Cool Kids: Cognitive Behavioral Therapy in a Spanish Sample of Children and Adolescents with Anxiety Disorders.

Anxiety disorders (ADs) negatively impact functioning and life quality. Studies on cognitive behavioral therapy (CBT) have demonstrated its short- and long-term efficacy. Cool Kids (CK) is a 10-session CBT-based group program administered to participants with ADs aged 7-17 years and their parents, and it has demonstrated efficacy compared with control groups. This study analyzes the effectiveness of CK in a clinical cohort of Spanish children and adolescents with ADs. CK was offered to 57 patients with AD and their caregivers at the Hospital Clínic, Barcelona. In all global registered measures, the results demonstrated a reduction of symptoms and their interference in daily functioning. Moreover, a significant improvement was observed in participants who completed more sessions. Thus, CK reduced the severity of anxiety and its interference over individual and family functioning.

Internet-based cognitive behavioral therapy in children and adolescents with obsessive compulsive disorder: a feasibility study.

Cognitive behavioral therapy (CBT) is the first choice of treatment of obsessive-compulsive disorder (OCD) in children and adolescents. However, there is often a lack of access to appropriate treatment close to the home of the patients. An internet-based CBT via videoconferencing could facilitate access to state-of-the-art treatment even in remote areas. The aim of this study was to investigate feasibility and acceptability of this telemedical approach. A total of nine children received 14 sessions of CBT. The first session took place face-to-face, the remaining 13 sessions via videoconference. OCD symptoms were recorded with a smartphone app and therapy materials were made accessible in a data cloud. We assessed diagnostic data before and after treatment and obtained measures to feasibility, treatment satisfaction and acceptability. Outcomes showed high acceptance and satisfaction on the part of patients with online treatment (89%) and that face-to-face therapy was not preferred over an internet-based approach (67%). The majority of patients and their parents classified the quality of treatment as high. They emphasized the usefulness of exposures with response prevention (E/RP) in triggering situations at home. The app itself was rated as easy to operate and useful. In addition to feasibility, a significant decrease in obsessive-compulsive symptoms was also achieved. Internet-based CBT for pediatric OCD is feasible and well received by the patients and their parents. Furthermore, obsessive-compulsive symptomatology decreased in all patients. The results of this study are encouraging and suggest the significance of further research regarding this technology-supported approach, with a specific focus on efficacy.Trial registration number: Clinical trials AZ53-5400.1-004/44.

Familial aggregation analysis of cognitive performance in early-onset bipolar disorder.

We analysed the familial aggregation (familiality) of cognitive dimensions and explored their role as liability markers for early-onset bipolar disorder (EOBD). The sample comprised 99 subjects from 26 families, each with an offspring diagnosed with EOBD. Four cognitive dimensions were assessed: reasoning skills; attention and working memory; memory; and executive functions. Their familiality was investigated in the total sample and in a subset of healthy relatives. The intra-family resemblance score (IRS), a family-based index of the similarity of cognitive performance among family members, was calculated. Familiality was detected for the attention and working memory (AW) dimension in the total sample (ICC = 0.37, p = 0.0004) and in the subsample of healthy relatives (ICC = 0.37, p = 0.016). The IRS reflected that there are families with similar AW mean scores (either high or low) and families with heterogeneous scores. Families with the most common background for the AW dimension (IRS > 0) were selected and dichotomized in two groups according to the mean family AW score. This allowed differentiating families whose members had similar high scores than those with similar low scores: both patients (t = - 4.82, p = 0.0005) and relatives (t = - 5.04, p < 0.0001) of the two groups differed in their AW scores. AW dimension showed familial aggregation, suggesting its putative role as a familial vulnerability marker for EOBD. The IRS estimation allowed the identification of families with homogeneous scores for this dimension. This represents a first step towards the investigation of the underlying mechanisms of AW dimension and the identification of etiological subgroups.

Spanish Validation of the School Anxiety Scale-Teacher Report (SAS-TR).

This study aimed to examine the factorial structure and psychometric properties of the School Anxiety Scale-Teacher Report (SAS-TR) in a community sample of 315 Spanish children aged 5 to 12 years. Thirty-seven teachers from eleven schools completed the SAS-TR and the Strengths and Difficulties Questionnaire (SDQ) for each child. Confirmatory factor analysis supported the original two-factor structure, but a better fit model was obtained after removing four items. The scale was found to have high internal consistency (α = 0.91) and satisfactory test-retest reliability (ICC = 0.87) for the Spanish sample. Convergent validity was supported by positive significant correlations between the SAS-TR and the Emotional Symptoms subscale of the SDQ. Lower correlations between the SAS-TR and the SDQ Conduct Problems subscale supported the divergent validity. Overall, the findings suggest that the Spanish version of the SAS-TR is a reliable and valid instrument for teachers to assess anxiety in Spanish children.

Family accommodation in obsessive-compulsive disorder: An updated systematic review and meta-analysis.

Family accommodation might play a crucial role in obsessive-compulsive disorder (OCD). Previous systematic reviews on family accommodation in OCD have focused on specific populations or variables or are outdated. We conducted a preregistered systematic review and meta-analysis on family accommodation in adults, children, and adolescents with OCD (CRD42021264461). We searched PubMed, Scopus, and Web of Science using the keywords "family accommodation" and "obsessive-compulsive disorder. One hundred-eight studies involving 8928 individuals with OCD were included. Our results indicate that levels of family accommodation in OCD are moderate, that there is a significant positive correlation between family accommodation and OCD severity (r = 0.42), that baseline family accommodation does not predict pre- to post-treatment change in OCD severity (g = -0.03), and that family accommodation decreases as a result of both individual and family-focused cognitive behavioral therapy for OCD (g = 2.00 and g = 1.17, respectively). Our findings highlight the relevance of family accommodation in OCD and may help guide assessment and treatment.

Psychological impact during COVID-19 lockdown in children and adolescents with previous mental health disorders.

OBJECTIVE: During the COVID-19 pandemic, authorities confined adults, adolescents and children to their homes. Recent articles warn of possible long-term consequences on mental health, especially for those who suffer from underlying psychiatric conditions and for vulnerable sections of the population. The present study explores the psychological impact of the COVID-19 quarantine on outpatients at the Centre of Child and Adolescent Mental Health (CAMHS), which is based in Barcelona. METHODS: A total of 441 caregivers answered an online ad-hoc survey on their sociodemographic and economic situation, perceived stress, and clinical changes and coping strategies observed in their children during lockdown. The Chi-square test was used to compare the response percentages for each behaviour or symptom between age, gender and diagnostic groups. Variance and post-hoc test were also analyzed, as was the Pearson correlation. RESULTS: The use of electronic devices has significantly increased. There has also been an increase in symptoms such as attentional problems, fatigue and irritability, among others. Differences were found between age and gender groups. The diagnostic groups most affected by confinement were Autism Spectrum Disorders and Conduct Disorders. The survey also discovered a relationship between the loss of family income, parental stress and increased symptoms in children. CONCLUSION: Confinement has increased externalizing symptoms and behaviours as well as COVID-19 related concerns, somatic problems and anxieties. It is important to observe the fluctuation of symptoms and how young people adapt to the pandemic in order to reach a better understanding of the situation and devise new strategies to reduce the psychological impact of the pandemic.

Internet-based psychotherapy in children with obsessive-compulsive disorder (OCD): protocol of a randomized controlled trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. While successful state-of-the art cognitive behavioral interventions exist, there is still a lack of available experts for treatment at home, where most symptoms manifest. Internet-based cognitive behavioral therapy (iCBT) could overcome these restrictions; however, studies about iCBT in children with OCD are rare and mostly target computerized self-help resources and only email contact with the therapist. Therefore, we intended to build up and to evaluate an iCBT approach for children with OCD, replacing successful elements of traditional in-office face-to-face CBT, with face-to-face teleconferences, online materials, and apps. METHODS: With the help of a pilot feasibility study, we developed the iCBT consisting of 14 teleconference sessions with the child and parents. The sessions are supported by an app assessing daily and weekly symptoms and treatment course completed by children and parents. Additionally, we obtain heart rate and activity scores from the child via wristbands during several days and exposure sessions. Using a waiting list randomized control trial design, we aim to treat and analyze 20 children with OCD immediately after a diagnostic session whereas the control group of another set of 20 OCD patients will be treated after waiting period of 16 weeks. We will recruit 30 patients in each group to take account for potential dropouts. Outcomes for the treatment group are evaluated before randomization (baseline, t0), 16 weeks (end of treatment, t1), 32 weeks (follow-up 1, t2), and 48 weeks after randomization (follow-up 2, t3). For the waiting list group, outcomes are measured before the first randomization (baseline), at 16 weeks (waiting list period), 32 weeks (end of treatment), 48 weeks after the first randomization (follow-up I), and 64 weeks after the first randomization (follow-up II). DISCUSSION: Based on our experience of feasibility during the pilot study, we were able to develop the iCBT approach and the current study will investigate treatment effectiveness. Building up an iCBT approach, resembling traditional in-office face-to-face therapy, may ensure the achievement of well-known therapy effect factors, the acceptance in both patients and clinicians, and the wide distribution within the health system. TRIAL REGISTRATION: ClinicalTrials.gov NCT05037344 . Registered May 2019, last release August 13th, 2021.

Early-onset bipolar disorder: how about visual-spatial skills and executive functions?

Early-onset bipolar disorder is an impairing condition that is strongly associated with genetic inheritance. Neurocognitive deficits are core traits of this disorder which seem to be present in both young and adult forms. Deficits in verbal memory and attention are persistent within euthymic phases in bipolar adults, adolescents, and children. In younger samples, including type I or II and not otherwise specified patients, executive functions are not widely impaired and the existence of visual-spatial deficits remains unclear. The main aim of this study was to compare the neurocognitive performance in young stabilized type I or II bipolar patients and healthy controls. Fifteen medicated adolescents with bipolar disorder and 15 healthy adolescents, matched in age and gender, were compared on visual-spatial skills (reasoning, memory, visual-motor accuracy) and executive functioning (attention and working memory, set-shifting, inhibition) using t-tests and MANCOVA. Correcting for verbal competence, MANCOVA showed that patients performed significantly worse than controls in letters and numbers sequencing (P = 0.003), copy (P < 0.001) and immediate recall (P = 0.007) of the Rey Complex Figure Test, interference of the Stroop Color-Word Test (P = 0.007) and non-perseverative errors on the Wisconsin Card Sorting Test (P = 0.038). Impaired cognitive performance was found in young bipolar patients in working memory, visual-motor skills, and inhibitory control.

Clinical and biological correlates of adolescent anorexia nervosa with impaired cognitive profile.

Some neuropsychological studies of anorexia nervosa (AN) have yielded conflicting results, and it has been established that not all adult patients with AN are cognitively impaired. The objective of this study is to determine the percentage of adolescents with AN who present worse cognitive functioning according to neuropsychological criteria of cognitive impairment, and to study their clinical characteristics. Thirty-seven adolescents (11-18 years) with a diagnosis of AN in an acute state of the illness and with low body mass index (BMI) were compared with 41 healthy subjects of the same sex and similar age and intelligence using a comprehensive neuropsychological battery. Overall, AN patients took longer to copy Rey's Figure than the control group (p = 0.001). Thirty per cent of patients showed impaired neuropsychological functioning (defined as scoring two standard deviations lower than the average or lower than their intelligence level in two tasks) with worse performance on visuo-spatial tasks. This subgroup of patients presented lower BMI (p = 0.023) and higher trait anxiety (p = 0.028). The performance of adolescents in an acute state of AN was similar to that of the healthy control group, with the exception of lower time to completion in copying a complex figure. However, cognitive performance varied in these patients, being clearly impaired in one-third of the sample. The cognitive impairment subgroup showed lower BMI and higher anxiety. Longitudinal follow-up studies are necessary to assess the stability of this profile after longer treatment periods.

Dysbindin-1 gene contributes differentially to early- and adult-onset forms of functional psychosis.

Dysbindin-1 is a relatively ubiquitous protein in the brain which is involved in the modulation of synaptic homeostasis. The dysbindin-1 gene (DTNBP1) has been associated with schizophrenia and bipolar disorder diagnoses. However, its contribution to the severity of the clinical and neurocognitive expression of these disorders remains controversial. We aimed to explore the association between DTNBP1 and the phenotypes which are more directly linked with the underlying biology, such as age at onset and neurocognitive impairment. The present family sample comprised 894 Caucasian individuals: 268 patients affected by functional psychosis [58% with illness onset before 18 years, mean age at onset (SD): 14.71 (2.10)], 483 parents and 143 siblings. Ten DTNBP1 single nucleotide polymorphisms were genotyped in all individuals and their transmission disequilibrium was tested in relation to: (i) the risk for psychosis; (ii) patients' age at onset; and (iii) familial neurocognitive performance (including IQ estimation and executive functioning). In early-onset families a 5-marker haplotype encompassing exons 2-4 and the surrounding introns was significantly over-transmitted to cases, while in adult-onset families two haplotypes corresponding to the region between introns 4 and 7 were over-transmitted to cases. Estimated IQ was associated with the rs760666 marker in the whole sample, whereas a significant association between executive functioning and the rs2619522 marker appeared in early-onset families. Our findings confirm the role of the dysbindin-1 gene in the risk for functional psychosis and show a differential haplotypic risk pattern in families with early as opposed to adult onset in the affected offspring.

Psychometric Properties of the Children's Version of the Spence Children's Anxiety Scale (SCAS) in a Spanish Clinical Sample.

The Spence Children's Anxiety Scale (SCAS) has demonstrated good psychometric properties in several countries and cultures. Nevertheless, most of the previous studies that explore these properties have combined clinical and community samples. We aimed to validate the Spanish version of the SCAS in a large clinical sample (N = 130) of children and adolescents. The Spanish adaptation of the SCAS showed good internal consistency for the total scale, and good test-retest reliability for all the subscales. Furthermore, its convergent and discriminant validity were supported by significant correlations with other anxiety questionnaires (Screen for Child Anxiety Related Emotional Disorders [SCARED], Youth Self-Report [YSR] subscales for anxiety disorders and internalizing symptomatology), and lower or non-significant correlations with depression symptoms and externalizing symptoms scales respectively. For the first time in a purely clinical sample, the original factor structure of the SCAS based on six correlated factors was confirmed. Future studies need to evaluate whether the factorial structure of the present instrument is the most suitable for use in clinical populations.

Functional Impairment and Clinical Correlates in Adolescents with Bipolar Disorder Compared to Healthy Controls. A Case-control Study.

BACKGROUND: Evidence shows that most adolescents with bipolar disorder (BD) achieve syndromic recovery after being referred to specialized treatment. However, functional recovery is reached in less than 50% of those cases. METHOD: Descriptive cross-sectional case-control study, based on a clinical sample of 44 BD patients aged 12-19, matched by age and sex with 44 healthy controls (HC). Psychopathology was ascertained using the KSADS-PL, in addition to the clinical scales. Information about previous academic performance was included, as well as functional outcome based on the Children's Global Assessment Functioning Scale (CGAS). Previous exposure to stressful experiences was assessed using the Schedule for Stressful Life Events (SLES). All analyses were performed using either conditional or stepwise logistic regression models. RESULTS: Once they have become stabilized, and even after controlling for socio-demographic differences, BD patients were associated with lower levels of functionality [OR 0.65 (0.46, 0.93), p=0.02], and worse performance at school [OR 0.03 (0.01, 0.67), p=0.03] compared with HC. Persistent sub-syndromal psychosis showed the strongest negative correlation with functionality (rho=-0.65, -0.57 for BD and HC respectively; p<0.001). Although BD was associated with more stressful life events, this association did not remain significant in the multivariate models. LIMITATIONS: The small sample size limits our ability to detect differences between groups, and between BD subtypes. CONCLUSIONS: Even when early detection and intervention is provided, BD has a significant impact on functioning and academic performance. It is important to address persistent sub-threshold symptoms and to emphasize the social and rehabilitative components of treatment.

CONTEXTE: Les données probantes indiquent que la plupart des adolescents souffrant de trouble bipolaire (TB) obtiennent un rétablissement syndromique après avoir été adressés à un traitement spécialisé. Cependant, le rétablissement fonctionnel n'est réalisé que dans moins de 50 % de ces cas. MÉTHODE: Une étude cas-témoins transversale descriptive, basée sur un échantillon clinique de 44 patients de TB âgés de 12 à 19 ans, appariés selon l'âge et le sexe avec 44 témoins en santé (TS). La psychopathologie a été déterminée à l'aide de KSADS-PL, en plus des échelles cliniques. L'information sur le rendement scolaire antérieur était incluse de même que le résultat fonctionnel basé sur l'échelle d'évaluation globale du fonctionnement pour les enfants (CGAS). L'exposition précédente à des expériences stressantes a été évaluée à l'aide de l'échelle des événements stressants de la vie (SLES). Toutes les analyses ont été menées à l'aide de modèles de régression logistique conditionnelle ou séquentielle. RÉSULTATS: Une fois stabilisés, et même après contrôle des différences sociodémographiques, les patients de TB ont été associés à des niveaux plus faibles de fonctionnalité [RC 0,65 (0,46, 0,93), p = 0,02], et à un rendement scolaire plus mauvais [RC 0,03 (0,01, 0,67), p = 0,03] comparé aux TS. Une psychose sous-syndromale persistante présentait la corrélation négative la plus forte avec la fonctionnalité (rho =−0,65, −0,57 pour TB et TS respectivement; p < 0,001). Bien que le TB soit associé à des événements plus stressants, cette association ne demeurait pas significative dans les modèles multivariés. LIMITATIONS: La taille modeste de l'échantillon limite notre capacité de détecter les différences entre les groupes, et entre les sous-types de TB. CONCLUSIONS: Même lorsque la détection et l'intervention précoces sont fournies, le TB a un effet significatif sur le fonctionnement et sur le rendement scolaire. Il est important de prendre en compte les symptômes de sous-seuil persistants et de mettre l'accent sur les composantes sociale et de rétablissement du traitement.

Autoantibodies, elevated cytokines, and neurocognitive abnormalities in offspring of women with systemic lupus erythematosus: comparison with healthy controls.

INTRODUCTION: Research describes higher incidence of neurodevelopmental disorders and learning disabilities in offspring of women affected by lupus. Factors implied are pregnancy and delivery adversities and exposure to maternal antibodies and cytokines. Little is known about the offspring immunological condition or the relation between offspring and maternal condition. OBJECTIVES: This study was conducted in order to analyze immunological configuration, psychopathology, and neuropsychological performance of young offspring of women with lupus, in comparison with healthy controls and in relation to maternal psychophysical condition. METHODS: Twenty-one offspring aged 8-17 of 17 women with lupus and 34 controls were recruited. Pregnancy conditions, stress factors, and immunological, psychopathological, and neuropsychological characteristics were compared. Immunological tests included standard lupus screening, lupus-related autoantibodies, antibodies against GluN2 subunit of the N-methyl-D-aspartate receptor (NMDAR) (anti-DWEYS Ab), and levels of ten cytokines (IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, GMCSF, IFN-γ, TNF-α). RESULTS: Offspring had lower leukocyte count (p = 0.001) and higher levels of anti-dsDNA Ab (p = 0.022), anti-DWEYS-GluN2 Ab (p < 0.001), and eight cytokines (IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-10, TNF-α-all p < 0.001-and IFN-γ, p = 0.026) than controls. Their cytokine levels did not differ from their mothers'; 23.9% of offspring met the criteria for a clinical psychiatric diagnosis. No differences were found in intelligence measures. Various neuropsychological scores correlated inversely with maternal psychophysical health. CONCLUSIONS: Offspring's profile suggests proinflammatory and autoimmune activation. Their rate of psychiatric diagnosis appears higher than in the general population, and their cognitive performance is related to maternal psychophysical health. Longitudinal research might investigate whether immunological and psychosocial conditions influence psychopathology and cognition. Graphical abstract The hypothesized sequence for physical and neuropsychological development for the SLE offspring.

Brain Imaging of the Cortex in ADHD: A Coordinated Analysis of Large-Scale Clinical and Population-Based Samples.

OBJECTIVE: Neuroimaging studies show structural alterations of various brain regions in children and adults with attention deficit hyperactivity disorder (ADHD), although nonreplications are frequent. The authors sought to identify cortical characteristics related to ADHD using large-scale studies. METHODS: Cortical thickness and surface area (based on the Desikan-Killiany atlas) were compared between case subjects with ADHD (N=2,246) and control subjects (N=1,934) for children, adolescents, and adults separately in ENIGMA-ADHD, a consortium of 36 centers. To assess familial effects on cortical measures, case subjects, unaffected siblings, and control subjects in the NeuroIMAGE study (N=506) were compared. Associations of the attention scale from the Child Behavior Checklist with cortical measures were determined in a pediatric population sample (Generation-R, N=2,707). RESULTS: In the ENIGMA-ADHD sample, lower surface area values were found in children with ADHD, mainly in frontal, cingulate, and temporal regions; the largest significant effect was for total surface area (Cohen's d=-0.21). Fusiform gyrus and temporal pole cortical thickness was also lower in children with ADHD. Neither surface area nor thickness differences were found in the adolescent or adult groups. Familial effects were seen for surface area in several regions. In an overlapping set of regions, surface area, but not thickness, was associated with attention problems in the Generation-R sample. CONCLUSIONS: Subtle differences in cortical surface area are widespread in children but not adolescents and adults with ADHD, confirming involvement of the frontal cortex and highlighting regions deserving further attention. Notably, the alterations behave like endophenotypes in families and are linked to ADHD symptoms in the population, extending evidence that ADHD behaves as a continuous trait in the population. Future longitudinal studies should clarify individual lifespan trajectories that lead to nonsignificant findings in adolescent and adult groups despite the presence of an ADHD diagnosis.

Assessing Advanced Theory of Mind in Children and Adolescents with High-Functioning Autism: The Spanish Version of the Stories of Everyday Life.

Most individuals with autism spectrum disorders often fail in tasks of theory of mind (ToM). However, those with normal intellectual functioning known as high functioning ASD (HF-ASD) sometimes succeed in mentalizing inferences. Some tools have been developed to more accurately test their ToM abilities. The aims of this study were to examine the psychometric properties of the Spanish version of Stories of Everyday Life Test (SEL) in a sample of 29 children and adolescents with HF-ASD and 25 typically developing controls and to compare their performance. The Spanish-SEL demonstrated good internal consistency, strong convergence with clinical severity and another ToM test, and adequate discriminant validity from intellectual capability and age, identifying the condition of 70 % of participants.

Involvement of NRN1 gene in schizophrenia-spectrum and bipolar disorders and its impact on age at onset and cognitive functioning.

OBJECTIVES: Neuritin 1 gene (NRN1) is involved in neurodevelopment processes and synaptic plasticity and its expression is regulated by brain-derived neurotrophic factor (BDNF). We aimed to investigate the association of NRN1 with schizophrenia-spectrum disorders (SSD) and bipolar disorders (BPD), to explore its role in age at onset and cognitive functioning, and to test the epistasis between NRN1 and BDNF. METHODS: The study was developed in a sample of 954 SSD/BPD patients and 668 healthy subjects. Genotyping analyses included 11 SNPs in NRN1 and one functional SNP in BDNF. RESULTS: The frequency of the haplotype C-C (rs645649-rs582262) was significantly increased in patients compared to controls (P = 0.0043), while the haplotype T-C-C-T-C-A (rs3763180-rs10484320-rs4960155-rs9379002-rs9405890-rs1475157) was more frequent in controls (P = 3.1 × 10(-5)). The variability at NRN1 was nominally related to changes in age at onset and to differences in intelligence quotient, in SSD patients. Epistasis between NRN1 and BDNF was significantly associated with the risk for SSD/BPD (P = 0.005). CONCLUSIONS: Results suggest that: (i) NRN1 variability is a shared risk factor for both SSD and BPD, (ii) NRN1 may have a selective impact on age at onset and intelligence in SSD, and (iii) the role of NRN1 seems to be not independent of BDNF.

Two-year follow-up of treated adolescents with early-onset bipolar disorder: Changes in neurocognition.

BACKGROUND: Few studies have analyzed the course of neurocognition in treated children and adolescents with early-onset bipolar disorder (EOBD) and shown improvements in attention, working memory, and verbal memory after treatment. The aim of this study was to determine the progress over two years in neuropsychological performance of a sample of medicated adolescents with EOBD compared to healthy controls (HC). METHODS: Twenty adolescents, diagnosed in clinical setting as DSM-IV bipolar disorder, treated for two years, euthymic, and 20 gender and age-matched HC were assessed at two moments in reasoning, verbal and visual memory, working memory, speed, visual-motor skills and executive function. Multivariate analyses of variance was carried out to analyze the differences between groups over time, and to monitor the influence of psychotic symptoms and type of mood-stabilizer. RESULTS: The entire sample improved on verbal and visual memory tests (verbal recall p<0.01; visual recall p<0.001). Moreover, patients improved more than controls in verbal reasoning (p<0.01), working memory (p<0.01), processing speed (p<0.01) and visual-motor skills (p<0.001). Psychotic symptoms and treatment with lithium were associated with poorer development in executive control tasks. LIMITATIONS: Sample size was small and groups were re-evaluated in slight different follow-up periods. Doses of antipsychotics drugs over time were not controlled. CONCLUSIONS: Processing speed and visual-motor skills in the EOBD group normalized during follow-up. Executive functioning, working memory, and verbal and visual memory remained impaired in patients versus controls. The knowledge of cognitive deficits due to normal course of illness or to drug effects allows better therapeutic strategies.