Limits...
Neuropsychological profile according to the clinical stage of young persons presenting for mental health care.

Hermens DF, Naismith SL, Lagopoulos J, Lee RS, Guastella AJ, Scott EM, Hickie IB - BMC Psychol (2013)

Bottom Line: Clinical staging rated 94 persons as having an 'attenuated syndrome' (stage 1b) and 100 with a discrete or persistent disorder (stage 2/3).Greatest impairments were seen in verbal memory and executive functioning.The degree of neuropsychological impairment in young persons with mental disorders appears to discriminate those with attenuated syndromes from those with a discrete disorder, independent of diagnostic status and current symptoms.

View Article: PubMed Central - PubMed

Affiliation: Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallet Street, Camperdown, NSW 2050 Australia.

ABSTRACT

Background: Clinical staging of mental disorders proposes that individuals can be assessed at various sub-syndromal and later developed phases of illness. As an adjunctive rating, it may complement traditional diagnostic silo-based approaches. In this study, we sought to determine the relationships between clinical stage and neuropsychological profile in young persons presenting to youth-focused mental health services.

Methods: Neuropsychological testing of 194 help-seeking young people (mean age 22.6 years, 52% female) and 50 healthy controls. Clinical staging rated 94 persons as having an 'attenuated syndrome' (stage 1b) and 100 with a discrete or persistent disorder (stage 2/3).

Results: The discrete disorder group (stage 2/3) showed the most impaired neuropsychological profile, with the earlier stage (1b) group showing an intermediate profile, compared to controls. Greatest impairments were seen in verbal memory and executive functioning. To address potential confounds created by 'diagnosis', profiles for those with a mood syndrome or disorder but not psychosis were also examined and the neuropsychological impairments for the stage 2/3 group remained.

Conclusions: The degree of neuropsychological impairment in young persons with mental disorders appears to discriminate those with attenuated syndromes from those with a discrete disorder, independent of diagnostic status and current symptoms. Our findings suggest that neuropsychological assessment is a critical aspect of clinical evaluation of young patients at the early stages of a major psychiatric illness.

No MeSH data available.


Related in: MedlinePlus

Profile ofz-scores (with standard error bars) for neuropsychological measures across the stage 1b (n = 94), stage 2/3 (n = 100) and control (n = 50) groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4270041&req=5

Fig1: Profile ofz-scores (with standard error bars) for neuropsychological measures across the stage 1b (n = 94), stage 2/3 (n = 100) and control (n = 50) groups.

Mentions: The neuropsychological profiles (mean z-scores) for all three groups are depicted in Figure 1 and the corresponding ANOVAs and post-hoc tests are summarised in Table 2. With the exception of verbal fluency (COWAT FAS), the control group showed a normal profile of neuropsychological function with all variables averaging between 0.0 and 0.5 standardised scores. In contrast, the stage 2/3 group showed the worst profile with neuropsychological z-scores ranging between 0.0 and -1.0; the stage 1b group showed an intermediate profile (see Figure 1). The differences in these three profiles was confirmed by the ANOVA’s which showed a significant (at least p<.05) main effect of group for all but one variable. The lack of a difference in verbal fluency is consistent with the lack of differences in the premorbid IQ measure (which is based on a verbal IQ score). Post-hoc Scheffe’s tests revealed that for the remaining eight neuropsychological variables (i.e. not including verbal fluency) the stage 2/3 group performed significantly worse than controls. As compared to the stage 1b group, stage 2 patients were worse on three variables: verbal learning (RAVLT sum), verbal memory (RAVLT A7) and set-shifting (IED errors). Interestingly, for the remaining five variables, the stage 1b group was significantly worse than controls but no different (statistically) to the stage 2 group (see final three columns in Table 2). Follow-up ANCOVAs revealed that all of the eight neuropsychological variables remained significant after controlling for gender.Figure 1


Neuropsychological profile according to the clinical stage of young persons presenting for mental health care.

Hermens DF, Naismith SL, Lagopoulos J, Lee RS, Guastella AJ, Scott EM, Hickie IB - BMC Psychol (2013)

Profile ofz-scores (with standard error bars) for neuropsychological measures across the stage 1b (n = 94), stage 2/3 (n = 100) and control (n = 50) groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4270041&req=5

Fig1: Profile ofz-scores (with standard error bars) for neuropsychological measures across the stage 1b (n = 94), stage 2/3 (n = 100) and control (n = 50) groups.
Mentions: The neuropsychological profiles (mean z-scores) for all three groups are depicted in Figure 1 and the corresponding ANOVAs and post-hoc tests are summarised in Table 2. With the exception of verbal fluency (COWAT FAS), the control group showed a normal profile of neuropsychological function with all variables averaging between 0.0 and 0.5 standardised scores. In contrast, the stage 2/3 group showed the worst profile with neuropsychological z-scores ranging between 0.0 and -1.0; the stage 1b group showed an intermediate profile (see Figure 1). The differences in these three profiles was confirmed by the ANOVA’s which showed a significant (at least p<.05) main effect of group for all but one variable. The lack of a difference in verbal fluency is consistent with the lack of differences in the premorbid IQ measure (which is based on a verbal IQ score). Post-hoc Scheffe’s tests revealed that for the remaining eight neuropsychological variables (i.e. not including verbal fluency) the stage 2/3 group performed significantly worse than controls. As compared to the stage 1b group, stage 2 patients were worse on three variables: verbal learning (RAVLT sum), verbal memory (RAVLT A7) and set-shifting (IED errors). Interestingly, for the remaining five variables, the stage 1b group was significantly worse than controls but no different (statistically) to the stage 2 group (see final three columns in Table 2). Follow-up ANCOVAs revealed that all of the eight neuropsychological variables remained significant after controlling for gender.Figure 1

Bottom Line: Clinical staging rated 94 persons as having an 'attenuated syndrome' (stage 1b) and 100 with a discrete or persistent disorder (stage 2/3).Greatest impairments were seen in verbal memory and executive functioning.The degree of neuropsychological impairment in young persons with mental disorders appears to discriminate those with attenuated syndromes from those with a discrete disorder, independent of diagnostic status and current symptoms.

View Article: PubMed Central - PubMed

Affiliation: Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallet Street, Camperdown, NSW 2050 Australia.

ABSTRACT

Background: Clinical staging of mental disorders proposes that individuals can be assessed at various sub-syndromal and later developed phases of illness. As an adjunctive rating, it may complement traditional diagnostic silo-based approaches. In this study, we sought to determine the relationships between clinical stage and neuropsychological profile in young persons presenting to youth-focused mental health services.

Methods: Neuropsychological testing of 194 help-seeking young people (mean age 22.6 years, 52% female) and 50 healthy controls. Clinical staging rated 94 persons as having an 'attenuated syndrome' (stage 1b) and 100 with a discrete or persistent disorder (stage 2/3).

Results: The discrete disorder group (stage 2/3) showed the most impaired neuropsychological profile, with the earlier stage (1b) group showing an intermediate profile, compared to controls. Greatest impairments were seen in verbal memory and executive functioning. To address potential confounds created by 'diagnosis', profiles for those with a mood syndrome or disorder but not psychosis were also examined and the neuropsychological impairments for the stage 2/3 group remained.

Conclusions: The degree of neuropsychological impairment in young persons with mental disorders appears to discriminate those with attenuated syndromes from those with a discrete disorder, independent of diagnostic status and current symptoms. Our findings suggest that neuropsychological assessment is a critical aspect of clinical evaluation of young patients at the early stages of a major psychiatric illness.

No MeSH data available.


Related in: MedlinePlus