CrossRefGoogle ScholarPubMed
Penades, R., Lopez-Vilchez, I., Catalan, R., Arias, B., Gonzalez-Rodriguez, A., Garcia-Rizo, C., … Bernardo, M. (2017). BDNF As a marker of response to cognitive remediation in patients with schizophrenia: A randomized and controlled trial. Schizophrenia Research, 197, 458464. doi: 10.1016/j.schres.2017.12.002CrossRefGoogle ScholarPubMed
Reeder, C., Smedley, N., Butt, K., Bogner, D., & Wykes, T. (2006). Cognitive predictors of social functioning improvements following cognitive remediation for schizophrenia. Schizophrenia Bulletin, 32, 123131.CrossRefGoogle ScholarPubMed
Reinares, M., Papachristou, E., Harvey, P., Mar Bonnín, C., Sánchez-Moreno, J., Torrent, C., … Frangou, S. (2013). Towards a clinical staging for bipolar disorder: Defining patient subtypes based on functional outcome. Journal of Affective Disorders, 144, 6571. doi: 10.1016/j.jad.2012.06.005CrossRefGoogle ScholarPubMed
Reitan, R. (1958). Validity of the trail making test as a indication of organic brain damage. Percept Mot Skills, 8, 271276.CrossRefGoogle Scholar
Rey, A. (1997). Test de copia de una figura compleja. Manual adaptación española. Ed. Ediciones, T. Madrid.Google Scholar
Rodewald, K., Holt, D. V., Rentrop, M., Roesch-Ely, D., Liebrenz, M., Funke, J., … Kaiser, S. (2014). Predictors for improvement of problem-solving during cognitive remediation for patients with schizophrenia. Journal of the International Neuropsychological Society, 20, 455460. doi: 10.1017/S1355617714000162CrossRefGoogle ScholarPubMed
Rosa, A. R., Sánchez-Moreno, J., Martínez-Aran, A., Salamero, M., Torrent, C., Reinares, M., … Vieta, E. (2007). Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice and Epidemiology in Mental Health, 3, 5.CrossRefGoogle ScholarPubMed
Roux, P., Raust, A., Cannavo, A. S., Aubin, V., Aouizerate, B., Azorin, J.-M., … Passerieux, C. (2017). Cognitive profiles in euthymic patients with bipolar disorders: Results from the FACE-BD cohort. Bipolar Disorders, 19, 146153. doi: 10.1111/bdi.12485CrossRefGoogle ScholarPubMed
Salagre, E., Arango, C., Artigas, F., Ayuso-Mateos, J. L., Bernardo, M., Castro-Fornieles, J., … Vieta, E. (2019). CIBERSAM: Ten years of collaborative translational research in mental disorders. Rev Psiquiatr Salud Ment, 12(1), 18. doi: 10.1016/j.rpsm.2018.10.001CrossRefGoogle ScholarPubMed
Salagre, E., Solé, B., Tomioka, Y., Fernandes, B. S., Hidalgo-Mazzei, D., Garriga, M., … Grande, I. (2017). Treatment of neurocognitive symptoms in unipolar depression: A systematic review and future perspectives. Journal of Affective Disorders, 221, 205221. doi: 10.1016/j.jad.2017.06.034CrossRefGoogle ScholarPubMed
Sanchez-Moreno, J., Bonnin, C. M., González-Pinto, A., Amann, B. L., Solé, B., Balanzá-Martinez, V., … Vieta, E. (2018). Factors associated with poor functional outcome in bipolar disorder: Sociodemographic, clinical, and neurocognitive variables. Acta Psychiatrica Scandinavica, 138, 145154. doi: 10.1111/acps.12894CrossRefGoogle ScholarPubMed
Sanchez-Moreno, J., Bonnín, C., González-Pinto, A., Amann, B. L., Solé, B., Balanzá-Martínez, V., … CIBERSAM Functional Remediation Group (2017a). Do patients with bipolar disorder and subsyndromal symptoms benefit from functional remediation? A 12–month follow-up study. European Neuropsychopharmacology, 27, 350359. doi: 10.1016/j.euroneuro.2017.01.010CrossRefGoogle ScholarPubMed
Sanchez-Moreno, J., Martinez-Aran, A., & Vieta, E. (2017b). Treatment of functional impairment in patients with bipolar disorder. Current Psychiatry Reports, 19, 17. doi: 10.1007/s11920-017-0752-3CrossRefGoogle ScholarPubMed
Scheu, F., Aghotor, J., Pfueller, U., Moritz, S., Bohn, F., Weisbrod, M., & Roesch-Ely, D. (2013). Predictors of performance improvements within a cognitive remediation program for schizophrenia. Psychiatry Research, 209, 375380. doi: 10.1016/j.psychres.2013.04.015CrossRefGoogle ScholarPubMed
Solé, B., Jiménez, E., Torrent, C., Reinares, M., Bonnin, C. D. M., Torres, I., … Vieta, E. (2017). Cognitive impairment in bipolar disorder: Treatment and prevention strategies. International Journal of Neuropsychopharmacology, 20, 670680. doi: 10.1093/ijnp/pyx032CrossRefGoogle ScholarPubMed
Stern, Y. (2006). Cognitive reserve and Alzheimer disease. Alzheimer disease and associated disorders, 20, S69S74.CrossRefGoogle ScholarPubMed
Torrent, C., del Bonnin, C. M., Martínez-Arán, A., Valle, J., Amann, B. L., González-Pinto, A., … Vieta, E. (2013). Efficacy of functional remediation in bipolar disorder: A multicenter randomized controlled study. The American Journal of Psychiatry, 170, 852859. doi: 10.1176/appi.ajp.2012.12070971CrossRefGoogle ScholarPubMed
Torrent, C., & Vieta, E. (2015). Lifting the burden of bipolar disorder: The role of psychotherapies. The Australian and New Zealand Journal of psychiatry, 49(8), 754755. doi: 10.1177/0004867415587746CrossRefGoogle ScholarPubMed
Torres, I. J., Kozicky, J., Popuri, S., Bond, D. J., Honer, W. G., Lam, R. W., & Yatham, L. N. (2014). 12-month Longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar disorders, 16, 159171.CrossRefGoogle ScholarPubMed
Twamley, E. W., Burton, C. Z., & Vella, L. (2011). Compensatory cognitive training for psychosis: Who benefits? Who stays in treatment? Schizophrenia Bulletin, 37, 5562. doi: 10.1093/schbul/sbr059CrossRefGoogle ScholarPubMed
Vieta, E. (2011). Bipolar units and programmes: Are they really needed? World Psychiatry, 10, 152152.CrossRefGoogle ScholarPubMed
Vieta, E., Torrent, C., & Martinez-Arán, A. (2014). Functional remediation for bipolar disorder. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Vita, A., Deste, G., De Peri, L., Barlati, S., Poli, R., Cesana, B. M., & Sacchetti, E. (2013). Predictors of cognitive and functional improvement and normalization after cognitive remediation in patients with schizophrenia. Schizophrenia Research, 150, 5157. doi: 10.1016/j.schres.2013.08.011CrossRefGoogle ScholarPubMed
Wechsler, D. (1997). The wechsler adult intelligence scale- III (WAIS- III). San Antonio, TX: Psychological Corporation.Google Scholar
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429435.CrossRefGoogle ScholarPubMed
Zyto, S., Jabben, N., Schulte, P. F. J., Regeer, B. J., & Kupka, R. W. (2016). A pilot study of a combined group and individual functional remediation program for patients with bipolar i disorder. Journal of Affective Disorders, 194, 915. doi: 10.1016/j.jad.2016.01.029CrossRefGoogle ScholarPubMed