Neuropsychological performance and affective temperaments in Euthymic patients with bipolar disorder type II

Processing speed and sustained attention in bipolar disorder and major depressive disorder: A systematic review and meta-analysis

OBJECTIVES

Cognitive impairment is a core feature of bipolar disorder (BD) and major depressive disorder (MDD). Deficits in processing speed (PS) and sustained attention (SA) may be particularly impaired and may underpin a broader profile of deficits, however current knowledge of the nature of these impairments is limited by heterogeneous results in the literature. Few reviews to date have attempted to disentangle sources of heterogeneity to assess the presence and magnitude of impairments in PS and SA in BD and MDD.

METHODS

One hundred and three studies were reviewed to examine performance in tests of PS and SA in BD (n = 3452) and MDD (n = 5461) compared to healthy controls (n = 8016). Neuropsychological methodology used in the literature was summarised. Data were meta-analysed to assess impairments in PS and SA for each neuropsychological test separately. Subgroup analysis was performed across mood states to investigate sources of heterogeneity.

RESULTS

Impairments were found across most neuropsychological tests, with small to large effect sizes for BD (range: d = 0.19-0.96) and MDD (range: d = 0.29-0.86). Impairments were present in symptomatic states and euthymia in most cases. Some outcome measures were not impaired in euthymia. Heterogeneity was observed for most neuropsychological tests and remained after separating by mood state. There inadequate data to meta-analyse some outcome measures, particularly for symptomatic groups.

CONCLUSION

Impairments in PS and SA in BD and MDD can be observed across most neuropsychological tests. Future research should further investigate the nature of these impairments across mood states, controlling for clinical confounds.

Impact of cognitive reserve on bipolar disorder: a systematic review

Background

Cognitive reserve (CR) is a complex concept that includes premorbid IQ, years of education, and exposure to neuropsychological stimuli through work and leisure. Previous studies have suggested that CR has a positive impact on several aspects of bipolar disorder. Synthesizing the evidence to date is an important work in providing directions for future studies. The objectives of this systematic review to summary impact of CR on onsetting, relapsing bipolar episodes, buffering cognitive dysfunctions, and maintaining quality of life (QOL) in bipolar disorder.

Methods

Two researchers independently reviewed selected paper from three database as PubMed, PsychINFO, and Web of Science. The search keywords were "bipolar disorder" and "cognitive reserve." The selected studies were classified as the levels of evidence according to the criteria of the Oxford Center for Evidence- Based Medicine. The results of the selected studies were summarized according to the objectives.

Results

Thrity six studies were included in this review. People with high CR may have fewer bipolar episodes and alleviate cognitive impairments and dysfunction. CR may keep the functional level in patients with bipolar disorder.

Conclusion

The results of this systematic review suggest that CR may be involved in preventing relapse of bipolar episodes and may alleviate cognitive dysfunction. However, effect on prevention of onset-risk and relapse of bipolar episodes need further investigation in prospective studies.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021270293, the protocol was registered with PROSERO (CRD42021270293).

Affective Temperament Traits Measured by TEMPS-A and Their Associations with Cognitive Functions among Offspring of Parents with Bipolar Disorder with and without Subthreshold Symptoms

BACKGROUND

To our knowledge, there have been no studies that have examined affective temperament traits in offspring of parents with bipolar disorder (BD). The aim of this study was to identify affective temperamental characteristics and their relationships with cognitive functions in BD offspring.

METHODS

A group of BD offspring were enrolled in this study. Subthreshold symptoms were used to categorize participants as either symptomatic offspring (SO) (n=60) or asymptomatic offspring (AO) (n=52). Healthy controls (HCs; n=48) were also enrolled for comparison. We used the Chinese Short Version of Temperament Evaluation of Memphis, Pisa, Paris, and San Diego, Auto-questionnaire (TEMPS-A) to measure temperament traits, and MATRICS Consensus Cognitive Battery (MCCB) to measure cognitive functions.

RESULTS

We observed higher cyclothymic, irritable, depressive and anxious temperament scores in SO than AO when compared to HCs. In BD offspring (SO and AO), cyclothymic individuals performed better in processing speed and verbal learning than depressive individuals and better in attention/vigilance than irritable and anxious individuals; hyperthymic individuals performed better in processing speed than depressive individuals. We also observed that a higher cyclothymic score was associated with better verbal learning and verbal fluency, a higher hyperthymic score was associated with better processing speed and verbal learning; while a higher depressive score was associated with worse processing speed, verbal learning and verbal fluency and a higher irritable score was associated with worse attention/vigilance.

CONCLUSIONS

The relationships between cognitive functions and measures of temperament suggest that these features may share neurobiological substrates and appear to be heritable.

Clinical Features, Neuropsychology and Neuroimaging in Bipolar and Borderline Personality Disorder: A Systematic Review of Cross-Diagnostic Studies

Background: Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) have clinically been evolving as separate disorders, though there is still debate on the nosological valence of both conditions, their interaction in terms of co-morbidity or disorder spectrum and their distinct pathophysiology. Objective: The objective of this review is to summarize evidence regarding clinical features, neuropsychological performance and neuroimaging findings from cross-diagnostic studies comparing BD and BPD, to further caracterize their complex interplay. Methods: Using PubMed, PsycINFO and TripDataBase, we conducted a systematic literature search based on PRISMA guidelines of studies published from January 1980 to September 2019 which directly compared BD and BPD. Results: A total of 28 studies comparing BD and BPD were included: 19 compared clinical features, 6 neuropsychological performance and three neuroimaging abnormalities. Depressive symptoms have an earlier onset in BPD than BD. BD patients present more mixed or manic symptoms, with BD-I differing from BPD in manic phases. BPD patients show more negative attitudes toward others and self, more conflictive interpersonal relationships, and more maladaptive regulation strategies in affective instability with separate pathways. Impulsivity seems more a trait in BPD rather than a state as in BD. Otherwise, BD and BPD overlap in depressive and anxious symptoms, dysphoria, various abnormal temperamental traits, suicidal ideation, and childhood trauma. Both disorders differ and share deficits in neuropsychological and neuroimaging findings. Conclusion: Clinical data provide evidence of overlapping features in both disorders, with most of those shared symptoms being more persistent and intense in BPD. Thus, categorical classifications should be compared to dimensional approaches in transdiagnostic studies investigating BPD features in BD regarding their respective explanatory power for individual trajectories. Systematic Review Registration: The search strategy was pre-registered in PROSPERO: CRD42018100268.

Associations among childhood parenting, affective temperaments, depressive symptoms, and cognitive complaints in adult community volunteers

BACKGROUND

Correlations between depressive symptoms and affective temperaments or quality of childhood parenting have been investigated previously; however, how childhood parenting and affective temperaments affect cognitive complaints remains unknown. Thus, we evaluated correlations among childhood parenting, affective temperaments, depressive symptoms, and cognitive complaints in adults.

METHODS

Participants (N = 490) completed the Parental Bonding Instrument (PBI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire version (TEMPS-A), the Patient Health Questionnaire-9 (PHQ-9), and the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA). Multiple regression analyses and structural equation modeling were performed to evaluate scale correlations.

RESULTS

As per structural equation modeling, the direct effect of PHQ-9 and four subscales (cyclothymic, depressive, irritable, and anxious temperament) of TEMPS-A on COBRA were significant; the indirect effect of the four subscales of TEMPS-A on COBRA via PHQ-9 was significant; the direct effect of the three subscales (paternal care, maternal care, and maternal overprotection) of PBI on PHQ-9 and four subscales of TEMPS-A were significant; the indirect effect of the three subscales of PBI on PHQ-9 via the four subscales of TEMPS-A was significant.

LIMITATIONS

Cross-sectional designs cannot identify causal relationships between parameters. As participants were adult volunteers from the community, results may not be generalizable to individuals with psychiatric disorders.

CONCLUSIONS

Childhood parenting affects cognitive complaints indirectly via affective temperaments and depressive symptoms in adult community volunteers. An important role of affective temperaments and depressive symptoms in the effects of childhood parenting on cognitive complaints is suggested.

Executive functions and memory in bipolar disorders I and II: new insights from meta-analytic results

OBJECTIVE

To perform a systematic review and meta-analysis of executive functions (EF) and episodic memory in bipolar disorder (BD).

METHODS

A literature search was conducted on three electronic databases. Results were combined using random-effects meta-analysis.

RESULTS

A total of 126 studies (6424 patients with BDI, 702 with BDII, and 8276 controls) were included. BDI was associated with moderate to large impairments across all cognitive functions and BDII with small-to-medium impairments. Small significant differences were identified between BDI and BDII on all cognitive functions except inhibition. The Trail Making Test (TMT) (g = 0.74, 95% CI: 0.67-0.80), Hayling Test (g = 0.58, 95% CI: 0.34-0.81), Digit Span Total (g = 0.79, 95% CI: 0.57-1.01), and Category Fluency (g = 0.59, 95% CI: 0.45-0.72) tasks were most sensitive to cognitive impairment in BDI. The TMT (g = 0.65, 95% CI: 0.50-0.80) and Category Fluency (g = 0.56, 95% CI: 0.37-0.75) were also sensitive to cognitive alterations in patients with BDII.

CONCLUSION

BD type I was associated with more severe and widespread impairments than BDII, which showed smaller impairments on all functions except inhibition, where impairments were larger. Education and (hypo)manic symptoms should be further investigated in future studies due to their possible influence on the neuropsychological profile of BD. The instruments identified in this review should be considered for inclusion in cognitive assessment batteries in BD.

Does Subjective Cognitive Function Mediate the Effect of Affective Temperaments on Functional Disability in Japanese Adults?

PURPOSE

Functional disability is affected by subjective cognitive function, depressive symptoms, and affective temperaments in adults. However, the role of subjective cognitive function as a mediator of affective temperaments in functional disability remains unknown. Therefore, we aimed to determine how subjective cognitive function mediates the effect of affective temperaments on functional disability in adults.

MATERIALS AND METHODS

A total of 544 participants completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire version (TEMPS-A), the Patient Health Questionnaire-9 (PHQ-9), the cognitive complaints in bipolar disorder rating assessment (COBRA), and the Sheehan Disability Scale (SDS). The association among these instruments was evaluated by multiple regression and covariance structure analyses.

RESULTS

The structural equation model showed that the COBRA scores could be predicted directly by the four affective temperaments of the TEMPS-A (cyclothymic, depressive, irritable, and anxious) and indirectly by the PHQ-9. Moreover, the SDS score was predicted directly by these four affective temperaments and indirectly by the COBRA and PHQ-9.

CONCLUSION

Subjective cognitive function mediates the effect of affective temperaments on functional disability in Japanese adults. However, the cross-sectional design may limit the identification of causal associations between the parameters. In the present study, the participants were from a specific community population; therefore, the results may not be generalizable to other communities.

An International Society of Bipolar Disorders task force report: Precursors and prodromes of bipolar disorder

OBJECTIVES

To clarify the clinical features preceding the onset of bipolar disorder (BD) has become a public health priority for the prevention of high morbidity and mortality. BD remains frequently under- or misdiagnosed, and under- or mistreated, often for years.

METHODS

We assessed the predictive value of precursors and prodromes of BD. We assessed precursors of first-lifetime manic or hypomanic episodes with/without mixed features in retrospective and prospective studies. The task force evaluated and summarized separately assessments of familial risk, premorbid personality traits, retrospective, and prospective studies.

RESULTS

Cyclothymic features, a family history of BD, retrospectively reported attenuated manic symptoms, prospectively identified subthreshold symptoms of hypomania, recurrence of depression, panic anxiety and psychotic features, have been identified as clinical precursors of BD. The prodromal symptoms like [hypo]mania often appears to be long enough to encourage early identification and timely intervention.

CONCLUSIONS

The predictive value of any risk factor identified remains largely unknown. Prospective controlled studies are urgently needed for prevention and effective treatment.

Visual memory dysfunction as a neurocognitive endophenotype in bipolar disorder patients and their unaffected relatives. Evidence from a 5-year follow-up Valencia study

BACKGROUND

Scarce research has focused on Visual Memory (VM) deficits as a possible neurocognitive endophenotype of bipolar disorder (BD). The main aim of this longitudinal, family study with healthy controls was to explore whether VM dysfunction represents a neurocognitive endophenotype of BD.

METHODS

Assessment of VM by Rey-Osterrieth Complex Figure Test (ROCF) was carried out on a sample of 317 subjects, including 140 patients with BD, 60 unaffected first-degree relatives (BD-Rel), and 117 genetically-unrelated healthy controls (HC), on three occasions over a 5-year period (T1, T2, and T3). BD-Rel group scores were analyzed only at T1 and T2.

RESULTS

Performance of BD patients was significantly worse than the HC group (p < 0.01). Performance of BD-Rel was also significantly different from HC scores at T1 (p < 0.01) and T2 (p = 0.05), and showed an intermediate profile between the BD and HC groups. Only among BD patients, there were significant differences according to sex, with females performing worse than males (p = 0.03). Regarding other variables, education represented significant differences only in average scores of BD-Rel group (p = 0.01).

LIMITATIONS

Important attrition in BD-Rel group over time was detected, which precluded analysis at T3.

CONCLUSIONS

BD patients show significant deficits in VM that remain stable over time, even after controlling sociodemographic and clinical variables. Unaffected relatives also show stable deficits in VM. Accordingly, the deficit in VM could be considered a potential endophenotype of BD, which in turn may be useful as a predictor of the evolution of the disease. Further studies are needed to confirm these findings.

Are affective temperaments determinants of quality of life in euthymic patients with bipolar disorder?

BACKGROUND

Bipolar disorder (BD) is a disabling illness that is associated with low quality of life (QoL). This low QoL goes further than mood episodes, which suggests that stable traits, such as affective temperaments, can cause functional impairment.

OBJECTIVE

Our study analyses the impact of affective temperaments on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of QoL in euthymic BD patients.

METHODS

A multicentre study was conducted in 180 euthymic BD patients and 95 healthy controls. Firstly, statistical analyses were performed to compare QoL and affective temperaments between the two groups. Secondly, Adaptive Lasso Analysis was carried out to identify the potential confounding variables and select the affective temperaments as potential predictors on the PCS and MCS of QoL in BD patients, as well as the control group.

RESULTS

QoL scores in terms of PCS and MCS in BD patients were significantly lower than in healthy individuals. Whereas anxious temperament, anxiety disorder comorbidity, and age were the best predictors of PCS impairment in BD patients, anxious temperament, subclinical depressive symptoms, and age were the best predictors of MCS impairment.

LIMITATIONS

Further longitudinal studies with unaffected high-risk relatives are needed to examine the potential interaction between affective temperament and psychopathology.

CONCLUSIONS

Anxious temperament has an impact on QoL in BD in terms of both the physical component and the mental component. Systematic screening of temperament in BD would give clinicians better knowledge of QoL predictors. Further research should allow more individualized treatment of BD patients based on temperamental factors.

Neurocognitive functioning in individuals with bipolar disorder and their healthy siblings: A preliminary study

BACKGROUND

Cognitive deficits have been consistently reported in individuals with bipolar disorder (BD). The cognitive profile of siblings of individuals with BD is, however, less clearly established possibly due to the heterogeneity of neuropsychological measures used in previous studies. The aim of this exploratory study was to assess the cognitive function of siblings of individuals with BD and compare it with that of their first-degree relatives suffering with BD, and healthy controls (HC) using the Cambridge Neuropsychological Test Automated Battery (CANTAB) - a comprehensive and validated computerized cognitive battery.

METHODS

We recruited 23 HC (33.52±10.29 years, 8 males), 27 individuals with BD (34.26±10.19 years, 9 males, 25 BDI, 1BDII and 1 BD-NOS), and 15 of their biologically related siblings (37.47±13.15 years, 4 males). Siblings had no current or lifetime history of mental disorders. Participants performed the CANTAB and completed questionnaires assessing mood and global functioning. Multivariate analyses compared CANTAB measures across the three participant groups.

RESULTS

Individuals with BD and their siblings were less accurate in a task of sustained attention (Rapid Visual Processing) when compared to HC. Further, individuals with BD displayed pronounced deficits in affective processing (Affective Go/No-Go) compared to HC. There were no cognitive differences between siblings and individuals with BD. After correcting for current depressive symptoms, these results did not reach statistical significance.

CONCLUSIONS

Subthreshold depressive symptoms may be associated with reduced sustained attention in healthy siblings of BD patients. This preliminary result needs to be corroborated by large-scale, longitudinal studies assessing the relationship between cognition and mood in vulnerable individuals.