A randomized controlled trial of cognitive remediation and d-cycloserine for individuals with bipolar disorder

Breitborde, Nicholas J. K.; Dawson, Spencer C.; Woolverton, Cindy; Dawley, David D.; Bell, Emily K.; Norman, Kaila R.; Polsinelli, Angelina J.; Bernstein, Beth; Mirsky, Pamela; Pletkova, Christine; Grucci, Felix; Montoya, Carly; Nanadiego, Bernard; Sarabi, Ehsan; DePalma, Michael J.; Moreno, Francisco

doi:10.1186/s40359-014-0041-4

Cited by 13 publications

(10 citation statements)

References 89 publications

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“…A highly promising treatment approach is the combination of pharmacological and psychological interventions (eg, ). This is likely to produce synergistic effects on brain function that may translate into more robust efficacy on cognition and functional outcome than either treatment modality alone.…”

Section: Results: Task Force Recommendationsmentioning

confidence: 99%

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

et al. 2018

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Section: Results: Task Force Recommendationsmentioning

confidence: 99%

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

et al. 2018

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“…At EPICENTER, participants received metacognitive remediation (MCR: [ 71 , 72 ])—a form of cognitive remediation shown to improve numerous domains of cognitive functioning among individuals with first-episode psychosis, including processing speed, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem-solving, and social cognition [ 71 ]. MCR involves participation in both computerized cognitive remediation exercises and metacognitive skills development exercises with a clinician.…”

Section: Methodsmentioning

confidence: 99%

The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service

et al. 2015

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BackgroundThere is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER).MethodsSixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation.ResultsOver the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system.ConclusionsThe results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States.Trial registrationClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011

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“…Very little is known about the longitudinal course of cognitive deficits and the neuropsychological underpinnings of the dynamics of BD (74). Improving the knowledge on the development in time of cognitive dysfunction in BD [role of depressive episodes, role of manic episodes, role of mixed episodes, role of specific medications for better or for worse, role of cognitive remediation programs, role of inflammatory mediators (75), role of genetic factors (76,77)] would contribute to identify targets for treatment, to determine possible subtypes of the disorder, and to develop better therapeutic strategies (78,79). The metaanalytic study by Samamé et al (13) showed that cognitive deficits remain stable after a follow-up period of 4.62 years.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Functional Outcome in Patients With Bipolar Disorder: Effects of Cognitive Psychoeducational Group Therapy After 12 Months

et al. 2020

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Background: Cognitive deficits are known as a core feature in bipolar disorder. Persisting neurocognitive impairment is associated with low psychosocial functioning. The aim of this study was to identify potential cognitive, clinical and treatment-dependent predictors for functional impairment, symptom severity and early recurrence in bipolar patients, as well as to analyze neurocognitive performance compared to healthy controls.Methods: Forty three remitted bipolar patients and 40 healthy controls were assessed with a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed.Results: Compared to healthy controls, bipolar patients showed lower performance in executive function (perseverative errors p < 0.01, categories correct p < 0.001), sustained attention (total hits p < 0.001), verbal learning (delayed recall p < 0.001) and verbal fluency (p-words p < 0.002). Cognitive psychoeducational group therapy and attention predicted occupational functioning with a hit ratio of 87.5%. Verbal memory recall was found to be a predictor for symptom severity (hit ratio 86.8%). Recurrence in the follow-up period was predicted by premorbid IQ and by years of education (hit ratio 77.8%).Limitations: Limitations of the present study result mainly from a small sample size. The extent of cognitive impairment appears to impact occupational disability, clinical outcome as well as recurrence rate. This result must be interpreted with caution because statistical analysis failed to show higher significance.Conclusions: Bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. Deficits in sustained attention have an impact on occupational impairment. Implications for treatment strategies are discussed. Further evaluation in larger studies is needed.

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A randomized controlled trial of cognitive remediation and d-cycloserine for individuals with bipolar disorder

Cited by 13 publications

References 89 publications

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service

Predictors of Functional Outcome in Patients With Bipolar Disorder: Effects of Cognitive Psychoeducational Group Therapy After 12 Months

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