Cognition and disability in bipolar disorder: Lessons from schizophrenia research

Bipolar Disorders

Volumn 12, Issue 4, 2010, Pages 364-375

  Harvey, Philip D ^a   Wingo, Aliza P ^a   Burdick, Katherine E ^b,c,d   Baldessarini, Ross J ^e,f  

^a EMORY UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b ZUCKER HILLSIDE HOSPITAL   (United States)

^c FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH   (United States)

^d ALBERT EINSTEIN COLLEGE OF MEDICINE   (United States)

^e HARVARD MEDICAL SCHOOL   (United States)

^f MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

Bipolar disorder; Cognition; Disability; Schizophrenia; Treatment

Indexed keywords

BIPOLAR DISORDER; COGNITION; COGNITIVE DEFECT; DISABILITY; FUNCTIONAL DISEASE; MEDICAL RESEARCH; PRIORITY JOURNAL; REVIEW; SCHIZOPHRENIA;

ADULT; AGED; BIPOLAR DISORDER; COGNITION; DISABILITY EVALUATION; EXECUTIVE FUNCTION; HUMANS; META-ANALYSIS AS TOPIC; MIDDLE AGED; SCHIZOPHRENIA; SCHIZOPHRENIC PSYCHOLOGY;

EID: 77954839370     PISSN: 13985647     EISSN: 13995618     Source Type: Journal    
DOI: 10.1111/j.1399-5618.2010.00831.x     Document Type: Review

References (118)

1. Torrent C, Martínez-Arán A, Daban C. Cognitive impairment in bipolar II disorder. Br J Psychiatry 2006, 189:254-259.
2. Simonsen C, Sundet K, Vaskinn A. Neurocognitive profiles in bipolar I and bipolar II disorder: differences in pattern and magnitude of dysfunction. Bipolar Disord 2008, 10:245-255.
3. Martínez-Arán A, Vieta E, Colom F. Do cognitive complaints in euthymic bipolar patients reflect objective cognitive impairment? Psychother Psychosom 2005, 74:295-302.
4. Burdick KE, Endick CJ, Goldberg JF. Assessing cognitive deficits in bipolar disorder: are self-reports valid? Psychiatry Res 2005, 136:43-50.
5. Malhi GS, Ivanovski B, Hadzi-Pavlovic D, Mitchell PB, Vieta E, Sachdev P. Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord 2007, 9:114-125.
6. Martínez-Arán A, Vieta E, Reinares M. Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004, 161:262-270.
7. Ferrier Stanton BR, Kelly TP, Scott J. Neuropsychological function in euthymic patients with bipolar disorder. Br J Psychiatry 1999, 175:246-251.
8. Robinson LJ, Thompson JM, Gallagher P. A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 2006, 93:105-115.
9. Torres IJ, Boudreau VG, Yatham LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand 2007, 116(Suppl. 434):17-26.
10. van Gorp WG, Altshuler L, Theberge DC, Wilkins J, Dixon W. Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence: preliminary study. Arch Gen Psychiatry 1998, 55:41-46.
11. Zubieta JK, Huguelet P, O'Neil RL, Giordani BJ. Cognitive function in euthymic bipolar I disorder. Psychiatry Res 2001, 102:9-20.
12. Martínez-Arán A, Vieta E, Colom F. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004, 6:224-232.
13. Mur M, Portella MJ, Martínez-Arán A, Pifarre J, Vieta E. Persistent neuropsychological deficit in euthymic bipolar patients: executive function as a core deficit. J Clin Psychiatry 2007, 68:1078-1086.
14. Thompson JM, Gallagher P, Hughes JH. Neurocognitive impairment in euthymic patients with bipolar affective disorder. Br J Psychiatry 2005, 186:32-40.
15. Martino DJ, Strejilevich SA, Scápola M. Heterogeneity in cognitive functioning among patients with bipolar disorder. J Affect Disord 2008, 109:149-156.
16. Zanelli J, Reichenberg A, Morgan K. Specific and generalized neuropsychological deficits: a comparison of patients with various first-episode psychosis presentations. Am J Psychiatry 2010, 167:78-85.
17. Mur M, Portella MJ, Martínez-Arán A, Pifarre J, Vieta E. Long-term stability of cognitive impairment in bipolar disorder: a 2-year follow-up study of lithium-treated euthymic bipolar patients. J Clin Psychiatry 2008, 69:712-719.
18. Balanza-Martinez V, Tabares-Seisdedos R, Selva-Vera G. Persistent cognitive dysfunctions in bipolar I disorder and schizophrenic patients: 3-year follow-up study. Psychother Psychosom 2005, 74:113-119.
19. Robinson LJ, Ferrier IN. Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disord 2006, 8:103-116.
20. Bora E, Yucel M, Pantelis C. Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord 2009, 113:1-20.
21. Arts B, Jabben N, Krabbendam L, van Os J. Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychol Med 2008, 38:771-785.
22. Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 1998, 12:426-445.
23. O'Donovan MC, Williams NM, Owen MJ. Recent advances in the genetics of schizophrenia. Hum Mol Genet 2003, 12:R125-R133. Spec No. 2
24. Gale CR, Batty GD, Tynelius P, Deary IJ, Rasmussen F. Intelligence in early adulthood and subsequent hospitalization for mental disorders. Epidemiology 2010, 21:70-77.
25. Kieseppä T, Partonen T, Haukka J, Kaprio J, Lönnqvist J. High concordance of bipolar I disorder in a nationwide sample of twins. Am J Psychiatry 2004, 161:1814-1821.
26. Compton M, Harvey PD. Risk factors for the development of schizophrenia during adulthood. Vulnerablity to Psychopatholog 2010, 389-416. Ingram R, Price J. eds, Second edition, New York, Guilford
27. Davidson M, Reichenberg A, Rabinowitz J. Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents. Am J Psychiatry 1999, 156:1328-1335.
28. Lencz T, Smith CW, McLaughlin D. Generalized and specific neurocognitive deficits in prodromal schizophrenia. Biol Psychiatry 2006, 59:863-871.
29. Gur RE, Calkins ME, Gur RC. The consortium on the genetics of schizophrenia: neurocognitive endophenotypes. Schizophr Bull 2007, 33:49-68.
30. Greenwood TA, Braff DL, Light GA. Initial heritability analyses of endophenotypic measures for schizophrenia: the consortium on the genetics of schizophrenia. Arch Gen Psychiatry 2007, 64:1242-1250.
31. Cornblatt BA, Erlenmeyer-Kimling L. Global attentional deviance as a marker of risk for schizophrenia: specificity and predictive validity. J Abnorm Psychol 1985, 94:470-486.
32. Forty L, Jones L, Jones I. Polarity at illness onset in bipolar I disorder and clinical course of illness. Bipolar Disord 2009, 11:82-88.
33. Daban C, Colom F, Sanchez-Moreno J, García-Amador M, Vieta E. Clinical correlates of first-episode polarity in bipolar disorder. Compr Psychiatry 2006, 47:433-437.
34. Jackson A, Cavanagh J, Scott J. A systematic review of manic and depressive prodromes. J Affect Disord 2003, 74:209-217.
35. Burdick KE, Gunawardane N, Woodberry K, Malhotra AK. The role of general intelligence as an intermediate phenotype for neuropsychiatric disorders. Cogn Neuropsychiatry 2009, 14:299-311.
36. McIntosh AM, Harrison LK, Forrester K, Lawrie SM, Johnstone EC. Neuropsychological impairments in people with schizophrenia or bipolar disorder and their unaffected relatives. Br J Psychiatry 2005, 186:378-385.
37. Weiser M, Reichenberg A, Rabinowitz J. Cognitive performance of male adolescents is lower than controls across psychiatric disorders: a population-based study. Acta Psychiatr Scand 2004, 110:471-475.
38. Koenen KC, Moffitt TE, Roberts AL. Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. Am J Psychiatry 2009, 166:50-57.
39. Barrett SL, Mulholland CC, Cooper SJ, Rushe TM. Patterns of neurocognitive impairment in first-episode bipolar disorder and schizophrenia. Br J Psychiatry 2009, 195:67-72.
40. Hill SK, Reilly JL, Harris MS. A comparison of neuropsychological dysfunction in first-episode psychosis patients with unipolar depression, bipolar disorder, and schizophrenia. Schizophr Res 2009, 113:167-175.
41. Maziade M, Rouleau N, Gingras N. Shared neurocognitive dysfunctions in young offspring at extreme risk for schizophrenia or bipolar disorder in eastern Quebec multigenerational families. Schizophr Bull 2009, 35:919-930.
42. Duffy A, Hajek T, Alda M, Grof P, Milin R, MacQueen G. Neurocognitive functioning in the early stages of bipolar disorder: visual backward masking performance in high risk subjects. Eur Arch Psychiatry Clin Neurosci 2009, 259:263-269.
43. Harvey P, Winters KC, Weintraub S, Neale JM. Distractibility in children vulnerable to psychopathology. J Abnorm Psychol 1981, 90:298-304.
44. Dickinson D, Ramsey ME, Gold JM. Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Arch Gen Psychiatry 2007, 64:532-542.
45. Frangou S, Donaldson S, Hadjulis M, Landau S, Goldstein LH. The Maudsley Bipolar Disorder Project: executive dysfunction in bipolar disorder I and its clinical correlates. Biol Psychiatry 2005, 58:859-864.
46. Donaldson S, Goldstein LH, Landau S, Raymont V, Frangou S. The Maudsley Bipolar Disorder Project: effect of medication, family history, and duration of illness on IQ and memory in bipolar I disorder. J Clin Psychiatry 2003, 64:86-93.
47. Huxley N, Baldessarini RJ. Disability and its treatment in bipolar disorder patients. Bipolar Disord 2007, 9:183-196.
48. Wingo AP, Harvey PD, Baldessarini RJ. Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disord 2009, 11:113-125.
49. Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 1996, 153:321-330.
50. Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff" ? Schizophr Bull 2000, 26:119-136.
51. Depp CA, Moore DJ, Sitzer D. Neurocognitive impairment in middle-aged and older adults with bipolar disorder: Comparison to schizophrenia and normal comparison subjects. J Affect Disord 2007, 101:201-209.
52. Schretlen DJ, Cascella NG, Meyer SM. Neuropsychological functioning in bipolar disorder and schizophrenia. Biol Psychiatry 2007, 62:179-186.
53. Reichenberg A, Harvey PD, Bowie CR. Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. Schizophr Bull 2009, 35:1022-1029.
54. Daban C, Martínez-Arán A, Torrent C. Specificity of cognitive deficits in bipolar disorder vs. schizophrenia. Psychother Psychosom 2006, 75:72-84.
55. Trivedi JK, Goel D, Sharma S, Singh AP, Sinha PK, Tandon R. Cognitive functions in stable schizophrenia and euthymic state of bipolar disorder. Indian J Med Res 2007, 126:433-439.
56. Bowie CR, Harvey PD. Cognition in schizophrenia: impairments, determinants, and functional importance. Psychiatr Clin N Am 2005, 28:613-633.
57. Gold JM, Harvey PD. Cognitive deficits in schizophrenia. Psychiatr Clin N Am 1993, 16:295-312.
58. Mohamed S, Paulsen JS, O'Leary D, Arndt S, Andreasen N. Generalized cognitive deficits in schizophrenia: a study of first-episode patients. Arch Gen Psychiatry 1999, 56:749-754.
59. Strauss ME. Relations of symptoms to cognitive deficits in schizophrenia. Schizophr Bull 1993, 19:215-231.
60. Keefe RSE, Fenton WS. How should DSM-V criteria for schizophrenia include cognitive impairment? Schizophr Bull 2007, 33:912-920.
61. Kopelowicz A, Liberman RP, Ventura J, Zarate R, Mintz J. Neurocognitive correlates of recovery from schizophrenia. Psychol Med 2005, 35:1165-1173.
62. Keefe RSE, Poe M, Walker TM, Kang JW, Harvey PD. The schizophrenia cognition rating scale: an interview-based assessment and its relationship to cognition, real-world functioning, and functional capacity. Am J Psychiatry 2006, 163:426-432.
63. Tohen M, Zarate CA, Hennen J. The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry 2003, 160:2099-2107.
64. Keck PE, McElroy SL, Strakowski SM. 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. Am J Psychiatry 1998, 155:646-652.
65. Baldessarini RJ, Tarazi FI. Drug therapy of depression and anxiety disorders; pharmacotherapy of psychosis and mania. Goodman and Gilman's The Pharmacological Basis of Therapeutics 2005, 429-500. Brunton LL, Lazo JSParker KL. ds, Eleventh edition, New York, McGraw-Hill Press
66. Atre-Vaidya N, Taylor MA, Seidenberg M, Reed R, Perrine A, Glick-Oberwise F. Cognitive deficits, psychopathology, and psychosocial functioning in bipolar mood disorder. Neuropsychiatry Neuropsychol Behav Neurol 1998, 11:120-126.
67. Martínez-Arán A, Penades R, Vieta E. Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome. Psychother Psychosom 2002, 71:39-46.
68. Dittmann S, Seemüller F, Schwarz MJ. Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results. Bipolar Disord 2007, 9:63-70.
69. Martínez-Arán A, Vieta E, Torrent C. Functional outcome in bipolar disorder: role of clinical and cognitive factors. Bipolar Disord 2007, 9:103-113.
70. Gildengers AG, Butters MA, Chisholm D. Cognitive functioning and instrumental activities of daily living in late-life bipolar disorder. Am J Geriatr Psychiatry 2007, 15:174-179.
71. Altshuler LL, Bearden CE, Green MF, van Gorp W, Mintz J. Relationship between neurocognitive impairment and functional impairment in bipolar disorder: pilot study. Psychiatry Res 2008, 157:289-293.
72. Dickerson FB, Boronow JJ, Stallings CR, Origoni AE, Cole S, Yolken RH. Association between cognitive functioning and employment status of persons with bipolar disorder. Psychiatr Serv 2004, 55:54-58.
73. Jaeger J, Berns S, Loftus S, Gonzalez C, Czobor P. Neurocognitive test performance predicts functional recovery from acute exacerbation leading to hospitalization in bipolar disorder. Bipolar Disord 2007, 9:93-102.
74. Altshuler L, Tekell J, Biswas K. Executive function and employment status among veterans with bipolar disorder. Psychiatr Serv 2007, 58:1441-1447.
75. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976, 33:766-771.
76. Weissman MM, Bothwell S. Assessment of social adjustment by patient self-report. Arch Gen Psychiatry 1976, 33:1111-1115.
77. Jaeger J, Berns S, Czobor P. The multidimensional scale for independent functioning: a new instrument for measuring functional disability in psychiatric populations. Schizophr Bull 2003, 29:153-168.
78. Dickinson D, Harvey PD. Systemic hypotheses for generalized cognitive deficits in schizophrenia: a new take on an old problem. Schizophr Bull 2009, 35:403-414.
79. Nuechterlein KH, Green MF, Kern RS. The MATRICS Consensus Cognitive Battery: test selection, reliability, and validity. Am J Psychiatry 2008, 165:203-213.
80. Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD. Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry 2006, 163:418-425.
81. Bowie CR, Leung WW, Reichenberg A. Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry 2008, 63:505-551.
82. Patterson TL, Goldman S, McKibbin CL, Hughs T, Jeste DV. UCSD Performance-Based Skills Assessment: development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bull 2001, 27:235-245.
83. Heaton RK, Marcotte TD, Mindt MR. Impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 2004, 10:317-331.
84. Harvey PD, Velligan DI, Bellack AS. Performance-based measures of functional skills: usefulness in clinical treatment studies. Schizophr Bull 2007, 33:1138-1148.
85. Bellack AS, Brown CH, Thomas-Lohrman S. Psychometric characteristics of role-play assessments of social skill in schizophrenia. Behav Ther 2006, 37:339-352.
86. Dickinson D, Bellack AS, Gold JM. Social/communication skills, cognition, and vocational functioning in schizophrenia. Schizophr Bull 2007, 33:1213-1220.
87. Leifker FR, Bowie CR, Harvey PD. Determinants of everyday outcomes in schizophrenia: the influences of cognitive impairment, functional capacity, and symptoms. Schizophr Res 2009, 115:82-87.
88. Gard DE, Fisher M, Garrett C, Genevsky A, Vinogradov S. Motivation and its relationship to neurocognition, social cognition, and functional outcome in schizophrenia. Schizophr Res 2009, 115:74-81.
89. Depp CA, Mausbach BT, Eyler LT. Performance-based and subjective measures of functioning in middle-aged and older adults with bipolar disorder. J Nerv Ment Dis 2009, 197:471-475.
90. Depp CA, Cain AE, Palmer BW. Assessment of medication management ability in middle-aged and older adults with bipolar disorder. J Clin Psychopharmacol 2008, 28:225-229.
91. Patterson TL, Lacro J, McKibbin CL, Moscona S, Hughs T, Jeste DV. Medication management ability assessment: results from a performance-based measure in older outpatients with schizophrenia. J Clin Psychopharmacol 2002, 22:11-19.
92. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960, 23:56-62.
93. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987, 13:261-276.
94. Mausbach BT, Harvey PD, Pulver AE. Relationship of the Brief UCSD Performance-based Skills Assessment (UPSA-B) to multiple indicators of functioning in people with schizophrenia and bipolar disorder. Bipolar Disord 2010, 12:45-55.
95. Bowie CR, Depp CA, McGrath JA. Prediction of real world functional impairments in community-dwelling schizophrenia and bipolar disorder patients. Am J Psychiatry
96. McKibbin C, Patterson TL, Jeste DV. Assessing disability in older patients with schizophrenia: results from the WHODAS-II. J Nerv Ment Dis 2004, 192:405-413.
97. Bowie CR, Twamley EW, Anderson H, Halpern B, Patterson TL, Harvey PD. Self-assessment of functional status in schizophrenia. J Psychiatr Res 2007, 41:1012-1018.
98. Atkinson M, Zibin S, Chuang H. Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology. Am J Psychiatry 1997, 154:99-105.
99. Alloy LB, Abramson LY. Judgment of contingency in depressed and non-depressed students: sadder but wiser? J Exper Psychol Gen 1979, 108:441-485.
100. Pallanti S, Quercioli L, Pazzagli A. Awareness of illness and subjective experience of cognitive complaints inpatients with bipolar I and bipolar II disorder. Am J Psychiatry 1999, 156:1094-1096.
101. Piccinni A, Catena M, Del Debbio A. Health-related quality of life and functioning in remitted bipolar I outpatients. Compr Psychiatry 2007, 48:323-328.
102. Hyman SE, Fenton WS. What are the right targets for pharmacotherapy? Science 2003, 299:350-351.
103. Buchanan RW, Davis M, Goff D. Summary of an FDA-NIMH-MATRICS workshop on clinical trial design for neurocognitive drugs for schizophrenia. Schizophr Bull 2005, 31:5-19.
104. Harvey PD. Pharmacological cognitive enhancement in schizophrenia. Neuropsychol Rev 2009, 19:324-335.
105. Young AH, Gallagher P, Watson S, Del-Estal D, Owen BM, Ferrier IN. Improvements in neurocognitive function and mood following adjunctive treatment with mifepristone (RU-486) in bipolar disorder. Neuropsychopharmacol 2004, 29:1538-1545.
106. Burdick KE, Braga RJ, Goldberg JF, Malhotra AK. Cognitive dysfunction in bipolar disorder: future place of pharmacotherapy. CNS Drugs 2007, 21:971-981.
107. Twamley EW, Jeste DV, Bellack AS. Review of cognitive training in schizophrenia. Schizophr Bull 2003, 29:359-382.
108. Sartory G, Zorn C, Groetzinger G, Windgassen K. Computerized cognitive remediation improves verbal learning and processing speed in schizophrenia. Schizophr Res 2005, 75:219-223.
109. Kurtz MM, Seltzer JC, Shagan DS, Thime WR, Wexler BE. Computer-assisted cognitive remediation in schizophrenia: What is the active ingredient? Schizophr Res 2007, 89:251-260.
110. Pilling S, Bebbington P, Kuipers E. Psychological treatments in schizophrenia: meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychol Med 2002, 32:783-791.
111. McGurk SR, Twamley EW, Sitzer DI, McHugo GJ, Mueser KT. Meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry 2007, 164:1791-1802.
112. Miklowitz DJ, Otto MW, Frank E. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry 2007, 64:419-426.
113. Deckersbach T, Nierenberg AA, Kessler R. Cognitive rehabilitation for bipolar disorder: a open trial for employed patients with residual depressive symptoms. CNS Neursci Ther 2009, [Epub ahead of print]
114. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry 2009, 166:805-811.
115. Vinogradov S, Fisher M, Holland C, Shelly W, Wolkowitz O, Mellon SH. Is Serum brain-derived neurotrophic factor a biomarker for cognitive enhancement in schizophrenia? Biol Psychiatry 2009, 66:549-553.
116. Heinrichs DW, Hanlon TE, Carpenter WTJ. The Quality of Life Scale: an instrument for rating the schizophrenia deficit syndrome. Schizophr Bull 1984, 10:388-396.
117. Campbell K, Bond GR, Drake RE. Who benefits from supported employment: a meta-analytic study. Schizophr Bull 2009, 10.1093/schbul/sbp066, Epub; doi
118. Bush PW, Drake RE, Xie H, McHugo GJ, Haslett WR. The long-term impact of employment on mental health service use and costs for persons with severe mental illness. Psychiatr Serv 2009, 60:1024-1031.