RESEARCH: Cognitive rehabilitation for bipolar disorder: An open trial for employed patients with residual depressive symptoms

Abstract

Bipolar disorder is characterized by recurrent episodes of depression and/or mania along with interepisodic mood symptoms that interfere with psychosocial functioning. Despite periods of symptomatic recovery, individuals with bipolar disorder often continue to experience impairments in psychosocial functioning, particularly occupational functioning. Two determinants of psychosocial functioning of euthymic (neither fully depressed nor manic) individuals with bipolar disorder are residual depressive symptoms and cognitive impairment (i.e., difficulties with executive functioning, attention, and memory). The present study explored whether a new cognitive remediation (CR) treatment designed to treat residual depressive symptoms and, for the first time to the best of our knowledge, address cognitive impairment would be associated with improvement in psychosocial functioning in individuals with bipolar disorder. Following a neuropsychological and clinical assessment 18 individuals with DSM-IV bipolar disorder were treated with 14 individual sessions of CR. Results indicated that at the end of treatment, as well as at the 3-months follow-up, patients showed lower residual depressive symptoms, and increased occupational, as well as overall psychosocial functioning. Pretreatment neuropsychological impairment predicted treatment response. Improvements in executive functioning were associated with improvements in occupational functioning. These findings suggest that treating residual depressive symptoms and cognitive impairment may be an avenue to improving occupational and overall functioning in individuals with bipolar disorder.

Conflict of interest statement

Dr. T. Deckersbach's research has been funded by NIMH, NARSAD, TSA, and OCF. He has received honoraria and/or consultation fees from Medacorp, MGH Psychiatry Academy, and Boston University. He has also participated in research funded Janssen Pharmaceuticals, The Forest Research Institute, Shire Development Inc., Medtronic, Cyberonics, and Northstar.

In the past 3 years, Dr. A. Nierenberg consulted to or served on advisory boards of Abbott Laboratories, Appliance Computing Inc, Brain Cells Inc, Bristol Myers Squibb, EpiQ, Pam Labs, PGx Health, Forest Pharmaceuticals, Eli Lilly & Co, GlaxoSmithKline, Janssen, Pharmaceutica, Jazz Pharmaceuticals, Merck, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Schering‐Plough, Sepracor, Shire, Somerset, Takeda, and Targacept. He has received research support from Cyberonics, Cederroth, Forest Pharmaceuticals, Medtronics, NIMH, NARSAD, the Stanley Foundation through the Broad Institute, Ortho‐McNeil‐Janssen, Pfizer, Pam Labs, and Shire. Past research support includes Bristol Myers Squibb, Cederroth, Forest Pharmaceuticals, Eli Lilly and Company, Glaxo Smith Kline, Janssen, Lictwer Pharma, Pfizer pharmaceuticals, and Wyeth Ayerst. He received honoraria from the MGH Psychiatry Academy (MGHPA activities are supported through Independent Medical Education (IME) grants from the following pharmaceutical companies in 2008: Astra Zeneca, Eli Lilly, and Janssen Pharmaceuticals). He earns fees for editorial functions for CNS Spectrums through MBL Publishing and Psychiatric Annals through Slack Inc. He receives honoraria as a CME Executive Director for the Journal of Clinical Psychiatry through Physicians Postgraduate Press. No other speaker bureaus for the past 3 years. Past speaker bureaus include Bristol Myers Squibb, Cyberonics, Forest Pharmaceuticals, Eli Lilly and Company, Glaxo SmithKline, and Wyeth Ayerst. Royalties have been received from Cambridge University Press and Belvoir Publishing. Dr. Nierenberg owns stock options in Appliance Computing, Inc. He owns copyrights to the Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery Asberg Depression Scale exclusively licensed to the MGH Clinical Trials Network and Institute (CTNI).

Dr. R. Kessler has been a consultant for GlaxoSmithKline Inc., Kaiser Permanente, Pfizer Inc., Sanofi‐Aventis, Shire Pharmaceuticals, and Wyeth‐Ayerst; has served on advisory boards for Eli Lilly & Company and Wyeth‐Ayerst; and has had research support for his epidemiological studies from Bristol‐Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho‐McNeil Pharmaceuticals Inc., Pfizer Inc., and Sanofi‐Aventis.

Dr. Gary S. Sachs serves on the speakers bureaus of Abbott, AstraZeneca, Bristol‐Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Memory Pharmaceuticals, Novartis, Pfizer, Sanofi‐Aventis, and Wyeth; he serves as an advisory board member or consultant for Abbott, AstraZeneca, Bristol‐Myers Squibb, Cephalon, CNS Response, Concordant Rater Systems, Elan Pharmaceuticals, Eli Lilly, GlaxoSmithKline, Janssen, Memory Pharmaceuticals, Merck, Novartis, Organon, Otsuka, Pfizer, Repligen, Sanofi‐Aventis, Schering Plough, Sepracor, Shire, Sigma‐Tau, Solvay Pharmaceuticals, and Wyeth; and his spouse holds shares in Concordant Rater Systems.

Dr. S. Rauch has received honoraria and/or consultation fees from Neurogen, Sepracor, Novartis and Medtronic. He has also participated in research funded by Medtronic, Cyberonics, Cephalon and Northstar.

Dr. D. Dougherty has received honoraria and/or consultation fees from Medtronic, Eli Lily, Jazz Pharmaceuticals, Northstar, Wyeth, Bristol Myers Squibb, Brand Ideas, McNeil, Reed Elsevier, Trancept Pharmaceuticals, Cyberonics, JK Associates, Inc., American Psychiatric Publishing, Inc., Advocate Health and Hosp. Corp., DHHS/NIH, Leerink Swann LLC, Oxford University Press, Professional Practice Group/Psychiatry Syracuse, Y&R Inc., and DBA Sudler & Henessy. He has also participated in research funded by Medtronic, Eli Lily, Northstar, McNeil, Cyberonics, Forest, and Cephalon.

© 2009 Blackwell Publishing Ltd.