Redefining Remission in Mental Health

When a psychiatric client is in remission, it usually means that he or she is no longer experiencing clinical levels of symptoms related to the original issue. For instance, people with depression may be classified as being in remission when they have more periods of positive affect than negative affect, when they do not ruminate and when their eating and sleeping patterns return to normal. However, according to a recent study led by Rico S. C. Lee of the Clinical Research Unit of the Brain and Mind Research Institute at the University of Sydney in Australia, individuals who meet clinical thresholds of remission may not simultaneously achieve cognitive levels of remission.

Research in the area of cognitive remission is scant. Some studies show that cognitive deficits rebound at the same time symptoms decrease, while others reveal that clients who are in remission from symptoms still report feeling impaired in specific areas of their lives. To determine if cognitive deficits persisted in the absence of clinical symptoms, Lee assessed the cognitive capacities of 93 young adults with psychosis, depression, or bipolar at baseline and approximately two years later. The results revealed a direct relationship between cognitive and functioning and later impairment. In this study, the participants who had stronger cognitive abilities at baseline had higher rates of employment, better qualities of life, fewer disabilities, and more satisfaction in relationships than those who had cognitive impairments.

Visuospatial, working, and verbal memory, along with the ability to switch attention at baseline, were all predictive of better global functioning two years later. Lee noted that cognitive functioning at baseline did not predict symptomology at baseline or later on, and baseline symptoms did not predict later symptom severity or cognitive functioning. This suggests that clinical symptoms and cognitive functioning affect the course of these illness in unique and independent ways. Lee added, “Taken together, these results strongly suggest that a traditional, or sole, focus on symptom factors is inadequate in characterizing prognosis and recovery.”

Reference:
Lee, R.S.C., Hermens, D.F., Redoblado-Hodge, M.A., Naismith, S.L., Porter, M.A., et al. (2013). Neuropsychological and socio-occupational functioning in young psychiatric outpatients: A longitudinal investigation. PLoS ONE 8(3): e58176. doi:10.1371/journal.pone.0058176

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