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Jones BDM, Fernandes BS, Husain MI, Ortiz A, Rajji TK, Blumberger DM, Butters MA, Gildengers AG, Shablinski T, Voineskos A, Mulsant BH. A cross-sectional study of cognitive performance in bipolar disorder across the lifespan: the cog-BD project. Psychol Med 2023; 53:6316-6324. [PMID: 36464659 PMCID: PMC10520592 DOI: 10.1017/s0033291722003622] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuroprogressive models of the trajectory of cognitive dysfunction in patients with bipolar disorder (BD) have been proposed. However, few studies have explored the relationships among clinical characteristics of BD, cognitive dysfunction, and aging. METHODS We conducted a cross-sectional analysis in euthymic participants with the MATRICS Cognitive Consensus Battery, the Trail Making Test B, the Stroop Test, and the Wechsler Test of Adult Reading. Age- and gender-equated control participants without a mental disorder ['Healthy Controls' - HC)] were assessed similarly. We compared cognitive performance both globally and in seven domains in four groups: younger BD (age ⩽49 years; n = 70), older BD (age ⩾50 years; n = 48), younger HC (n = 153), and older HC (n = 44). We also compared the BD and HC groups using age as a continuous measure. We controlled for relevant covariates and applied a Bonferroni correction. RESULTS Our results support both an early impairment ('early hit') model and an accelerated aging model: impairment in attention/vigilance, processing speed, and executive function/working memory were congruent with the accelerated aging hypothesis whereas impairment in verbal memory was congruent with an early impairment model. BD and HC participants exhibited similar age-related decline in reasoning/problem solving and visuospatial memory. There were no age- or diagnosis-related differences in social cognition. CONCLUSION Our findings support that different cognitive domains are affected differently by BD and aging. Longitudinal studies are needed to explore trajectories of cognitive performance in BD across the lifespan.
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Affiliation(s)
- Brett D. M. Jones
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brisa S. Fernandes
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M. Ishrat Husain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abigail Ortiz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K. Rajji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M. Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tatiana Shablinski
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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The efficacy of cariprazine on cognition: a post hoc analysis from phase II/III clinical trials in bipolar mania, bipolar depression, and schizophrenia. CNS Spectr 2022; 28:319-330. [PMID: 35193729 DOI: 10.1017/s109285292200013x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the effect of cariprazine on cognitive symptom change across bipolar I disorder and schizophrenia. METHODS Post hoc analyses of 3- to 8-week pivotal studies in bipolar I depression and mania were conducted; one schizophrenia trial including the Cognitive Drug Research System attention battery was also analyzed. Outcomes of interest: Montgomery-Åsberg Depression Rating Scale [MADRS], Functioning Assessment Short Test [FAST], Positive and Negative Syndrome Scale [PANSS]). LSMDs in change from baseline to end of study were reported in the overall intent-to-treat population and in patient subsets with specified levels of baseline cognitive symptoms or performance. RESULTS In patients with bipolar depression and at least mild cognitive symptoms, LSMDs were statistically significant for cariprazine vs placebo on MADRS item 6 (3 studies; 1.5 mg=-0.5 [P<.001]; 3 mg/d=-0.2 [P<.05]) and on the FAST Cognitive subscale (1 study; 1.5 mg/d=-1.4; P=.0039). In patients with bipolar mania and at least mild cognitive symptoms, the LSMD in PANSS Cognitive subscale score was statistically significant for cariprazine vs placebo (3 studies; -2.1; P=.001). In patients with schizophrenia and high cognitive impairment, improvement in power of attention was observed for cariprazine 3 mg/d vs placebo (P=.0080), but not for cariprazine 6 mg/d; improvement in continuity of attention was observed for cariprazine 3 mg/d (P=.0012) and 6 mg/d (P=.0073). CONCLUSION These post hoc analyses provide preliminary evidence of greater improvements for cariprazine vs placebo across cognitive measures in patients with bipolar I depression and mania, and schizophrenia, suggesting potential benefits for cariprazine in treating cognitive symptoms.
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Jiménez-López E, Villanueva-Romero CM, Sánchez-Morla EM, Martínez-Vizcaíno V, Ortiz M, Rodriguez-Jimenez R, Vieta E, Santos JL. Neurocognition, functional outcome, and quality of life in remitted and non-remitted schizophrenia: A comparison with euthymic bipolar I disorder and a control group. Schizophr Res 2022; 240:81-91. [PMID: 34991042 DOI: 10.1016/j.schres.2021.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
There are discrepancies about if the severity of the symptomatology in schizophrenia is related to neurocognitive performance, functional outcome, and quality of life (QoL). Also, there are controversial data about the comparison between euthymic bipolar patients and different subgroups of schizophrenia in neurocognition, functioning, and QoL level. The present study aimed to compare the neurocognitive performance, functional outcome, and QoL of remitted and non-remitted patients with SC with respect to a group of euthymic patients with BD, and a control group. It included 655 subjects: 98 patients with schizophrenia in remission (SC-R), 184 non-remitted patients with schizophrenia (SC-NR), 117 euthymic patients with bipolar I disorder (BD), and 256 healthy subjects. A comprehensive clinical, neurocognitive (six cognitive domains), functional, and QoL assessment was carried out. Remission criteria of Andreasen were used to classify schizophrenia patients as remitted or non-remitted. Compared with control subjects all groups of patients showed impaired neurocognitive performance, functioning and QoL. SC-R patients had an intermediate functioning between control subjects and SC-NR, all at a neurocognitive, functional, or QoL level. There were no significant differences between SC-R and BD. These results suggest that reaching clinical remission is essential to achieve a better level of psychosocial functioning, and QoL. Likewise, the results of this study suggest that euthymic patients with bipolar disorder and patients with schizophrenia in remission are comparable at the neurocognitive and functional levels, which might have implications in the pathophysiology of both disorders.
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Affiliation(s)
- Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | | | - Eva María Sánchez-Morla
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain.
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad Autónoma de Chile. Facultad de Ciencias de la Salud, Talca, Chile
| | - M Ortiz
- Interdisciplinary Center for Security, Reliability and Trust (SnT), University of Luxembourg, 1855 Luxembourg, Luxembourg
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Eduard Vieta
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
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Perceived barriers to assessing understanding and appreciation of informed consent in clinical trials: A mixed-method study. J Clin Transl Sci 2021; 5:e164. [PMID: 34589234 PMCID: PMC8453455 DOI: 10.1017/cts.2021.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Participants and research professionals often overestimate how well participants understand and appreciate consent information for clinical trials, and experts often vary in their determinations of participant’s capacity to consent to research. Past research has developed and validated instruments designed to assess participant understanding and appreciation, but the frequency with which they are utilized is unknown. Methods: We administered a survey to clinical researchers working with older adults or those at risk of cognitive impairment (N = 1284), supplemented by qualitative interviews (N = 60). Results: We found that using a validated assessment of consent is relatively uncommon, being used by only 44% of researchers who had an opportunity. Factors that predicted adoption of validated assessments included not seeing the study sponsor as a barrier, positive attitudes toward assessments, and being confident that they had the resources needed to implement an assessment. The perceived barriers to adopting validated assessments of consent included lack of awareness, lack of knowledge, being unsure of how to administer such an assessment, and the burden associated with implementing this practice. Conclusions: Increasing the use of validated assessments of consent will require educating researchers on the practice and emphasizing very practical assessments, and may require Institutional Review Boards (IRBs) or study sponsors to champion the use of assessments.
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Szmulewicz A, Millett C, Shanahan M, Gunning F, Burdick K. Emotional processing subtypes in bipolar disorder: A cluster analysis. J Affect Disord 2020; 266:194-200. [PMID: 32056876 PMCID: PMC8414557 DOI: 10.1016/j.jad.2020.01.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/17/2019] [Accepted: 01/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence regarding the performance of Bipolar Disorder patients (BD) on Emotional Processing (EP) is conflicting, suggesting that heterogeneity within this population may exist. It is not completely understood if this impacts on clinical presentation and functional outcomes. METHODS A total of 212 BD patients were recruited. Patients underwent MATRICS Consensus Cognitive Battery as well as a clinical evaluation to detect premorbid traits, comorbidities and clinical features. Performance on each basic emotion on the Emotional Recognition Task (ERT) and Reading the Mind in the Eyes Test were entered into hierarchical cluster analyses in order to determine the number of clusters and to assign subjects to specific clusters. We then compared subgroups on clinical factors and real-world community functioning. RESULTS No differences between BD patients as a group and controls were found in EP performance. Two clusters of BD patients were found, one with "intact" performance (71.2%) that performed as healthy controls (HC) and other with "impaired" performance (28.8%) performing worse than HC and schizophrenic patients on basic emotion recognition. Patients in the "impaired group" presented higher rates of childhood trauma, schizotypal traits, lower premorbid IQ and education, poor psychosocial functioning and cognitive performance. LIMITATIONS Cross-sectional data which limits our ability to infer directionality of our findings. CONCLUSION These results suggest the presence of two subgroups regarding EP performance with unique clinical and neurodevelopmental profiles associated. Next steps will include using these data to identify a homogeneous group of patients to target these disabling symptoms with treatment.
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Affiliation(s)
- A. Szmulewicz
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - C.E. Millett
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - M. Shanahan
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,James J. Peters Veterans Administration Hospital, Bronx, NY
| | - F. Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - K.E. Burdick
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,James J. Peters Veterans Administration Hospital, Bronx, NY,Icahn School of Medicine at Mount Sinai, NY, NY
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Brain structural correlates of executive and social cognition profiles in behavioral variant frontotemporal dementia and elderly bipolar disorder. Neuropsychologia 2019; 126:159-169. [DOI: 10.1016/j.neuropsychologia.2017.02.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/31/2017] [Accepted: 02/15/2017] [Indexed: 01/31/2023]
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Wang P, Yang J, Yin Z, Duan J, Zhang R, Sun J, Xu Y, Liu L, Chen X, Li H, Kang J, Zhu Y, Deng X, Chang M, Wei S, Zhou Y, Jiang X, Wang F, Tang Y. Amplitude of low-frequency fluctuation (ALFF) may be associated with cognitive impairment in schizophrenia: a correlation study. BMC Psychiatry 2019; 19:30. [PMID: 30654778 PMCID: PMC6337807 DOI: 10.1186/s12888-018-1992-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/18/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cognitive impairments are prominent in schizophrenia (SZ). Imaging studies have demonstrated that functional changes of several areas of the brain exist in SZ patients. The relationships between these two indexes are largely unexplored in SZ. The MATRICS Consensus Cognitive Battery (MCCB) was used to measure cognitive impairment in multi-dimensional cognitive fields of SZ patients. This study was conducted to explore the relationship between cognitive functional impairment and the amplitude of low-frequency fluctuation (ALFF) in SZ patients. METHOD A total of 104 participants (44 SZ patients and 60 age- and gender-matched healthy controls (HC)) were recruited for this study. The MCCB was used to assess cognitive function of the participants, while brain activity was assessed using the ALFF. The relationship between the MCCB and the ALFF was investigated by using a correlation analysis. RESULTS There were significant differences between SZ patients and HC in MCCB total and domain scores as well as in ALFF results. The reduction of ALFF in the bilateral postcentral gyri and paracentral lobule in SZ patients has a negative correlation with the MCCB sub-test of symbol coding. CONCLUSION These findings suggest that the reduction of ALFF in bilateral postcentral gyri and paracentral lobule may be related to cognitive impairment in SZ patients.
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Affiliation(s)
- Pengshuo Wang
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Jian Yang
- grid.412636.4Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001 People’s Republic of China
| | - Zhiyang Yin
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Jia Duan
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Ran Zhang
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Jiaze Sun
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Yixiao Xu
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Luyu Liu
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Xuemei Chen
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Huizi Li
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Jiahui Kang
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Yue Zhu
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Xin Deng
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Miao Chang
- grid.412636.4Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001 People’s Republic of China
| | - Shengnan Wei
- grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001 People’s Republic of China
| | - Yifang Zhou
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China
| | - Xiaowei Jiang
- grid.412636.4Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001 People’s Republic of China ,grid.412636.4Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001 People’s Republic of China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China. .,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China. .,Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, People's Republic of China.
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China. .,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China. .,Department of Gerontology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, People's Republic of China.
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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GSK3β: a plausible mechanism of cognitive and hippocampal changes induced by erythropoietin treatment in mood disorders? Transl Psychiatry 2018; 8:216. [PMID: 30310078 PMCID: PMC6181907 DOI: 10.1038/s41398-018-0270-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 06/11/2018] [Accepted: 07/14/2018] [Indexed: 12/16/2022] Open
Abstract
Mood disorders are associated with significant psychosocial and occupational disability. It is estimated that major depressive disorder (MDD) will become the second leading cause of disability worldwide by 2020. Existing pharmacological and psychological treatments are limited for targeting cognitive dysfunctions in mood disorders. However, growing evidence from human and animal studies has shown that treatment with erythropoietin (EPO) can improve cognitive function. A recent study involving EPO-treated patients with mood disorders showed that the neural basis for their cognitive improvements appeared to involve an increase in hippocampal volume. Molecular mechanisms underlying hippocampal changes have been proposed, including the activation of anti-apoptotic, antioxidant, pro-survival and anti-inflammatory signalling pathways. The aim of this review is to describe the potential importance of glycogen synthase kinase 3-beta (GSK3β) as a multi-potent molecular mechanism of EPO-induced hippocampal volume change in mood disorder patients. We first examine published associations between EPO administration, mood disorders, cognition and hippocampal volume. We then highlight evidence suggesting that GSK3β influences hippocampal volume in MDD patients, and how this could assist with targeting more precise treatments particularly for cognitive deficits in patients with mood disorders. We conclude by suggesting how this developing area of research can be further advanced, such as using pharmacogenetic studies of EPO treatment in patients with mood disorders.
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Bogaty SER, Lee RSC, Hickie IB, Hermens DF. Meta-analysis of neurocognition in young psychosis patients with current cannabis use. J Psychiatr Res 2018; 99:22-32. [PMID: 29407284 DOI: 10.1016/j.jpsychires.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adult psychosis patients (i.e. over the age of 25 years) who are also lifetime cannabis users (CANN±) appear to exhibit superior cognition compared to never-using patients (CANN-). The objective of this meta-analysis was to evaluate the cognitive differences between CANN- and patients who currently use cannabis (CANN+) (i.e. during the CANN± patients' cannabis-using stage). Specifically, focusing on young patients under the age of 25 years, the typical stage of both psychosis- and cannabis-onset. METHOD Of the 308 studies identified through database searches and secondary referencing, 14 compared neurocognition of CANN+ and CANN- in young people with psychotic disorders (mean age between 15 and 45 years). Effect sizes were extracted using neurocognitive test performance between CANN+ and CANN- and random effects modelling was conducted on pooled ES and moderator analyses. RESULTS CANN+ performed worse on several cognitive domains (i.e. premorbid IQ, current IQ, verbal learning, verbal working memory, motor inhibition) compared to CANN-. The association between age and performance in CANN+ cognition was varied, with older age predictive of worse performance in processing speed, sustained attention, verbal memory, and better performance in verbal learning and very fluency. Of note, CANN+ outperformed CANN- in tests of conceptual set-shifting. CONCLUSION These results are consistent with previous findings indicating that CANN+ demonstrate poorer neurocognition than CANN-; and that this is exacerbated with increasing age. Our findings demonstrate significant cognitive differences between patients with CANN+ versus CANN- even at early-onset psychosis, which could suggest a different underlying mechanism towards psychosis for cannabis users.
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Affiliation(s)
| | - Rico S C Lee
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Brain and Mental Health Laboratory, Monash University, Melbourne, VIC, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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Lin GH, Wu CT, Huang YJ, Lin P, Chou CY, Lee SC, Hsieh CL. A Reliable and Valid Assessment of Sustained Attention for Patients With Schizophrenia: The Computerized Digit Vigilance Test. Arch Clin Neuropsychol 2018; 33:227-237. [PMID: 28981615 DOI: 10.1093/arclin/acx064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/28/2017] [Indexed: 11/12/2022] Open
Abstract
Objective The purposes of this study were to examine the test-retest reliability, concurrent validity, and ecological validity of the Computerized Digit Vigilance Test (C-DVT) in patients with schizophrenia. Method Each participant was assessed four times, with 1-week intervals. In each assessment, the participants completed both the C-DVT and the original DVT. The participants were also assessed using the Lawton Instrumental Activities of Daily Living Scale (LIADL) and the Personal and Social Performance Scale (PSP). Results Forty-nine participants were recruited in this study. The results showed that the test-retest agreement of the C-DVT was good-to-excellent (intraclass correlation coefficient = 0.71-0.89). The random measurement errors of the C-DVT were acceptable (percentages of minimal detectable change = 12.9%-24.1%). The practice effect of the C-DVT reached a plateau after three assessments (effect size <0.20). The concurrent validity of the C-DVT was good (r = .75-.79 with DVT) when we controlled for the randomized administration order of the two tests. The ecological validity of the C-DVT was good (r = -.44 with the LIADL; r = -.45 with the PSP). Conclusions The C-DVT had acceptable test-retest reliability, sound concurrent validity, and sound ecological validity in patients with schizophrenia. These findings indicate that the C-DVT has the potential to be a reliable and valid test of sustained attention in patients with schizophrenia.
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Affiliation(s)
- Gong-Hong Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Te Wu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jing Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Powen Lin
- Department of Occupational Therapy, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chia-Yeh Chou
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Occupational Therapy, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Shu-Chun Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Occupational Therapy, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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12
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Knight MJ, Baune BT. Executive Subdomains Are Differentially Associated With Psychosocial Outcomes in Major Depressive Disorder. Front Psychiatry 2018; 9:309. [PMID: 30042703 PMCID: PMC6048277 DOI: 10.3389/fpsyt.2018.00309] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/21/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Deficits in executive functioning are frequently associated with poor psychosocial outcomes in Major Depressive Disorder (MDD). However, there is a poor understanding of the domain-specific relationships between executive subdomains (e.g., forward planning, decision making) and specific psychosocial issues (e.g., occupational functioning, social relationships). The current study explored these relationships across currently depressed and remitted MDD patients, as well as a healthy control group. Methods: Data from 142 participants were obtained from the Cognitive Functioning and Mood Study (CoFaM-S), a cross sectional study of mood, cognition, and psychosocial functioning in mood disorders. Participants' [current depression n = 31, remitted depression n = 52, healthy controls (HC) n = 59] executive functioning was evaluated with well-established tests of executive subdomains (i.e., Tower of London, card sorting, Stroop task). The Functioning Assessment Short Test (FAST) was employed to clinically evaluate psychosocial dysfunction. Results: The results indicated that forward planning was most strongly associated with psychosocial issues in the current depression group as compared to HCs, while cognitive updating was primary in the remitted group vs. HC. Conclusions: These findings suggest that executive subdomains are deferentially associated with psychosocial issues across different stages of depressive illness, and that forward planning and cognitive updating should be considered in adjunctive cognitive treatment.
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Affiliation(s)
- Matthew J Knight
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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13
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O'Donnell LA, Deldin PJ, Pester B, McInnis MG, Langenecker SA, Ryan KA. Cognitive flexibility: A trait of bipolar disorder that worsens with length of illness. J Clin Exp Neuropsychol 2017; 39:979-987. [PMID: 28276284 DOI: 10.1080/13803395.2017.1296935] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Deficits in cognitive flexibility, a difficulty altering thoughts and behavioral responses in a changing environment, are found in individuals with bipolar disorder (BD) and are associated with poor social and work functioning. However, the current literature is inconsistent in clarifying the long-term nature of these deficits for those with BD. We administered a common task of cognitive flexibility, the Wisconsin Card Sorting Task (WCST) and accounted for demographics, clinical, and cognitive features of BD, to determine the state versus trait characteristics of these deficits. METHOD The Wisconsin Card Sorting Test (WCST) was administered to 154 adults with BD and 95 healthy controls twice, one year apart. RESULTS The main findings show that cognitive inflexibility is a trait feature of BD, independent of clinical features, that may modestly worsen over time due to the presence of certain demographic, cognitive, and functional features of the disorder. In addition, improvements in WCST performance over an extended period of time in both those with and those without already existing cognitive flexibility deficits indicate potential practice effects. CONCLUSIONS These findings suggest that the implementation of early interventions before the illness progresses could potentially prevent further cognitive impairment, mitigate functional outcomes, and improve the quality of life of the individual with BD.
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Affiliation(s)
- Lisa A O'Donnell
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | - Patricia J Deldin
- b Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Bethany Pester
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | - Melvin G McInnis
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | - Scott A Langenecker
- c Department of Psychiatry , University of Illinois at Chicago , Chicago , IL , USA
| | - Kelly A Ryan
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
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14
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Verbal fluency in bipolar disorders: A systematic review and meta-analysis. J Affect Disord 2017; 207:359-366. [PMID: 27744224 DOI: 10.1016/j.jad.2016.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/29/2016] [Accepted: 09/27/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND One of the main features of bipolar disorder (BD), besides mood dysregulation, is an alteration of the structure of language. Bipolar patients present changes in semantic contents, impaired verbal associations, abnormal prosody and abnormal speed of language highlighted with various experimental tasks. Verbal fluency tasks are widely used to assess the abilities of bipolar patients to retrieve and produce verbal material from the lexico-semantic memory. Studies using these tasks have however yielded discrepant results. The aim of this study was thus to determine the extent of the verbal fluency impairment in BD patients and to evaluate if the deficits are affected by the type of task or by mood states. METHODS A systematic literature search was conducted in MEDLINE, EBSCOHost and Google Scholar and relevant data were submitted to a meta-analysis. RESULTS Thirty-nine studies were retained providing data for 52 independent groups of BD patients. The overall meta-analysis revealed a moderate verbal fluency impairment in BD compared to healthy controls (effect size d=0.61). Comparisons between mood states showed significant differences only between euthymic and manic patients and only on category fluency performances. LIMITATIONS This review is limited by the heterogeneity between studies for the characteristics of BD populations. Also, few of the retained studies examined depressive or mixed episodes. CONCLUSIONS This work confirms that BD patients present with moderate verbal fluency impairments, and underlines the specific effect of mood state on category fluency. This emphasizes the need to distinguish semantic from phonological processes in verbal fluency assessments in BD.
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15
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Fekih-Romdhane F, Homri W, Mrabet A, Labbane R. [Factors predicting functioning in type 1 bipolar patients during remission period]. Pan Afr Med J 2016; 25:66. [PMID: 28292029 PMCID: PMC5324157 DOI: 10.11604/pamj.2016.25.66.8532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/08/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Recent studies indicate that bipolar disorder is associated with a profound impairment in almost all areas of functioning. This study aims to evaluate functional recovery in type 1 bipolar patients during remission period. METHOD We conducted a cross-sectional study of euthymic type 1 bipolar patients followed up on an ambulatory basis. In the analysis to be reported here we used Hamilton Depression Scale, Young Mania Rating Scale (YMRS), Rosenberg Self-Esteem Scale, and Functioning Assessment Short Test (FAST). RESULTS More than half of the study population (53.3%) had overall functional impairment. The overall functioning was associated with age, education level, professional activity, the number of manic and depressive episodes, the number of hospitalizations, a higher HDRS score as well as with the two self-esteem subscores: "self-confidence" and "self-deprecation". CONCLUSION Our results suggest that a paradigm shift in the treatment of bipolar disorders should happen and that the goals of therapy should be modified from symptomatic remission to functional remission.
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Affiliation(s)
- Feten Fekih-Romdhane
- Université de Tunis El Manar, Faculté de Medecine de Tunis, Tunisie; Hopital Razi, La Mannouba, Tunisie
| | - Wided Homri
- Université de Tunis El Manar, Faculté de Medecine de Tunis, Tunisie; Hopital Razi, La Mannouba, Tunisie
| | - Ali Mrabet
- Université de Tunis El Manar, Faculté de Medecine de Tunis, Tunisie; Unité de surveillance épidémiologique, Direction Générale de la Santé Militaire, Tunisie
| | - Raja Labbane
- Université de Tunis El Manar, Faculté de Medecine de Tunis, Tunisie; Hopital Razi, La Mannouba, Tunisie
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Liebers DT, Pirooznia M, Seiffudin F, Musliner KL, Zandi PP, Goes FS. Polygenic Risk of Schizophrenia and Cognition in a Population-Based Survey of Older Adults. Schizophr Bull 2016; 42:984-91. [PMID: 26873889 PMCID: PMC4903061 DOI: 10.1093/schbul/sbw001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cognitive impairment is a common feature of the major psychotic disorders, with deficits often present in at risk individuals and unaffected first-degree relatives. Previous studies have suggested that polygenic risk scores (PRS) for schizophrenia (SCZ) are associated with cognitive deficits, but there has been little examination of this association in longitudinal datasets, or comparison with other disorders. We used mixed models to study the association between PRS for 4 adult onset psychiatric disorders with cross-sectional cognitive performance and longitudinal cognitive decline in 8616 older adults from the Health and Retirement Study (HRS), followed for an average of 10 years. PRS were computed for SCZ, bipolar disorder (BD), Major Depressive Disorder (MDD), and Alzheimer's disease (ALZ). SCZ PRS associated with decreased cognitive function (z = -3.00, P = .001, ΔR (2) = 0.04%), which was largely driven by an association with impaired attention and orientation (z = -3.33, P = 4.3×10(-4), ΔR (2) = 0.08%). We found no effect of BD or MDD PRS on cognition, in contrast to a robust effect of the APOE4/TOMM40 locus (z = -5.05, P = 2.2×10(-7), ΔR (2) = 0.36%), which was primarily associated with impaired verbal memory (z = -5.15, P = 1.3×10(-7), ΔR (2) = 0.21%). APOE4/TOMM40 locus and the ALZ PRS, but not the PRS for SCZ, were associated with greater cognitive decline. In summary, using a large, representative sample of older adults, we found evidence for different degrees of association between polygenic risk for SCZ and genetic risk factors for ALZ on cognitive function and decline, highlighting potential differences in the pathophysiology of cognitive deficits seen in SCZ and ALZ.
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Affiliation(s)
- David T. Liebers
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mehdi Pirooznia
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Fayaz Seiffudin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Katherine L. Musliner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Peter P. Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD;,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Fernando S. Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD;,*To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Meyer 4-119A, 600 N. Wolfe Street, Baltimore, MD 21287, US; tel: 443-287-6382, fax: 410-502-0065, e-mail:
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17
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Tan D, Özerdem A, Güntekin B, Atagün MI, Tülay E, Karadağ F, Başar E. Increased Beta Frequency (15-30 Hz) Oscillatory Responses in Euthymic Bipolar Patients Under Lithium Monotherapy. Clin EEG Neurosci 2016; 47:87-95. [PMID: 25465436 DOI: 10.1177/1550059414561056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
The effect of lithium on neurocognition is not still fully explored. Brain oscillatory activity is altered in bipolar disorder. We aimed to assess the oscillatory responses of euthymic bipolar patients and how they are affected by lithium monotherapy. Event-related oscillations in response to visual target stimulus during an oddball paradigm in 16 euthymic drug-free and 13 euthymic lithium-treated bipolar patients were compared with 16 healthy controls. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta (15-30 Hz) responses in the 0- to 300-ms time window over frontal (F3, Fz, F4), central (C3, Cz, C4), temporal (T7, T8), temporo-parietal (TP7, TP8), parietal (P3, Pz, P4), and occipital (O1, Oz, O2) areas. Patients under lithium monotherapy had significantly higher beta responses to visual target stimuli than healthy controls (P=.017) and drug-free patients (P=.015). The increase in beta response was observed at all electrode locations, however, the difference was statistically significant for the left (T7; P=.016) and right (T8; P=.031) temporal beta responses. Increased beta responses in drug-free patients and further significant increase in lithium-treated patients may be indicative of a core pathophysiological process of bipolar disorder and how it is affected by lithium. Whether the finding corresponds to lithium's corrective effect on the underlying pathology or to its neurocognitive side effect remains to be further explored. In either case, the finding is a sign that the oscillatory activity may be useful in tracking medication effect in bipolar disorder.
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Affiliation(s)
- Devran Tan
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Ayşegül Özerdem
- Department of Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey Department of Neuroscience, Dokuz Eylul University Health Sciences Institute, Izmir, Turkey Multidisciplinary Brain Dynamics Research Center, Dokuz Eylul University, Izmir, Turkey
| | - Bahar Güntekin
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - M Ilhan Atagün
- Department of Psychiatry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Elif Tülay
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - Figen Karadağ
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Erol Başar
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
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18
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Tyler E, Lobban F, Sutton C, Depp C, Johnson S, Laidlaw K, Jones SH. Feasibility randomised controlled trial of Recovery-focused Cognitive Behavioural Therapy for Older Adults with bipolar disorder (RfCBT-OA): study protocol. BMJ Open 2016; 6:e010590. [PMID: 26940112 PMCID: PMC4785318 DOI: 10.1136/bmjopen-2015-010590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/05/2016] [Accepted: 01/19/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Bipolar disorder is a severe and chronic mental health problem that persists into older adulthood. The number of people living with this condition is set to rise as the UK experiences a rapid ageing of its population. To date, there has been very little research or service development with respect to psychological therapies for this group of people. METHODS AND ANALYSIS A parallel two-arm randomised controlled trial comparing a 14-session, 6-month Recovery-focused Cognitive-Behavioural Therapy for Older Adults with bipolar disorder (RfCBT-OA) plus treatment as usual (TAU) versus TAU alone. Participants will be recruited in the North-West of England via primary and secondary mental health services and through self-referral. The primary objective of the study is to evaluate the feasibility and acceptability of RfCBT-OA; therefore, a formal power calculation is not appropriate. It has been estimated that randomising 25 participants per group will be sufficient to be able to reliably determine the primary feasibility outcomes (eg, recruitment and retention rates), in line with recommendations for sample sizes for feasibility/pilot trials. Participants in both arms will complete assessments at baseline and then every 3 months, over the 12-month follow-up period. We will gain an estimate of the likely effect size of RfCBT-OA on a range of clinical outcomes and estimate parameters needed to determine the appropriate sample size for a definitive, larger trial to evaluate the effectiveness and cost-effectiveness of RfCBT-OA. Data analysis is discussed further in the Analysis section in the main paper. ETHICS AND DISSEMINATION This protocol was approved by the UK National Health Service (NHS) Ethics Committee process (REC ref: 15/NW/0330). The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and local, participating NHS trusts. TRIAL REGISTRATION NUMBER ISRCTN13875321; Pre-results.
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Affiliation(s)
- Elizabeth Tyler
- Division of Health Research, The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Fiona Lobban
- Division of Health Research, The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Chris Sutton
- Lancashire Clinical Trials Unit, College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Colin Depp
- Department of Psychiatry, School of Medicine of the University of California, San Diego, San Diego, California, USA
| | - Sheri Johnson
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Ken Laidlaw
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Steven H Jones
- Division of Health Research, The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
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Kuswanto C, Chin R, Sum MY, Sengupta S, Fagiolini A, McIntyre RS, Vieta E, Sim K. Shared and divergent neurocognitive impairments in adult patients with schizophrenia and bipolar disorder: Whither the evidence? Neurosci Biobehav Rev 2016; 61:66-89. [DOI: 10.1016/j.neubiorev.2015.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
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Are there differences in pattern and magnitude of cognitive deficits between euthymic patients with bipolar I and bipolar II disorder? MIDDLE EAST CURRENT PSYCHIATRY 2016. [DOI: 10.1097/01.xme.0000475311.46243.2f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Sajatovic M, Strejilevich SA, Gildengers AG, Dols A, Al Jurdi RK, Forester BP, Kessing LV, Beyer J, Manes F, Rej S, Rosa AR, Schouws SNTM, Tsai SY, Young RC, Shulman KI. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord 2015; 17:689-704. [PMID: 26384588 PMCID: PMC4623878 DOI: 10.1111/bdi.12331] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). METHODS This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. RESULTS The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data have brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline. CONCLUSIONS Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Annemiek Dols
- GGZinGeest, VU Medical Center, Amsterdam, the Netherlands
| | - Rayan K Al Jurdi
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Brent P Forester
- Geriatric Psychiatry Research Program, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Lars Vedel Kessing
- Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Beyer
- Duke University Medical Center, Durham, NC, USA
| | - Facundo Manes
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina
- UPD-INECO Foundation Core on Neuroscience (UNIFCoN), Chile
- National Scientific and Technical Rsearch Council (CONICET), Argentina
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Australia
| | - Soham Rej
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geri PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Adriane R Rosa
- Federal University of Rio Grande do Sul, Brazil
- Department of Pharmacology, Laboratory of Molecular Psychiatry, INCT for Translational Medicine–CNPq, Hospital de Clínicas de Porto Alegre, Brazil
| | - Sigfried NTM Schouws
- GGZ inGeest, Department of Psychiatry, EMGO Institute of Care and Health Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Robert C Young
- Weill Cornell Medical College and New York Presbyterian Hospital, White Plains, NY, USA
| | - Kenneth I Shulman
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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22
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Cardoso T, Bauer IE, Meyer TD, Kapczinski F, Soares JC. Neuroprogression and Cognitive Functioning in Bipolar Disorder: A Systematic Review. Curr Psychiatry Rep 2015; 17:75. [PMID: 26257147 DOI: 10.1007/s11920-015-0605-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bipolar disorder (BD) has been associated with impairments in a range of cognitive domains including attention, verbal learning, and mental flexibility. These deficits are increased during the acute phases of the illness and worsen over the course of BD. This review will examine the literature in relation to potential mechanisms associated with cognitive decline in BD. Scopus (all databases), Pubmed, and Ovid Medline were systematically searched with no language or year restrictions, up to January 2015, for human studies that collected cross-sectional and longitudinal cognitive data in adults with BD and matched healthy controls (HC). Selected search terms were "bipolar," "cognitive," "aging," "illness duration," "onset," and "progression." Thirty-nine studies satisfied the criteria for consideration. There is evidence that cognitive function in BD is negatively associated with features of illness progression such as number of mood episodes, illness duration, and hospitalizations. Aging does not appear to affect cognitive functioning to a greater extent than in HC. Furthermore, the small number of longitudinal studies in this field does not allow to reaching firm conclusion in terms of which sub-populations would be more prone to cognitive decline in BD. The decline in cognitive abilities over the course of the BD seems to be associated with the number of episodes and number of hospitalizations. No meaningful interaction of age and bipolar disorder has been found in terms of cognitive decline. Future large-scale longitudinal studies are necessary to confirm these findings and assist in the development of preventive interventions in vulnerable individuals.
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Affiliation(s)
- Taiane Cardoso
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77054, USA
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Forester BP, Ajilore O, Spino C, Lehmann S. Clinical Characteristics of Patients with Late Life Bipolar Disorder in the Community: Data from the NNDC Registry. Am J Geriatr Psychiatry 2015; 23:977-84. [PMID: 25670662 PMCID: PMC4503521 DOI: 10.1016/j.jagp.2015.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare clinical characteristics of older and younger patients with bipolar disorder enrolled in the United States' National Network of Depression Centers (NNDC) Clinical Care Registry (CCR). DESIGN Multicenter, de-identified naturalistic data from the National NNDC's CCR for all patients with a diagnosis of bipolar disorder who were enrolled in the registry as of April 25, 2013. PARTICIPANTS Community-dwelling patients (N = 218), ages 18 years or older, with bipolar disorder diagnosis recruited by NNDC-affiliated medical centers to participate in the NNDC CCR. Subjects aged 55 years or older were compared with subjects younger than age 55 years on clinical measures. MEASUREMENTS Patient Health Questionnaire; Quick Inventory of Depressive Symptomatology - Self-Report; Altman Self-Rating Mania Scale; Work and Social Adjustment Scale; Frequency and Intensity of Burden of Side Effects Rating; and the Self-Administered Comorbidity Questionnaire. RESULTS A greater percentage of older patients were prescribed antidepressant medications (71.9% versus 50.0%), and the younger cohort had significantly more psychostimulant use (16.7% versus 0%). Younger patients endorsed significantly more depressive symptoms compared with older patients. The mean number of psychotropic medications was not different in both older and younger patients with bipolar disorder. There was no statistically significant difference in frequency, intensity, or burden of psychotropic medication side effects as measured by the Frequency and Intensity of Burden of Side Effects Rating. CONCLUSION Findings of higher antidepressant use rates in the older cohort, combined with lower depression symptom severity and a similar degree of manic symptoms, suggests the possibility that older adults with bipolar disorder may have improved antidepressant efficacy and lower switch rates into manic or mixed states compared with younger cohorts. Ongoing data collection by the NNDC CCR will add to current knowledge to inform the care of older patients with bipolar disorder by providing multi-site data regarding phenomenology, treatment response, and longitudinal course of late life bipolar disorder in community settings.
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Pooters T, Van der Jeugd A, Callaerts-Vegh Z, D'Hooge R. Telencephalic neurocircuitry and synaptic plasticity in rodent spatial learning and memory. Brain Res 2015; 1621:294-308. [PMID: 25619550 DOI: 10.1016/j.brainres.2015.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 01/14/2023]
Abstract
Spatial learning and memory in rodents represent close equivalents of human episodic declarative memory, which is especially sensitive to cerebral aging, neurodegeneration, and various neuropsychiatric disorders. Many tests and protocols are available for use in laboratory rodents, but Morris water maze and radial-arm maze remain the most widely used as well as the most valid and reliable spatial tests. Telencephalic neurocircuitry that plays functional roles in spatial learning and memory includes hippocampus, dorsal striatum and medial prefrontal cortex. Prefrontal-hippocampal circuitry comprises the major associative system in the rodent brain, and is critical for navigation in physical space, whereas interconnections between prefrontal cortex and dorsal striatum are probably more important for motivational or goal-directed aspects of spatial learning. Two major forms of synaptic plasticity, namely long-term potentiation, a lasting increase in synaptic strength between simultaneously activated neurons, and long-term depression, a decrease in synaptic strength, have been found to occur in hippocampus, dorsal striatum and medial prefrontal cortex. These and other phenomena of synaptic plasticity are probably crucial for the involvement of telencephalic neurocircuitry in spatial learning and memory. They also seem to play a role in the pathophysiology of two brain pathologies with episodic declarative memory impairments as core symptoms, namely Alzheimer's disease and schizophrenia. Further research emphasis on rodent telencephalic neurocircuitry could be relevant to more valid and reliable preclinical research on these most devastating brain disorders. This article is part of a Special Issue entitled SI: Brain and Memory.
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Affiliation(s)
- Tine Pooters
- Laboratory of Biological Psychology, University of Leuven, Leuven, 102 Tiensestraat, BE-3000 Leuven, Belgium
| | - Ann Van der Jeugd
- Laboratory of Biological Psychology, University of Leuven, Leuven, 102 Tiensestraat, BE-3000 Leuven, Belgium
| | - Zsuzsanna Callaerts-Vegh
- Laboratory of Biological Psychology, University of Leuven, Leuven, 102 Tiensestraat, BE-3000 Leuven, Belgium
| | - Rudi D'Hooge
- Laboratory of Biological Psychology, University of Leuven, Leuven, 102 Tiensestraat, BE-3000 Leuven, Belgium.
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Abstract
Both nonaffective and affective psychoses are associated with deficits in social functioning across the course of the illness. However, it is not clear how social functioning varies among diagnostic groups as a function of age. The current study examined the relationship between social functioning and age in schizophrenia (SZ), schizoaffective disorder (SZA), and psychotic bipolar disorder (PBD). We found that individuals with PBD had the highest functioning, whereas individuals with SZ had the poorest. The functioning of individuals with SZA fell in between those of other groups. We also found that older ages were associated with poorer functioning. Although there was not a significant diagnostic group by age interaction, visual inspection of our data suggests a subtly steeper trajectory of decline in PBD. Overall, these results indicate that early interventions targeting social functioning may benefit individuals with either non-affective or affective psychoses to slow a projected decline.
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Aprahamian I, Radanovic M, Nunes PV, Ladeira RB, Forlenza OV. The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:913-8. [DOI: 10.1590/0004-282x20140153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/20/2014] [Indexed: 11/22/2022]
Abstract
There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia. Objective To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer’s disease (AD). Method 209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT). Results Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups. Conclusion Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD.
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Lewandowski KE, Sperry SH, Malloy MC, Forester BP. Age as a predictor of cognitive decline in bipolar disorder. Am J Geriatr Psychiatry 2014; 22:1462-8. [PMID: 24262287 PMCID: PMC3977013 DOI: 10.1016/j.jagp.2013.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/06/2013] [Accepted: 10/02/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Cognitive dysfunction is a core feature of bipolar disorder (BD) in both adult and geriatric patients. However, little is known about whether cognitive functioning declines at a faster rate in patients with BD, and there are conflicting reports regarding the relationship between age and cognitive functioning in this population. This cross-sectional study examined the relationship between age and cognitive functioning in patients with BD. METHODS Patients with BD I (N = 113) and healthy adults (N = 64) ages 18-87 completed measures of processing speed, attention, executive functioning, verbal fluency, and clinical symptomatology. Groupwise comparisons were used to examine differences between patients and the comparison group and adult and geriatric BD cohorts. A series of linear regressions was conducted to examine the relationship of age and cognitive functioning and clinical variables and cognition. RESULTS Patients performed significantly worse than the comparison group on all neuropsychological measures. Age was a significant predictor of Trails A scores with older age associated with worse performance. CONCLUSIONS Older age was associated with poorer performance on Trails A in patients with BD but not healthy adults. These results are suggestive of greater dysfunction in processing speed with older age in patients with BD compared with a healthy comparison group. Because cognitive functioning is associated with community outcomes, these findings suggest a need for treatments targeting cognitive symptoms across the life span. Future research exploring neurobiologic evidence for neurodegenerative processes in BD will pave the way for potential therapeutic interventions.
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Affiliation(s)
- Kathryn E. Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA,Harvard Medical School, Department of Psychiatry, Landmark Ctr., 401 Park Dr., Boston, MA, 02215, USA
| | - Sarah H. Sperry
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA
| | - Mary C. Malloy
- Geriatric Mood Disorders Research Program, McLean Hospital, 115 Mill St., Belmont, MA 02478 USA
| | - Brent P. Forester
- Harvard Medical School, Department of Psychiatry, Landmark Ctr., 401 Park Dr., Boston, MA, 02215, USA,Geriatric Mood Disorders Research Program, McLean Hospital, 115 Mill St., Belmont, MA 02478 USA
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Barch DM, Sheffield JM. Cognitive impairments in psychotic disorders: common mechanisms and measurement. World Psychiatry 2014; 13:224-32. [PMID: 25273286 PMCID: PMC4219054 DOI: 10.1002/wps.20145] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Decades of research have provided robust evidence of cognitive impairments in psychotic disorders. Individuals with schizophrenia appear to be impaired on the majority of neuropsychological tasks, leading some researchers to argue for a "generalized deficit", in which the multitude of cognitive impairments are the result of a common neurobiological source. One such common mechanism may be an inability to actively represent goal information in working memory as a means to guide behavior, with the associated neurobiological impairment being a disturbance in the function of the dorsolateral prefrontal cortex. Here, we provide a discussion of the evidence for such impairment in schizophrenia, and how it manifests in domains typically referred to as cognitive control, working memory and episodic memory. We also briefly discuss cognitive impairment in affective psychoses, reporting that the degree of impairment is worse in schizophrenia than in bipolar disorder and psychotic major depression, but the profile of impairment is similar, possibly reflecting common mechanisms at the neural level. Given the recent release of the DSM-5, we end with a brief discussion on assessing cognition in the context of diagnosis and treatment planning in psychotic disorders.
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Affiliation(s)
- Deanna M Barch
- Departments of Psychology, Psychiatry and Radiology, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
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Mackala SA, Torres IJ, Kozicky J, Michalak EE, Yatham LN. Cognitive performance and quality of life early in the course of bipolar disorder. J Affect Disord 2014; 168:119-24. [PMID: 25043323 DOI: 10.1016/j.jad.2014.06.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Several studies have reported cognitive functioning as a significant predictor of quality of life (QoL) in patients with established bipolar disorder (BD), in addition to mood symptoms. However, it is unclear whether cognitive functioning predicts QoL early in the course of illness. The purpose of this study was therefore to evaluate the relationship between mood and neuropsychological variables and self-reported QoL early in the course of BD. METHODS Patients with BD-I (n=54) completed a neuropsychological battery and clinical assessment within 3 months of resolution of their first manic episode. QoL was assessed 6 months later using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Cognitive predictors of QoL were assessed through Pearson correlations and hierarchical multiple regression. RESULTS After accounting for mood rating scores at the time of cognitive testing (ΔR²=.27, p<.001), measures of sustained attention (ΔR²=.08, p<.05), verbal memory (ΔR²=.09, p<.01), working memory (ΔR²=.06, p<.05), and executive functioning (ΔR²=.08, p<.05) each predicted QoL when entered independently in separate regression models. When entered simultaneously, the cognitive domains explained 15% (R(2)=.42, p<.05) of the variance in QoL beyond mood. LIMITATIONS Some aspects of QoL that are particularly important in BD may be missing as a result of using the Q-LES-Q, because the measure was not specifically developed to assess QoL in BD. CONCLUSIONS In addition to mood symptoms, poorer cognitive functioning is a significant predictor of reduced QoL early in the course of BD. Recently diagnosed patients with BD may benefit from early cognitive-enhancing interventions to maintain or restore their QoL.
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Affiliation(s)
- Sylvia A Mackala
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Addictions Services, Vancouver, BC, Canada
| | - Jan Kozicky
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Reddy LF, Horan WP, Green MF. Revisions and refinements of the diagnosis of schizophrenia in DSM‐5. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2014. [DOI: 10.1111/cpsp.12071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reilly JL, Sweeney JA. Generalized and specific neurocognitive deficits in psychotic disorders: utility for evaluating pharmacological treatment effects and as intermediate phenotypes for gene discovery. Schizophr Bull 2014; 40:516-22. [PMID: 24574307 PMCID: PMC3984526 DOI: 10.1093/schbul/sbu013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A growing body of research suggests that schizophrenia and bipolar disorder share overlapping clinical, neurobiological, and genetic features, raising important questions about the boundaries and distinctiveness of these 2 major psychiatric disorders. A generalized cognitive impairment has long been understood to be a core feature of schizophrenia. More recently, it has become apparent that cognitive impairment also occurs in bipolar disorder, particularly in those patients with a history of psychotic symptoms. Whether a generalized deficit exists across a spectrum of psychotic disorders is less clearly established. Additionally, in the context of a broad impairment, it remains a significant challenge to identify deficits in specific cognitive processes that may have distinct neurochemical or regional brain substrates and linkages to particular risk-associated genetic factors. In this article, we review the findings from neuropsychological studies across a spectrum that includes schizophrenia, schizoaffective and bipolar disorders, and conclude the available evidence strongly supports that a generalized deficit is present across psychotic disorders that differs in severity more so than form. We then consider the implications of generalized and specific deficits in psychosis for 2 areas of research--the evaluation of pharmacological treatments targeting cognitive deficits, and the investigation of cognitive intermediate phenotypes in family genetic studies. Examples from the literature that touch on the relevance of the generalized deficit in these contexts are provided, as well as consideration for the continued need to identify specific impairments that are separable from the generalized deficit in order to advance drug and gene discovery.
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Affiliation(s)
- James L. Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL;,*To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Street Suite 7–100, Chicago, IL, US; tel: 312-503-4809, fax: 312-503-0527, e-mail:
| | - John A. Sweeney
- Departments of Psychiatry and Pediatrics, UT Southwestern Medical Center, Dallas, TX
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Cholet J, Sauvaget A, Vanelle JM, Hommet C, Mondon K, Mamet JP, Camus V. Using the Brief Assessment of Cognition in Schizophrenia (BACS) to assess cognitive impairment in older patients with schizophrenia and bipolar disorder. Bipolar Disord 2014; 16:326-36. [PMID: 24383665 DOI: 10.1111/bdi.12171] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 07/28/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A growing body of evidence suggests that impairment in cognitive functioning is an important clinical feature of both schizophrenia and bipolar disorder, and that these cognitive alterations worsen with age. Although cognitive assessments are increasingly becoming a part of research and clinical practice in schizophrenia, a standardized and easily administered test battery for elderly patients with bipolar disorder is still lacking. The Brief Assessment of Cognition in Schizophrenia (BACS) captures those domains of cognition that are the most severely affected in patients with schizophrenia and the most strongly correlated with functional outcome. The primary aim of our study was to investigate the clinical usefulness of the BACS in assessing cognitive functioning in elderly euthymic patients with bipolar disorder, and to compare their cognitive profile to that of elderly patients with schizophrenia. METHODS Elderly euthymic patients with bipolar disorder or schizophrenia were assessed using the BACS and a standard cognitive test battery. RESULTS Fifty-seven elderly patients (aged 60 years and older) with bipolar disorder (n = 42) or schizophrenia (n = 15) were invited to participate. All of the patients were assessed by the BACS as being cognitively impaired. The patients with bipolar disorder scored significantly higher on the global scale and the verbal memory and attention sub-scores of the BACS than the patients with schizophrenia. DISCUSSION The BACS appears to be a feasible and informative cognitive assessment tool for elderly patients with bipolar disorder. We believe that these preliminary results merit further investigation.
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Affiliation(s)
- Jennyfer Cholet
- Pôle Universitaire d'Addictologie et de Psychiatrie, CHU de Nantes, Université de Nantes, Nantes, France
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Aprahamian I, Ladeira RB, Diniz BS, Forlenza OV, Nunes PV. Cognitive impairment in euthymic older adults with bipolar disorder: a controlled study using cognitive screening tests. Am J Geriatr Psychiatry 2014; 22:389-97. [PMID: 23567429 DOI: 10.1016/j.jagp.2012.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 08/22/2012] [Accepted: 08/29/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVE Cognitive impairment is a common feature of bipolar disorder (BD), with increased risk of developing dementia in late life. The aim of this study was to investigate the performance on cognitive screening tests in a sample of older adults with BD, as compared to non-BD subjects. METHODS 186 older adults (86 with BD and 100 without BD) were included. Patients were stratified according to cognitive performance (normal cognition, mild impairment, and dementia). The comparison group comprised healthy controls; subjects with cognitive impairment but no dementia (CIND); or patients with probable or possible Alzheimer disease (AD). Sixty-five subjects were cognitively unimpaired (35 BD), 65 had CIND (25 BD), and 56 AD (26 BD). In each of these levels of cognitive function, we compared the performance of BD and non-BD subjects on the Mini-Mental State Examination (MMSE), verbal fluency test (VFT), and the Clock Drawing Test (CDT). RESULTS Non-demented patients with BD had a slightly worse global cognitive performance as compared with healthy controls and patients with CIND, as shown by lower scores on the MMSE. Similarly, BD patients performed worse on the VFT, both in the normal cognition range and in the dementia range. Finally, demented BD patients had a significantly worse performance on the CDT as compared with patients with dementia due to AD. CONCLUSION Older adults with BD perform significantly worse on some cognitive screening tests as compared with those without BD across different levels of cognition.
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Affiliation(s)
- Ivan Aprahamian
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Brazil
| | - Rodolfo B Ladeira
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Brazil
| | - Breno S Diniz
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Brazil.
| | - Paula V Nunes
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Brazil
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
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Barch DM, Bustillo J, Gaebel W, Gur R, Heckers S, Malaspina D, Owen MJ, Schultz S, Tandon R, Tsuang M, Van Os J, Carpenter W. Logic and justification for dimensional assessment of symptoms and related clinical phenomena in psychosis: relevance to DSM-5. Schizophr Res 2013; 150:15-20. [PMID: 23706415 DOI: 10.1016/j.schres.2013.04.027] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 12/31/2022]
Abstract
Work on the causes and treatment of schizophrenia and other psychotic disorders has long recognized the heterogeneity of the symptoms that can be displayed by individuals with these illnesses. Further, researchers have increasingly emphasized the ways in which the severity of different symptoms of this illness can vary across individuals, and have provided evidence that the severity of such symptoms can predict other important aspects of the illness, such as the degree of cognitive and/or neurobiological deficits. Additionally, research has increasingly emphasized that the boundaries between nosological entities may not be categorical and that the comorbidity of disorders may reflect impairments in common dimensions of genetic variation, human behavior and neurobiological function. As such, it is critical to focus on a dimensional approach to the assessment of symptoms and clinically relevant phenomena in psychosis, so as to increase attention to and understanding of the causes and consequences of such variation. In the current article, we review the logic and justification for including dimensional assessment of clinical symptoms in the evaluation of psychosis in the Fifth Edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5).
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Affiliation(s)
- Deanna M Barch
- Department of Psychology, Washington University, St. Louis, MO, USA; Department of Psychiatry, Washington University, St. Louis, MO, USA; Department of Radiology, Washington University, St. Louis, MO, USA.
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Tandon R, Gaebel W, Barch DM, Bustillo J, Gur RE, Heckers S, Malaspina D, Owen MJ, Schultz S, Tsuang M, Van Os J, Carpenter W. Definition and description of schizophrenia in the DSM-5. Schizophr Res 2013; 150:3-10. [PMID: 23800613 DOI: 10.1016/j.schres.2013.05.028] [Citation(s) in RCA: 368] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/24/2013] [Accepted: 05/24/2013] [Indexed: 12/21/2022]
Abstract
Although dementia praecox or schizophrenia has been considered a unique disease for over a century, its definitions and boundaries have changed over this period and its etiology and pathophysiology remain elusive. Despite changing definitions, DSM-IV schizophrenia is reliably diagnosed, has fair validity and conveys useful clinical information. Therefore, the essence of the broad DSM-IV definition of schizophrenia is retained in DSM-5. The clinical manifestations are extremely diverse, however, with this heterogeneity being poorly explained by the DSM-IV clinical subtypes and course specifiers. Additionally, the boundaries of schizophrenia are imprecisely demarcated from schizoaffective disorder and other diagnostic categories and its special emphasis on Schneiderian "first-rank" symptoms appears misplaced. Changes in the definition of schizophrenia in DSM-5 seek to address these shortcomings and incorporate the new information about the nature of the disorder accumulated over the past two decades. Specific changes in its definition include elimination of the classic subtypes, addition of unique psychopathological dimensions, clarification of cross-sectional and longitudinal course specifiers, elimination of special treatment of Schneiderian 'first-rank symptoms', better delineation of schizophrenia from schizoaffective disorder, and clarification of the relationship of schizophrenia to catatonia. These changes should improve diagnosis and characterization of individuals with schizophrenia and facilitate measurement-based treatment and concurrently provide a more useful platform for research that will elucidate its nature and permit a more precise future delineation of the 'schizophrenias'.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, University of Florida Medical School, Gainesville, FL, USA.
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Lewandowski KE, Cohen BM, Keshavan MS, Sperry SH, Ongür D. Neuropsychological functioning predicts community outcomes in affective and non-affective psychoses: a 6-month follow-up. Schizophr Res 2013; 148:34-7. [PMID: 23791391 PMCID: PMC3751391 DOI: 10.1016/j.schres.2013.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Neurocognitive dysfunction is a major symptom feature of schizophrenia and bipolar disorder. A prognostic relationship between cognition and community outcomes is well-documented in schizophrenia and increasingly recognized in bipolar disorder. However, specific associations among neurocognition, diagnosis, state symptomatology, and community functioning are unclear, and few studies have compared these relationships among patients with affective and non-affective psychoses in the same study. We examined neurocognitive, clinical, and community functioning in a cross-diagnostic sample of patients with psychotic disorders over a 6-month follow-up interval. METHOD Neurocognitive, clinical and community functioning were assessed in participants with schizophrenia (n=13), schizoaffective disorder (n=17), or bipolar disorder with psychosis (n=18), and healthy controls (n=18) at baseline and 6months later. RESULTS Neurocognitive functioning was impaired in all diagnostic groups and, despite reductions in primary symptoms, did not recover on most measures over the follow-up period. Neurocognitive impairment was not associated with diagnosis or clinical improvement. Several neurocognitive scores at baseline (but not diagnosis or clinical baseline or follow-up scores) predicted community functioning at follow-up. DISCUSSION In one of the few studies to longitudinally examine neurocognition in association with clinical and outcomes variables in a cross diagnostic sample of psychotic disorders patients, neurocognitive deficits were pronounced across diagnoses and did not recover on most measures despite significant reductions in clinical symptoms. Baseline neurocognitive functioning was the only significant predictor of patients' community functioning six months later. Efforts to recognize and address cognitive deficits, an approach that has shown promise in schizophrenia, should be extended to all patients with psychosis.
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Affiliation(s)
- Kathryn E Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St., Belmont, MA 02478 USA.
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Schoeyen HK, Melle I, Sundet K, Aminoff SR, Hellvin T, Auestad BH, Morken G, Andreassen OA. Occupational outcome in bipolar disorder is not predicted by premorbid functioning and intelligence. Bipolar Disord 2013; 15:294-305. [PMID: 23527993 DOI: 10.1111/bdi.12056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 01/23/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Bipolar disorder (BD), over the long term, can manifest a variety of outcomes depending on a number of different conditions. There is a need for further knowledge regarding preventive factors as well as predictors of the disabling course of the disorder. Studies regarding the impact on functional outcome of premorbid and current general intellectual function [intelligence quotient (IQ)] and premorbid functioning in BD patients are sparse. The present study addressed the role of premorbid functioning [assessed with the Premorbid Adjustment Scale (PAS)], intelligence, course of illness, and sociodemographics on occupational outcome in BD. METHODS Bipolar disorder patients were recruited consecutively from psychiatric units (outpatient and inpatient) in four major hospitals in Oslo, Norway [(N = 226: 64.4% bipolar I disorder (BD-I); 30.1% bipolar II disorder (BD-II); 5.5% bipolar disorder not otherwise specified (BD-NOS); 38.6% males]. The associations between current IQ, premorbid IQ [assessed using the National Adult Reading Test (NART)], PAS, clinical and sociodemographic characteristics, and receipt of disability benefit were analysed using descriptive statistics and logistic regression analyses. RESULTS The number of hospitalizations for depressive episodes and illness duration was associated with a higher risk of receipt of disability benefit. PAS, premorbid and current IQ, as well as decline in IQ, did not explain the higher risk of receipt of disability benefits. CONCLUSIONS Severe clinical course of BD was associated with receipt of disability benefit. Occupational outcome was unrelated to PAS, premorbid and current IQ, as well as decline in IQ. This suggests that the persistence of severe clinical symptoms, rather than global cognitive functioning, determines occupational outcome in BD and emphasizes the protective potential of early and continuous clinical treatment.
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Affiliation(s)
- Helle K Schoeyen
- Moodnet Research Group, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
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Grande I, Goikolea JM, de Dios C, González-Pinto A, Montes JM, Saiz-Ruiz J, Prieto E, Vieta E. Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data). Acta Psychiatr Scand 2013; 127:403-11. [PMID: 22924855 DOI: 10.1111/acps.12003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patients diagnosed with bipolar disorder (BD) are reported to have significant work impairment during interepisode intervals. This study was carried out to assess potential predictors of occupational disability in a longitudinal follow-up of euthymic patients. METHOD We included 327 euthymic patients diagnosed with BD type I or type II, 226 of whom were employed and 101 were receiving a severe disablement benefit (SDB). Sociodemographic data were studied and episode recurrence was assessed along a 1-year follow-up. Logistic regression analysis was applied to determine predictors of receiving SDB. Cox regression was built to study recurrences. RESULTS Predictors of receiving SDB were: axis II comorbidity [Odds Ratio (OR) = 2.94, CI: 1.26-6.86, P = 0.013], number of manic episodes (OR = 1.21, CI: 1.10-1.34, P < 0.001), being without stable partner (OR = 2.44, CI: 1.34-4.44, P = 0.004) and older age (OR = 1.08, CI: 1.05-1.12, P < 0.001). Bipolar patients receiving SDB presented more episodic recurrences regardless of polarity than employed bipolar patients (P = 0.002). The time until recurrence in 25% of the bipolar patients receiving SDB was 6.08 months (CI: 4.44-11.77) being 13.08 months (CI: 9.60 to -) in the employed group. CONCLUSION Occupational disability in bipolar patients is associated with axis II comorbidity, more previous manic episodes, not having a stable relationship, older age, and more recurrences at 1-year follow-up.
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Affiliation(s)
- I Grande
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Neurocognitive profiles in treatment-resistant bipolar I and bipolar II disorder depression. BMC Psychiatry 2013; 13:105. [PMID: 23557429 PMCID: PMC3637095 DOI: 10.1186/1471-244x-13-105] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/01/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The literature on the neuropsychological profiles in Bipolar disorder (BD) depression is sparse. The aims of the study were to assess the neurocognitive profiles in treatment-resistant, acutely admitted BD depression inpatients, to compare the neurocognitive functioning in patients with BD I and II, and to identify the demographic and clinical illness characteristics associated with cognitive functioning. METHODS Acutely admitted BD I (n = 19) and BD II (n = 32) inpatients who fulfilled the DSM-IV-TR criteria for a major depressive episode were tested with the MATRICS Consensus Cognitive Battery (MCCB), the Wechsler Abbreviated Scale of Intelligence, the National Adult Reading Test, and a battery of clinical measures. RESULTS Neurocognitive impairments were evident in the BD I and BD II depression inpatients within all MCCB domains. The numerical scores on all MCCB-measures were lower in the BD I group than in the BD II group, with a significant difference on one of the measures, category fluency. 68.4% of the BD I patients had clinically significant impairment (>1.5 SD below normal mean) in two or more domains compared to 37.5% of the BD II patients (p = 0.045). A significant reduction in IQ from the premorbid to the current level was seen in BD I but not BD II patients. Higher age was associated with greater neurocognitive deficits compared to age-adjusted published norms. CONCLUSIONS A high proportion of patients with therapy-resistant BD I or II depression exhibited global neurocognitive impairments with clinically significant severity. The cognitive impairments were more common in BD I compared to BD II patients, particularly processing speed. These findings suggest that clinicians should be aware of the severe neurocognitive dysfunction in treatment-resistant bipolar depression, particularly in BD I. TRIAL REGISTRATION NCT00664976.
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Gildengers AG, Chisholm D, Butters MA, Anderson SJ, Begley A, Holm M, Rogers JC, Reynolds CF, Mulsant BH. Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression? Psychol Med 2013; 43:801-11. [PMID: 22846332 PMCID: PMC3593938 DOI: 10.1017/s0033291712001614] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND While bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD. Method We recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects ('controls') were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs. RESULTS The BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years. CONCLUSIONS Over 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.
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Affiliation(s)
- A. G. Gildengers
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - D. Chisholm
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - M. A. Butters
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - S. J. Anderson
- University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, USA
| | - A. Begley
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - M. Holm
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - J. C. Rogers
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - C. F. Reynolds
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - B. H. Mulsant
- Centre for Addiction and Mental Health and the University of Toronto, Department of Psychiatry, Toronto, ON, Canada
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Michalak EE, Torres IJ, Bond DJ, Lam RW, Yatham LN. The relationship between clinical outcomes and quality of life in first-episode mania: a longitudinal analysis. Bipolar Disord 2013; 15:188-98. [PMID: 23437962 DOI: 10.1111/bdi.12049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Despite growing attention to the relationship between bipolar disorder (BD) and quality of life (QoL), there remains a lack of information about QoL in the early stages of BD, and about the course of QoL in people with BD over time. Here, we report on QoL and symptomatic outcomes over a 1.5-year period in a Canadian sample of first-episode mania patients. METHODS Patients (n = 63) with DSM-IV-TR BD type I recovering from a recent episode of mania were recruited from a university-based hospital setting in Vancouver, BC, Canada and assessed at six monthly intervals for 18 months. In addition to symptomatic and cognitive assessments, two self-report QoL scales [the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Medical Outcomes Study Short Form 36 (SF-36)] were administered. RESULTS Baseline QoL scores were high, with mean Q-LES-Q scores at 70% of the maximum possible score; QoL continued to show a trend towards improvement over time. Multiple hierarchical regressions were used to explore predictors of QoL over time, finding that: (i) length of illness and severity of depressive symptoms at baseline predicted Q-LES-Q scores at both baseline and six months; (ii) the number of previous depressive episodes and severity of depression at baseline and 12 months all predicted QoL at 12 months; and (iii) only severity of depressive symptoms at 12 months predicted QoL at 18 months. CONCLUSIONS Our observation that QoL in patients who have recently experienced an episode of mania can be relatively preserved offers hope, both for healthcare providers and for those newly diagnosed. Further, that severity of depressive symptoms even in the early stages of the disease was the consistent predictor of QoL suggests that depressive symptoms need to be aggressively treated to improve QoL.
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Affiliation(s)
- Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Rajji TK, Voineskos AN, Butters MA, Miranda D, Arenovich T, Menon M, Ismail Z, Kern RS, Mulsant BH. Cognitive performance of individuals with schizophrenia across seven decades: a study using the MATRICS consensus cognitive battery. Am J Geriatr Psychiatry 2013; 21:108-18. [PMID: 23343484 PMCID: PMC3548068 DOI: 10.1016/j.jagp.2012.10.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/15/2012] [Accepted: 06/27/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The objectives of this study were to determine the effect of aging, schizophrenia, and their interaction on cognitive function. DESIGN Cross-sectional controlled study. SETTING Community living. PARTICIPANTS A total of 235 subjects with schizophrenia age 19-79 and 333 comparison subjects age 20-81. MEASUREMENTS The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). RESULTS Older age was associated with poorer performance on 9 of 10 MCCB tests in both subjects with schizophrenia and comparison subjects. Subjects with schizophrenia were impaired relative to comparison subjects on each of the 10 tests. However, there was no interaction between aging and schizophrenia on any test. Essentially the same results were observed when analyzing performance on the seven MCCB cognitive domains and MCCB global composite score. CONCLUSIONS Consistent with other reports, schizophrenia appears to be a disorder marked by generalized cognitive dysfunction. However, the rate of cognitive decline appears to be similar to that observed in healthy comparison subjects. They do not experience acceleration in cognitive aging, which supports the hypothesis that schizophrenia is a syndrome of premature aging. Longitudinal studies including very old patients are needed to confirm and extend these findings.
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Affiliation(s)
- Tarek K. Rajji
- Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Canada
| | - Aristotle N. Voineskos
- Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Canada
| | | | | | - Tamara Arenovich
- Biostatistical Consulting Service, Centre for Addiction and Mental Health, Canada
| | - Mahesh Menon
- Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Canada
| | - Zahinoor Ismail
- Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Canada,Department of Psychiatry, University of Calgary, Canada
| | - Robert S. Kern
- Department of Psychiatry, University of California, Los Angeles; Department of Veterans Affairs VISN 22 MIRECC
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Canada,Department of Psychiatry, University of Pittsburgh, USA,Corresponding author: Geriatric Mental Health Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario, Canada M6J 1H4. Phone: +1 416 535 8501 x 4749. Fax: +1 416 583 1307.
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Lin CH, Tseng YL, Huang CL, Chang YC, Tsai GE, Lane HY. Synergistic effects of COMT and TPH2 on social cognition. Psychiatry 2013; 76:273-94. [PMID: 23965265 DOI: 10.1521/psyc.2013.76.3.273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Whether genetic factors affect social cognition, particularly emotion management, requires elucidation. This study investigates whether social cognition varies with genetic variations of COMT and tryptophan hydroxylase-2 (TPH2), which modulate dopamine and serotonin neurotransmissions respectively, and thereby emotion regulation. NIMH-recommended "managing emotions branch and 2 subtasks" of MSCEIT and six neurocognition domains, and genotypes of COMT Val158Met and TPH2 G703T were measured in 150 Han-Chinese healthy adults. Subjects carrying the M allele (M group) of COMT exceeded Val/Val homozygotes (V group) in managing emotions branch (p = 0.032) and emotional relation subtask (p = 0.037). TPH2 T/T homozygotes (T group) excelled those with the G allele (G group) in emotional management subtask (p = 0.025). Subjects with M+T variation surpassed the other 3 groups (M+G, V+T and V+G) in managing emotion branch (p = 0.002), emotional relation subtask (p = 0.023), and emotional management subtask (p = 0.002). The findings remained after control for gender, age, education, and neurocognitive functions. Synergistically, the effect size of COMT-TPH2 combination surmounted the sum of separate effect sizes of COMT and TPH2. The findings suggest that genetic variations of COMT and TPH2 have synergistic effects on social cognition in the general population.
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Affiliation(s)
- Chieh-Hsin Lin
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Kuswanto CN, Sum MY, Sim K. Neurocognitive Functioning in Schizophrenia and Bipolar Disorder: Clarifying Concepts of Diagnostic Dichotomy vs. Continuum. Front Psychiatry 2013; 4:162. [PMID: 24367337 PMCID: PMC3852029 DOI: 10.3389/fpsyt.2013.00162] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/21/2013] [Indexed: 11/13/2022] Open
Abstract
The Kraepelinian dichotomy posits that patients with schizophrenia (SCZ) and bipolar disorder (BD) present as two separate psychotic entities such that they differ in terms of clinical severity including neurocognitive functioning. Our study aimed to specifically compare and contrast the level of neurocognitive functioning between SCZ and BD patients and identify predictors of their poor neurocognitive functioning. We hypothesized that patients with SCZ had a similar level of neurocognitive impairment compared with BD. About 49 healthy controls (HC), 72 SCZ, and 42 BD patients who were matched for age, gender, and premorbid IQ were administered the Brief Assessment of Cognition battery (BAC). Severity of psychopathology and socio-occupational functioning were assessed for both patients groups. Both BD and SCZ groups demonstrated similar patterns of neurocognitive deficits across several domains (verbal memory, working memory, semantic fluency, processing speed) compared with HC subjects. However, no significant difference was found in neurocognitive functioning between BD and SCZ patients, suggesting that both patient groups suffer the same degree of neurocognitive impairment. Patients with lower level of psychosocial functioning [F (1,112) = 2.661, p = 0.009] and older age [F (1,112) = -2.625, p = 0.010], not diagnosis or doses of psychotropic medications, predicted poorer overall neurocognitive functioning as measured by the lower BAC composite score. Our findings of comparable neurocognitive impairments between SCZ and BD affirm our hypothesis and support less the Kraepelinian concept of dichotomy but more of a continuum of psychotic spectrum conditions. This should urge clinicians to investigate further the underlying neural basis of these neurocognitive deficits, and be attentive to the associated socio-demographic and clinical profile in order to recognize and optimize early the management of the widespread neurocognitive deficits in patients with SCZ and BD.
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Affiliation(s)
- Carissa N Kuswanto
- Research Division, Institute of Mental Health/Woodbridge Hospital , Singapore
| | - Min Y Sum
- Research Division, Institute of Mental Health/Woodbridge Hospital , Singapore
| | - Kang Sim
- Research Division, Institute of Mental Health/Woodbridge Hospital , Singapore ; Department of General Psychiatry, Institute of Mental Health/Woodbridge Hospital , Singapore
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Abstract
PURPOSE OF REVIEW This work aims to review the most recent publications on cognitive impairment and dementia associated with bipolar disorder (BPD), especially in the elderly. RECENT FINDINGS In the last years, a growing number of studies aiming at better understanding of cognitive impairment in BPD were found. Impairments found in BPD were compared with other psychiatric disorders and primary cognitive diseases. The impact of cognitive impairment on functionality was also recently highlighted. With respect to neurobiology, studies that explored inflammatory, neurotrophic and pathological cascades possibly associated with BPD and cognition were published. Finally, the first study covering treatment of cognitive impairment was carried out with pramipexole, and it raised important methodological issues for future research in BPD. SUMMARY Cognitive impairment and dementia in BPD should be better explored with cognitive and functionality protocols along with biological and neuroimaging markers.
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Meesters PD, Schouws S, Stek M, de Haan L, Smit J, Eikelenboom P, Beekman A, Comijs H. Cognitive impairment in late life schizophrenia and bipolar I disorder. Int J Geriatr Psychiatry 2013; 28:82-90. [PMID: 22407730 DOI: 10.1002/gps.3793] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 01/30/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Evidence in younger populations suggests quantitative but not categorical differences in cognitive impairments between schizophrenia and bipolar disorder. It is uncertain whether a similar distinction applies to patients in later life. METHODS We compared the cognitive abilities of older, community-living schizophrenia patients, controlling for their state of symptomatic remission, with those of older euthymic patients with bipolar I disorder. The study included 67 patients with schizophrenia (20 in symptomatic remission, 47 not in symptomatic remission; mean age 68 years) and 74 euthymic bipolar I patients (mean age 70 years), who were compared using analysis of covariance on clinical and neuropsychological variables (e.g., attention/working memory, verbal memory, executive function and verbal fluency) and contrasted with 69 healthy controls. RESULTS Remitted (SR) and non-remitted (SN) schizophrenia patients and bipolar I (BP) patients were impaired relative to healthy controls, with mostly large effect sizes for verbal memory (Cohen's d: SR 1.34, SN 1.48, BP 1.09), executive function (Cohen's d: SR 0.87, SN 1.29, BP 0.71) and verbal fluency (Cohen's d: SR 1.09, SN 1.25, BP 0.88), but smaller effect sizes for the domain of attention/working memory (Cohen's d: SR 0.26, SN 0.18, BP 0.52). Differences in cognitive performance between the remitted schizophrenia patients and the bipolar I patients were not significant. CONCLUSIONS In both older patients with schizophrenia and with bipolar disorder, serious and pervasive cognitive deficits can be demonstrated. Trait-related cognitive deficits in schizophrenia and bipolar disorder may share major phenotypic similarity in later life.
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Affiliation(s)
- Paul D Meesters
- GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands.
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Nio S, Suzuki T, Uchida H, Watanabe K, Mimura M. Deficit status in bipolar disorder: investigation on prevalence rate and description of seven cases. J Affect Disord 2012; 143:248-52. [PMID: 22840466 DOI: 10.1016/j.jad.2012.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE While the Kraepelinian dichotomy explicitly distinguishes between schizophrenia and bipolar disorder, it remains unclear as to whether a deficit form of bipolar disorder exists. METHOD We conducted a study to investigate the prevalence rate of the deficit form of bipolar disorder; the criteria of which were basically adopted by the original proposal for schizophrenia that described the predominance of negative symptoms for over a year. Moreover, we presented a series of cases with "deficit" bipolar disorder to characterize its clinical pictures in detail. RESULTS Consecutive outpatients who visited one psychiatric hospital in Tokyo, Japan in March 2007 were evaluated cross-sectionally. Additionally, medical charts of inpatients who were hospitalized in the same hospital between April 2006 and March 2007 were also thoroughly reviewed. Of 494 patients, 7 patients (1.4%; 10.9% of 64 bipolar cases) fulfilled the criteria for bipolar disorder with deficit syndrome. Seven "deficit" cases had a mean±SD age of 61±5 year-old with the age at onset being 25±8 year-old. In addition to pervasive negative symptoms, they exhibited evidence of cognitive impairments close to the magnitude of what is usually noted in schizophrenia (i.e. a mean±SD total IQ score of 80±9 in the Wechsler Adult Intelligence Scale and 0.4±0.5 in the Wisconsin Card Sorting Test, categories achieved). CONCLUSION Although preliminary, the evidence on deficit status in patients with bipolar disorder that we found in this study appears more consistent with recent evidence and challenges the Kraepelinian dichotomy that reserves deficit status solely to schizophrenia patients.
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Affiliation(s)
- Shintaro Nio
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Depp CA, Mausbach BT, Harmell AL, Savla GN, Bowie CR, Harvey PD, Patterson TL. Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disord 2012; 14:217-26. [PMID: 22548895 PMCID: PMC3396289 DOI: 10.1111/j.1399-5618.2012.01011.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Neurocognitive deficits are common in bipolar disorder and contribute to functional disability. However, the degree to which general and specific cognitive deficits affect everyday functioning in bipolar disorder is unknown. The goal of this meta-analysis was to examine the magnitude of the effect of specific neurocognitive abilities on everyday functioning in bipolar disorder. METHODS We conducted a comprehensive meta-analysis of studies that reported associations between performance on objective neuropsychological tasks and everyday functioning among individuals with bipolar disorder. From an initial pool of 486 papers, 22 studies met inclusion criteria, comprising a total of 1344 participants. Correlation coefficients were calculated for 11 cognitive domains and four measurement modalities for functioning. We also examined effect moderators, such as sample age, clinical state, and study design. RESULTS The mean Pearson correlation between neurocognitive ability and functioning was 0.27, and was significant for all cognitive domains and varied little by cognitive domain. Correlations varied by methods of everyday functioning assessment, being lower for clinician and self-report than performance-based tasks and real-world milestones such as employment. None of the moderator analyses were significant. CONCLUSIONS Overall, the strength of association between cognitive ability and everyday functioning in bipolar disorder is strikingly similar to that seen in schizophrenia, with little evidence for differences across cognitive domains. The strength of association differed to a greater extent according to functional measurement approach.
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Affiliation(s)
- Colin A. Depp
- Department of Psychiatry, University of California, San Diego
| | | | | | - Gauri N. Savla
- Department of Psychiatry, University of California, San Diego
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
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