Table 4.
Summary of findings for the FEM remission studies
| Cognitive function | Controls | FEM | Statistics | Study | |||||
|---|---|---|---|---|---|---|---|---|---|
| Domain | Test | Specific | n | Mean (SD) | n | Mean (SD) | p value | Effect size | First author (year) |
| Processing speed | Colour-word interference (D-KEFS) | Colour naming | 110 | 28.2 (4.8) | 34 | 31.6 (7.3) | 0.002b,e | 0.08g | Hellvin et al. (2012) |
| 21a | 32.2 (9.2) | ||||||||
| Word naming | 110 | 21.5 (3.3) | 34 | 22.1 (3.5) | 0.161b | 0.02g | |||
| 21a | 23.1 (4.4) | ||||||||
| Grooved pegboard | N/A | 110 | 64.0 (7.7) | 34 | 74.7 (16.0) | <0.001b,e | 0.20g | ||
| 21a | 77.4 (16.6) | ||||||||
| Stroop | Word naming | 25 | 103.2 (13.7) | 45 | 100.2 (12.9) | >0.05c,f | 0.09h | Torres et al. (2010) | |
| Colour naming | 25 | 73.7 (12.3) | 45 | 72.5 (11.8) | >0.05c,f | 0.07h | |||
| Trail Making Test | A | 50 | 83.70 (4.21) | 50 | 94.00 (7.72) | <0.001c | NR | Elshahawi et al. (2011) | |
| 66 | 55.89 (19.99) | 24 | 52.50 (18.27) | >0.05d | <0.2i | Lopez-Jaramillo et al. (2010) | |||
| 25 | 20.8 (6.4) | 45 | 26.0 (7.8) | >0.05c,f | 0.55h | Torres et al. (2010) | |||
| WAIS/WAIS-III | Digit symbol coding | 50 | 11.02 (2.48) | 50 | 7.36 (0.53) | <0.001b | NR | Elshahawi et al. (2011) | |
| 66 | 40.92 (12.92) | 24 | 38.63 (12.37) | >0.05d | <0.2i | Lopez-Jaramillo et al. (2010) | |||
| 110 | 78.1 (14.6) | 34 | 66.8 (14.8) | <0.001b,e | 0.11g | Hellvin et al. (2012) | |||
| 21a | 67.6 (14.3) | ||||||||
| Attention | CANTAB | RVIP | 25 | 0.92 (0.04) | 45 | 0.89 (0.05) | 0.008c,e,f | 0.62h | Torres et al. (2010) |
| CVLT | Trial 1 | 25 | 7.0 (1.6) | 45 | 6.5 (1.9) | >0.05c,f | 0.28h | Torres et al. (2010) | |
| WAIS-III/WMS/WMS-Revised | Digit span forward | 110 | 6.2 (1.1) | 34 | 5.9 (1.2) | 0.33b | 0.01g | Hellvin et al. (2012) | |
| 21a | 6.0 (1.3) | ||||||||
| 66 | 5.39 (1.14) | 24 | 5.42 (0.97) | >0.05d | <0.2i | Lopez-Jaramillo et al. (2010) | |||
| 50 | 6.44 (0.54) | 50 | 4.14 (0.35) | <0.001c | NR | Elshahawi et al. (2011) | |||
| Learning and memory | CANTAB | Pattern recognition | 25 | 97.0 (3.3) | 45 | 94.6 (7.0) | >0.05c,f | 0.27h | Torres et al. (2010) |
| Spatial recognition | 25 | 83.2 (11.8) | 45 | 76.8 (15.2) | >0.05c,f | 0.40h | |||
| Paired associates | 25 | 4.9 (5.4) | 45 | 9.1 (6.5) | >0.05c,f | 0.45h | |||
| CVLT | Total trials 1 to 5 | 110 | 57.2 (9.2) | 34 | 53.8 (13.7) | 0.158b | 0.02g | Hellvin et al. (2012) | |
| 21a | 54.0 (10.6) | ||||||||
| 25 | 58.7 (7.7) | 45 | 51.6 (11.6) | 0.004c,e,f | 0.61h | Torres et al. (2010) | |||
| Delayed recall | 110 | 13.2 (2.4) | 34 | 11.3 (4.2) | 0.007b,e | 0.06g | Hellvin et al. (2012) | ||
| 21a | 12.5 (3.0) | >0.05b | |||||||
| 25 | 12.7 (2.7) | 45 | 10.9 (3.0) | >0.05c,f | 0.57h | Torres et al. (2010) | |||
| Rey Complex Figure | Delayed recall | 109 | 22.8 (6.1) | 34 | 20.8 (7.5) | 0.030b | 0.04g | Hellvin et al. (2012) | |
| 21a | 19.1 (6.0) | ||||||||
| Immediate recall | 66 | 18.33 (10.98) | 24 | 14.79 (5.09) | >0.05d | <0.4i | Lopez-Jaramillo et al. (2010) | ||
| WMS | Logical memory (LM) | 66 | 10.05 (3.64) | 24 | 8.92 (2.78) | >0.05d | <0.4i | Lopez-Jaramillo et al. (2010) | |
| Visual reproduction | 66 | 8.70 (2.83) | 24 | 7.71 (3.38) | >0.05d | <0.4i | |||
| Associated pairs | 66 | 14.86 (3.46) | 24 | 13.69 (4.15) | >0.05d | <0.4i | |||
| LM recognition | 66 | 17.29 (3.13) | 24 | 18.53 (2.14) | >0.05d | <0.6i | |||
| WMS-Revised | Information | 50 | 5.98 (0.14) | 50 | 5.32 (0.47) | <0.001c | NR | Elshahawi et al. (2011) | |
| Mental control | 50 | 5.78 (0.76) | 50 | 4.78 (1.27) | <0.001c | NR | |||
| Logical memory | 50 | 13.93 (1.72) | 50 | 11.91 (1.19) | <0.001c | NR | |||
| Visual reproduction | 50 | 10.66 (0.96) | 50 | 10.80 (1.01) | 0.479c | NR | |||
| Total memory | 50 | 74.51 (4.08) | 50 | 62.93 (3.30) | <0.001c | NR | |||
| WMS-III | LM, learning | 110 | 26.5 (6.5) | 34 | 24.9 (7.9) | 0.381b | 0.01g | Hellvin et al. (2012) | |
| 21a | 24.9 (4.5) | ||||||||
| LM, recall | 110 | 23.8 (7.2) | 34 | 20.9 (8.2) | 0.084b | 0.03g | |||
| 21a | 21.4 (5.3) | ||||||||
| Visuospatial processing | Benton | Judgement of line orientation | 25 | 29.0 (2.0) | 45 | 27.4 (3.0) | >0.05c,f | 0.45h | Torres et al. (2010) |
| Executive functions | CANTAB | Stockings | 25 | 10.4 (1.6) | 45 | 9.0 (2.4) | 0.002c,e,f | 0.64h | Torres et al. (2010) |
| I/E-D | 25 | 3.1 (5.2) | 45 | 7.8 (8.9) | 0.002c,e,f | 0.61h | |||
| Colour-word interference (D-KEFS) | Inhibition | 110 | 49.4 (10.5) | 34 | 59.9 (26.6) | <0.001b,e | 0.09g | Hellvin et al. (2012) | |
| 21a | 61.1 (18.9) | ||||||||
| Inhibition/switching | 110 | 55.6 (12.5) | 34 | 60.9 (25.4) | 0.033b | 0.04g | |||
| 21a | 65.1 (20.6) | ||||||||
| Letter-number sequencing | N/A | 109 | 11.2 (2.3) | 34 | 9.6 (3.1) | <0.001b,e | 0.09g | ||
| 20a | 9.4 (2.4) | ||||||||
| 25 | 12.0 (3.1) | 45 | 10.8 (2.6) | >0.05c,f | 0.37h | Torres et al. (2010) | |||
| Spatial working memory | N/A | 25 | 9.2 (16.7) | 45 | 21.0 (20.1) | <0.001c,e,f | 0.72h | Torres et al. (2010) | |
| Stroop | Conflict time | 66 | 62.91 (13.78) | 24 | 65.04 (11.91) | >0.05d | <0.2i | Lopez-Jaramillo et al. (2010) | |
| Conflict errors | 66 | 2.02 (2.00) | 24 | 2.25 (2.95) | >0.05d | <0.2i | |||
| Interference | 25 | 49.7 (12.4) | 45 | 47.0 (9.3) | >0.05c,f | 0.20h | Torres et al. (2010) | ||
| Trail Making Test | B | 50 | 232.50 (23.24) | 50 | 264.50 (40.19) | <0.001c | NR | Elshahawi et al. (2011) | |
| 66 | 106.95 (55.88) | 24 | 127.67 (90.48) | >0.05d | <0.4i | Lopez-Jaramillo et al. (2010) | |||
| 25 | 46.1 (12.6) | 45 | 58.5 (23.8) | >0.05c,f | 0.58h | Torres et al. (2010) | |||
| WAIS-III | Digit span backward | 110 | 4.8 (1.2) | 34 | 4.1 (1.1) | 0.009b,e | 0.06g | Hellvin et al. (2012) | |
| 21a | 4.3 (1.2) | >0.05b | |||||||
| WCST | Perseveration errors | 50 | 10.52 (3.73) | 50 | 26.14 (6.92) | <0.001c | NR | Elshahawi et al. (2011) | |
| Perseveration responses | 72 | 7.1 (3.7) | 34 | 7.8 (3.5) | 0.703b | <0.01g | Hellvin et al. (2012) | ||
| 15a | 7.5 (3.3) | ||||||||
| Category completion | 50 | 5.84 (0.42) | 50 | 4.40 (1.44) | <0.001c | NR | Elshahawi et al. (2011) | ||
| 72 | 3.7 (1.2) | 34 | 3.8 (1.2) | 0.962b | <0.01g | Hellvin et al. (2012) | |||
| 15a | 3.7 (1.3) | ||||||||
| Total errors | 72 | 14.4 (6.4) | 26 | 15.4 (7.2) | 0.713b | <0.01g | |||
| 15a | 15.6 (6.2) | ||||||||
| WCST (short version) | Perseverative responses | 66 | 16.56 (6.74) | 24 | 19.29 (8.61) | >0.05d | <0.4i | Lopez-Jaramillo et al. (2010) | |
| Perseverative errors | 66 | 25.17 (7.42) | 24 | 26.42 (8.37) | >0.05d | <0.2i | |||
| Categories | 66 | 2.79 (1.21) | 24 | 2.67 (1.24) | >0.05d | <0.2i | |||
| WMS/WMS-Revised | Digit span backward | 66 | 3.08 (1.06) | 24 | 3.83 (1.02) | 0. 005d | 0.73i | Lopez-Jaramillo et al. (2010) | |
| 50 | 5.30 (0.79) | 50 | 3.66 (0.48) | <0.001c | NR | Elshahawi et al. (2011) | |||
| Verbal fluency (DKEFS) | Letter | 110 | 43.0 (10.1) | 34 | 41.3 (13.3) | 0.755b | <0.01g | Hellvin et al. (2012) | |
| 21a | 42.3 (13.6) | ||||||||
| Category | 110 | 48.9 (8.5) | 34 | 44.9 (11.0) | 0.208b | 0.02g | |||
| 21a | 45.8 (11.7) | ||||||||
| Category switching | 110 | 14.9 (2.4) | 34 | 14.0 (2.8) | 0.199b | 0.02g | |||
| 21a | 14.5 (3.6) | ||||||||
| Verbal fluency | Semantic | 66 | 18.08 (3.53) | 24 | 17.60 (3.21) | >0.05d | <0.2i | Lopez-Jaramillo et al. (2010) | |
| Phonological | 66 | 12.31 (3.64) | 24 | 11.23 (2.94) | >0.05d | <0.4h | |||
| FAS | 25 | 41.4 (12.6) | 45 | 38.5 (9.7) | >0.05c,f | 0.23h | Torres et al. (2010) | ||
| Intelligence | K-BIT | Vocabulary score | 25 | 103.5 (9.6) | 45 | 102.3 (11.3) | >0.05c,f | 0.09h | |
| Matrices | 25 | 113.4(7.7) | 45 | 106.6(11.6) | 0.01c,e,f | 0.59h | |||
| WAIS | Verbal IQ | 50 | 100.58 (9.71) | 50 | 90.22 (6.02) | <0.001b | NR | Elshahawi et al. (2011) | |
| Performance IQ | 50 | 104.06 (9.83) | 50 | 84.86 (4.80) | <0.001b | NR | |||
| Full scale IQ | 50 | 100.80 (8.87) | 50 | 86.58 (4.62) | <0.001b | NR | |||
| 66 | 99.53 (14.2) | 24 | 96.24 (14.7) | 0.002b | 0.10i | Lopez-Jaramillo et al. (2010) | |||
| WASI | Vocabulary | 110 | 60.6 (7.3) | 34 | 60.3 (8.8) | 0.902b | <0.01g | Hellvin et al. (2012) | |
| 21a | 61.2 (6.6) | ||||||||
| Similarities | 110 | 38.5 (5.2) | 34 | 37.4 (5.1) | 0.555b | <0.01g | |||
| 21a | 37.9 (4.1) | ||||||||
| Block design | 110 | 55.6 (10.2) | 34 | 47.2 (15.9) | <0.001b,e | 0.11g | |||
| 21a | 46.0 (12.2) | ||||||||
| Matrix reasoning | 110 | 28.2 (3.3) | 34 | 27.8 (5.8) | 0.042b | 0.04g | |||
| 21a | 25.7 (4.8) | ||||||||
| Full scale IQ | 110 | 111.6 (11.4) | 34 | 108.6 (14.7) | 0.159b | 0.02g | |||
| 21a | 106.9 (9.6) | ||||||||
FEM, first-episode mania; D-KEFS, Delis-Kaplan Executive System; WAIS, Wechsler Adult Intelligence Scale; CANTAB, Cambridge Neuropsychological Test Automated Battery; CVLT, California Verbal Learning Test; WMS, Wechsler Memory Scale; K-BIT, Kaufman Brief Intelligence Test; WASI, Wechsler Abbreviated Scale of Intelligence; RVIP, Rapid Information Visual Processing; I/E-D, intra/extra-dimensional test; NR, not reported. aFEM participants with previously untreated manic symptoms; bone-way ANOVA or univariate ANOVA; ctwo-tailed, independent-samples t-test, univariate t-test or student t-test; dMann-Whitney U test; esignificant difference after Bonferroni correction, ANOVA and t-test; fz-scores used in main analysis and effect size; geta squared; hCohen’s d with Hedges’ correction; ieffect size (ES) calculation for Mann-Whitney U, ES > 0.70 was considered significant.