Transcript (Speaker`s Bureau, Consulting Fees (eg, advisory boards))

PILOT STUDY ON THE APPLICABILITY OF THE SCREEN FOR COGNITIVE IMPAIRMENT IN PSYCHIATRY (SCIP)
IN A CLINICAL POPULATION WITH BIPOLAR DISORDER (BD)
,1
M.D.*
1 Douglas
Mental Health University Institute
2 Centre Recherche Fernand Séguin, Montréal
3 Département de psychiatrie, Hôpital Louis-H. Lafontaine,
Centre Universitaire en Santé Mentale de Montréal
4 Departement of psychiatry, McGill University, Montréal, Québec
*E-mail: [email protected]
1,4
FRCPC
ALAIN ABDEL MALEK,
1
SYBILLE SAURY, M.Sc.
AKRAM DJOUINI, M.D., M.Sc. 2
STÉPHANE POTVIN, PH.D. 2,3
SUZANE RENAUD, MD,
1,4
ANDRÉE DAIGNEAULT, M.D., FRCPC
VALÉRIE TOURJMAN, M.D. 2,3
SERGE BEAULIEU, M.D., PH.D., FRCPC 1,4
INTRODUCTION
RESULTS
There is growing evidence that individuals with bipolar disorders (BD) compared to healthy subjects, have neurocognitive deficits,
especially in memory and executive functioning domains. These deficits are present in all mood states and eventually affect the
functional capacity.1,2,3 Nevertheless, evaluation of cognition is time-consuming, costly and constrained by limited accessibility to
expertise. The Screen For Cognitive Impairment In Psychiatry (SCIP) is an inexpensive instrument with minimal training
requirements and minimal demands beyond the score sheet, a pencil and a stopwatch.4 It has shown adequate psychometric
properties for the detection of cognitive impairment in healthy controls and Bipolar Disorder – type I (DB-I).4,5 A French-Canadian
version has also been tested and proven to have good reliability and validity among healthy controls.6 This small pilot study aims
to apply the SCIP in a real-life clinical context with a clinical population of BD patients.
Demographics: Out of 31 participants, 55 % were women. Mean age was 50.06 yo (SD = 13.36) and 93.5% of the participants had a secondary education or
higher with mean years of education of 14.3 years (SD = 4.1). Fourteen patients were diagnosed with BD type I, 15 with BD type II and 2 with BD-NOS. CGI-S
mean was 3.1 (SD = 1.86) and GAF mean was 71 (SD: 15.45).
Objective 1: The mean time for taking the test was 13.7 minutes (SD=2.1). All recruited participants were cooperative and 77.4% thought that the SCIP
would help the treating team understand their cognitive functioning better.
Objective 2:
Objectives
Objective 1: to determine the feasibility of using the validated French version of the SCIP to assess cognitive functions in a clinical
population affected by BD.
Objective 2: to start exploring the correlation between the severity of the illness and the neurocognitive performance in BD.
z-scores
VLT-I
WMT
VFT
VLT-D
PST
TOTAL
Healthy controls
-1.34
-0.81
-1.13
-0.86
-1.04
-1.03
BD-I
0.27
0.30
-0.85
0.11
-0.60
-0.15
Table 2: z-scores of the SCIP sub-tests of our bipolar disorder cohort compared to healthy controls8 and to a large published BD-I cohort.7
METHODS AND MATERIALS
The study was approved by the Research Ethics Board and was performed at the Bipolar Disorders outpatient clinic of Douglas
Mental Health University Institute (DMHUI) in Montreal, Canada. Participants with a diagnosis of BD were included. All
psychiatric medications and co-morbidities were also allowed. Participants’ demographics were recorded and the SCIP was
performed. A Global Assessment of Functioning (GAF) and a Clinical Global Impression- Severity (CGI-S) were completed by the
treating psychiatrist who was blind to the SCIP’s results. CGI-S is a 7-point scale that requires the psychiatrist to rate the severity
of the patient's illness at the time of rating : 1, normal, not at all ill; 2, borderline mentally ill; 3, mildly ill; 4, moderately ill; 5,
markedly ill; 6, severely ill; or 7, extremely ill. Self-administrated questionnaires regarding participant’s experience with the SCIP
and perception of their cognitive functions were also completed.
The SCIP is a 15-minute pen and paper evaluation tool consisting of 5 subtests: Verbal Learning Test-Immediate (VLT-I); Working
Memory Test (WMT); Verbal Fluency Test (VFT); Verbal Learning Test-Delayed (VLT-D); and Processing Speed Test (PST).
SUBTEST
DESCRIPTION
SCORE
RANGE SCORES
VLT-I
WMT
VFT
VLT-D
PST
TOTAL
CGI-S
0.12
0.03
0.24
-0.39*
0.01
0.08
GAF
-0.08
-0.02
-0.16
0.43*
0.08
0.16
Table 3: Correlation between the CGI-S and GAF with SCIP sub-tests. * Correlation is significant at the 0.05 level (2-tailed).
The lower the CGI-S score was, indicating a more euthymic state, the higher the participants performed on the VLT-D. In addition, the higher the GAF score
was, the better the participants performed on the VLT-D. No other correlations were found.
CONCLUSION
Although the SCIP is not designed to replace a complete neurocognitive testing, this pilot data is promising as it demonstrates good tolerability and
responsiveness from a francophone Canadian clinical population with BD, suggesting that the SCIP can be integrated into a routine clinical evaluation of
patients.
This preliminary pilot study points to the need to continue our data collection in order to gather a better picture of the correlation between the illness
severity and the cognitive deficits in patients with BD.
VLT-I
Three trials of a 10 word list-learning task with immediate
recall after each list presentation
Sum of the number of words correctly
recalled over the three trial
0-30
WMT
Eight 3-letter combinations of consonants, with two trigrams
each assigned to a 0, 3, 9, or 18 second delay with backward
counting distraction
Sum of the letters correctly recalled
0-24
Two trials of 30 seconds during which the subject is asked to
generate words that begin with a given letter of the alphabet
under some specific rules
Sum of acceptable words over the
two trials
≥0
Delayed recall test of the VLT-I words
Sum of the number of words correctly
recalled
Sum of the number of correct
sequential translations
0-10
1.Torres I. J. et al, Acta Psychiatr Scand. 2007; 116(suppl. 434): 17-26.
2.Martínez-Arán A. et al, Am J Psychiatry. 2004; 161(2): 262-70.
3.Andreou C., Bozikas V.P., Curr Opin Psychiatry. 2013; 26(1): 54-9.
4.Purdon S.E.: The Screen for Cognitive Impairment in Psychiatry (SCIP):
Instructions and three alternate forms. PNL Inc, Edmonton: Alberta; 2005.
0-30
Disclosures
VFT
VLT-D
PST
Task that in 30 seconds requires the subject to translate the
Morse code equivalents of six letters from the alphabet in
boxes under a randomly distributed sequence of the letters
Table 1: Description of the SCIP sub-tests (table extracted from Gomez-Benito)7
All results were collected on REDCapTM. All descriptive statistics and Pearson correlations between CGI-S, GAF, and the SCIPS’s
subtests were run on IBM-SPSS 20.
SCIP sub-scores were transformed into z-scores based on a normative sample of a middle-aged general population (mean = 55.92
yo, SD = 11.09) with a mean number of years of education of 15.18 years (SD = 2.42).8
In addition, SCIP sub-scores were also transformed into z-scores based on a clinical normative cohort of stable BP-I cohort, aged
between 40-55 yo, with a secondary or higher level of education.7
REFERENCES
5. Guilera G. et al, Health and Quality of Life Outcomes. 2009; 7: 28-37.
6. Tourjman S.V., personal communication, submission in progress.
7. Gómez-Benito J. et al. BMC Psychiatry. 2013; 13: 127-43.
8. Purdon S.E., personal communication.
A. ABDEL MALEK, M.D. No financial relationships or conflicts of interest ; S. SAURY, M.SC. BMS (Contracted Research) ; A. DJOUINI, M.D., M.Sc. No financial
relationships or conflicts of interest ; S. POTVIN, PH.D. Disclosures to be reported ; S. RENAUD, MD, FRCPC Astra Zeneca (Contracted Research) ; A. DAIGNEAULT, M.D., FRCPC, DFAPA
Astra Zeneca (Speaker's Bureau, Consulting Fees (e.g., advisory boards)); BMS (Consulting Fees (e.g., advisory boards), Contracted Research); Lundbeck (Speaker's Bureau, Consulting
Fees (e.g., advisory boards)) ; S. BEAULIEU, M.D., PH.D., FRCPC, DFAPA Astra Zeneca (Speaker's Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); BMS (Speaker's
Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); Eli Lilly (Speaker's Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); Janssen-Ortho
(Speaker's Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); Lundbeck (Speaker's Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); Merck
(Consulting Fees (e.g., advisory boards)); Otsuka (Consulting Fees (e.g., advisory boards)); Pfizer (Contracted Research); Pfizer (Speaker's Bureau, Consulting Fees (e.g., advisory
boards)) ; V. TOURJMAN, M.D. Astra Zeneca (Speaker's Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); BMS (Speaker's Bureau, Consulting Fees (e.g., advisory
boards), Contracted Research); Eli Lilly (Speaker's Bureau, Consulting Fees (e.g., advisory boards), Contracted Research, unrestricted research fund); Lundbeck (Speaker's Bureau,
Consulting Fees (e.g., advisory boards), Contracted Research); Janssen-Ortho (Speaker's Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); Shire (Speaker's
Bureau, Consulting Fees (e.g., advisory boards), Contracted Research); Sunovion (Contracted Research, Speaker's Bureau); Teva (Contracted Research, Speaker's Bureau); Pfizer
(unrestricted research fund)
THIS STUDY WAS MADE POSSIBLE BY AN UNRESTRICTED GRANT FROM +PRENDS SOINS DE TOI+