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Solmi M, Miola A, Capone F, Pallottino S, Højlund M, Firth J, Siskind D, Holt RI, Corbeil O, Cortese S, Dragioti E, Du Rietz E, Nielsen RE, Nordentoft M, Fusar-Poli P, Hartman CA, Høye A, Koyanagi A, Larsson H, Lehto K, Lindgren P, Manchia M, Skonieczna-Żydecka K, Stubbs B, Vancampfort D, Vieta E, Taipale H, Correll CU. Risk factors, prevention and treatment of weight gain associated with the use of antidepressants and antipsychotics: a state-of-the-art clinical review. Expert Opin Drug Saf 2024. [PMID: 39225182 DOI: 10.1080/14740338.2024.2396396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/12/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION People with severe mental illness have poor cardiometabolic health. Commonly used antidepressants and antipsychotics frequently lead to weight gain, which may further contribute to adverse cardiovascular outcomes. AREAS COVERED We searched MEDLINE up to April 2023 for umbrella reviews, (network-)meta-analyses, trials and cohort studies on risk factors, prevention and treatment strategies of weight gain associated with antidepressants/antipsychotics. We developed 10 clinical recommendations. EXPERT OPINION To prevent, manage, and treat antidepressant/antipsychotic-related weight gain, we recommend i) assessing risk factors for obesity before treatment, ii) monitoring metabolic health at baseline and regularly during follow-up, iii) offering lifestyle interventions including regular exercise and healthy diet based on patient preference to optimize motivation, iv) considering first-line psychotherapy for mild-moderate depression and anxiety disorders, v) choosing medications based on medications' and patient's weight gain risk, vi) choosing medications based on acute vs long-term treatment, vii) using effective, tolerated medications, viii) switching to less weight-inducing antipsychotics/antidepressants where possible, ix) using early weight gain as a predictor of further weight gain to inform the timing of intervention/switch options, and x) considering adding metformin or glucagon-like peptide-1 receptor agonists, or topiramate (second-line due to potential adverse cognitive effects) to antipsychotics, or aripiprazole to clozapine or olanzapine.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | | | | | | | - Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Qld, Australia
- Physical and Mental Health Research Stream, Queensland Centre for Mental Health Research, School of Clinical Medicine, Brisbane, Qld, Australia
| | - Richard Ig Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Olivier Corbeil
- Faculty of Pharmacy, Université Laval, Canada
- Quebec Mental Health University Institute, Canada
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Greece
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Denmark
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Catharina A Hartman
- Interdisciplinary Centre Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway
- Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg, Leuven, Belgium
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Chakrabarty T, Frangou S, Torres IJ, Ge R, Yatham LN. Brain age and cognitive functioning in first-episode bipolar disorder. Psychol Med 2023; 53:5127-5135. [PMID: 35875930 PMCID: PMC10476063 DOI: 10.1017/s0033291722002136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is significant heterogeneity in cognitive function in patients with bipolar I disorder (BDI); however, there is a dearth of research into biological mechanisms that might underlie cognitive heterogeneity, especially at disease onset. To this end, this study investigated the association between accelerated or delayed age-related brain structural changes and cognition in early-stage BDI. METHODS First episode patients with BDI (n = 80) underwent cognitive assessment to yield demographically normed composite global and domain-specific scores in verbal memory, non-verbal memory, working memory, processing speed, attention, and executive functioning. Structural magnetic resonance imaging data were also collected from all participants and subjected to machine learning to compute the brain-predicted age difference (brainPAD), calculated by subtracting chronological age from age predicted by neuroimaging data (positive brainPAD values indicating age-related acceleration in brain structural changes and negative values indicating delay). Patients were divided into tertiles based on brainPAD values, and cognitive performance compared amongst tertiles with ANCOVA. RESULTS Patients in the lowest (delayed) tertile of brainPAD values (brainPAD range -17.9 to -6.5 years) had significantly lower global cognitive scores (p = 0.025) compared to patients in the age-congruent tertile (brainPAD range -5.3 to 2.4 yrs), and significantly lower verbal memory scores (p = 0.001) compared to the age-congruent and accelerated (brainPAD range 2.8 to 16.1 yrs) tertiles. CONCLUSION These results provide evidence linking cognitive dysfunction in the early stage of BDI to apparent delay in typical age-related brain changes. Further studies are required to assess how age-related brain changes and cognitive functioning evolve over time.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Sophia Frangou
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
- Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Ivan J. Torres
- British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ruiyang Ge
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
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Solé B, Bonnín CM, Radua J, Montejo L, Hogg B, Jimenez E, Reinares M, Valls E, Varo C, Pacchiarotti I, Valentí M, Garriga M, Torres I, Martínez-Arán A, Vieta E, Torrent C. Long-term outcome predictors after functional remediation in patients with bipolar disorder. Psychol Med 2022; 52:314-322. [PMID: 32539879 DOI: 10.1017/s0033291720001968] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Improving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD. METHODS A total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature. RESULTS The regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model. CONCLUSIONS Results suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.
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Affiliation(s)
- B Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C M Bonnín
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Radua
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - L Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Hogg
- Centre Fórum Research Unit, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Reinares
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Valls
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Varo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Garriga
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Torres
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martínez-Arán
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Torrent
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Farias CDA, de Azevedo Cardoso T, Campos Mondin T, Dias de Mattos Souza L, Silva RAD, Kapczinski F, Jansen K, Magalhães PVS. Early illness progression in mood disorders: A population-based longitudinal study. Psychiatry Res 2021; 306:114225. [PMID: 34627111 DOI: 10.1016/j.psychres.2021.114225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
This study is aimed at assessing changes in functioning among young people from the general population with bipolar disorder and major depressive disorder over a period of five years. Specifically, we hypothesized that significant illness progression would take place during euthymia over time in bipolar disorder. We conducted a longitudinal study with 231 people, assessed at baseline and again at a five-year follow-up. A structured clinical interview was used to diagnose participants with mood disorders. A control group without mood disorders was also included. Functioning was assessed with the Functioning Assessment Short Test, and linear mixed models were used to analyze the effect of psychopathology on change in functioning. Mood disorders were associated with significant functional impairment, but functioning significantly improved in both groups over the 5-year follow-up period. Depressive episodes, however, were associated with worse functioning at follow-up, independently of depression severity. In contrast to our initial hypothesis, we found a worsening of functioning in a five-year period associated only with depressive episodes. This suggests that interventions focused on the prevention of mood episodes early in the course of illness may be particularly promising to reduce adverse functioning outcomes.
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Affiliation(s)
- Clarisse de Azambuja Farias
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, RS, Brazil.
| | - Taiane de Azevedo Cardoso
- Universidade Católica de Pelotas, Graduate Program in Health and Behavior, Pelotas, RS, Brazil; McMaster University, Department of Psychiatry and Behavioral Neurosciences, Hamilton, Ontario, Canada
| | - Thaise Campos Mondin
- Universidade Católica de Pelotas, Graduate Program in Health and Behavior, Pelotas, RS, Brazil
| | | | | | - Flavio Kapczinski
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, RS, Brazil; McMaster University, Department of Psychiatry and Behavioral Neurosciences, Hamilton, Ontario, Canada
| | - Karen Jansen
- Universidade Católica de Pelotas, Graduate Program in Health and Behavior, Pelotas, RS, Brazil
| | - Pedro V S Magalhães
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, RS, Brazil.
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Le V, Kirsch DE, Tretyak V, Weber W, Strakowski SM, Lippard ETC. Recent Perceived Stress, Amygdala Reactivity to Acute Psychosocial Stress, and Alcohol and Cannabis Use in Adolescents and Young Adults With Bipolar Disorder. Front Psychiatry 2021; 12:767309. [PMID: 34867554 PMCID: PMC8634636 DOI: 10.3389/fpsyt.2021.767309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Psychosocial stress negatively affects the clinical course of bipolar disorder. Studies primarily focused on adults with bipolar disorder suggest the impact of stress is progressive, i.e., stress response sensitizes with age. Neural mechanisms underlying stress sensitization are unknown. As stress-related mechanisms contribute to alcohol/substance use disorders, variation in stress response in youth with bipolar disorder may contribute to development of co-occurring alcohol/substance use disorders. This study investigated relations between psychosocial stress, amygdala reactivity, and alcohol and cannabis use in youth with bipolar disorder, compared to typically developing youth. Methods: Forty-two adolescents/young adults [19 with bipolar disorder, 23 typically developing, 71% female, agemean ± SD = 21 ± 2 years] completed the Perceived Stress Scale (PSS), Daily Drinking Questionnaire modified for heaviest drinking week, and a modified Montreal Imaging Stress functional MRI Task. Amygdala activation was measured for both the control and stress conditions. Main effects of group, condition, total PSS, and their interactions on amygdala activation were modeled. Relationships between amygdala response to acute stress with recent alcohol/cannabis use were investigated. Results: Greater perceived stress related to increased right amygdala activation in response to the stress, compared to control, condition in bipolar disorder, but not in typically developing youth (group × condition × PSS interaction, p = 0.02). Greater amygdala reactivity to acute stress correlated with greater quantity and frequency of alcohol use and frequency of cannabis use in bipolar disorder. Conclusion: Recent perceived stress is associated with changes in amygdala activation during acute stress with amygdala reactivity related to alcohol/cannabis use in youth with bipolar disorder.
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Affiliation(s)
- Vanessa Le
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
| | - Dylan E. Kirsch
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States
- Institute for Neuroscience, University of Texas, Austin, TX, United States
| | - Valeria Tretyak
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States
- Department of Psychology, University of Texas, Austin, TX, United States
| | - Wade Weber
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
| | - Stephen M. Strakowski
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States
- Institute for Neuroscience, University of Texas, Austin, TX, United States
- Department of Psychology, University of Texas, Austin, TX, United States
| | - Elizabeth T. C. Lippard
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States
- Institute for Neuroscience, University of Texas, Austin, TX, United States
- Department of Psychology, University of Texas, Austin, TX, United States
- Institute of Early Life Adversity Research, University of Texas, Austin, TX, United States
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Dalkner N, Bengesser SA, Birner A, Fellendorf FT, Fleischmann E, Großschädl K, Lenger M, Maget A, Platzer M, Queissner R, Schönthaler E, Tmava-Berisha A, Reininghaus EZ. Metabolic Syndrome Impairs Executive Function in Bipolar Disorder. Front Neurosci 2021; 15:717824. [PMID: 34456679 PMCID: PMC8385126 DOI: 10.3389/fnins.2021.717824] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Metabolic syndrome (MetS) is more prevalent in individuals with bipolar disorder and has a negative impact on cognition, in particular on executive function, which is already impaired in individuals with bipolar disorder compared to healthy controls. Methods: In a cross-sectional study, we compared 148 euthymic patients with bipolar disorder and 117 healthy controls in cognitive function depending on the diagnosis of MetS. A neuropsychological test battery was used including the Trail Making Test A/B, Stroop Color and Word Interference Test, the d2 Test of Attention Revised, and the California Verbal Learning Test. In addition, MetS variables as well as the defining variables waist circumference, serum triglyceride levels, high-density lipoprotein cholesterol levels, blood pressure, fasting glucose levels, and body mass index were compared between patients and controls. In addition, illness-related variables were associated with MetS in individuals with bipolar disorder. Results: The prevalence of MetS in patients with bipolar disorder was higher than in controls (30.4 vs. 15.4%). Patients with bipolar disorder with MetS had impaired executive function compared to patients without MetS or healthy controls with and without MetS (p = 0.020). No MetS effects or interaction MetS × Group was found in attention/processing speed (p = 0.883) and verbal learning/memory (p = 0.373). Clinical variables (illness duration, suicidality, number of affective episodes, medication, age of onset, and history of psychosis) did not relate to MetS in bipolar disorder (p > 0.05). Conclusion: Bipolar disorder comorbid with MetS bears additional risk for impaired executive function. Executive function includes action planning, inhibition, and impulse control and could play a critical role in keeping long-term goals in mind associated with gaining and maintaining a healthy weight.
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Affiliation(s)
- Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Katja Großschädl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Elena Schönthaler
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Chakrabarty T, Torres IJ, Su WW, Sawatzky R, Keramatian K, Yatham LN. Cognitive subgroups in first episode bipolar I disorder: Relation to clinical and brain volumetric variables. Acta Psychiatr Scand 2021; 143:151-161. [PMID: 33089491 DOI: 10.1111/acps.13245] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Distinct cognitive subgroups are seen in patients with long duration bipolar I disorder (BDI), possibly reflective of underlying pathophysiological differences. It is unknown whether such cognitive heterogeneity is present at illness onset. We applied latent class analysis (LCA) to cognitive test scores in first episode BDI patients. Exploratory analysis elucidated whether impaired subgroups were characterized by 'early neurodevelopmental' (low premorbid IQ and intracranial volume) versus 'later neurodevelopmental' (decline from premorbid to current IQ, changes in relative grey (GM)/white (WM) matter volumes) pathology. METHODS Recently recovered first manic episode BDI patients (n = 91) and healthy controls (HC, n = 63) comprised the study sample. LCA identified subgroups based on processing speed, verbal memory, non-verbal memory, executive functioning, attention and working memory scores. Subgroups were compared amongst each other and HC on premorbid/current IQ, intracranial (ICV), total brain and regional volumes. RESULTS Three cognitive subgroups emerged: (i) globally impaired (GI, n = 31), scoring 0.5-1 SD below demographically corrected norms across domains, (ii) selectively impaired (SI, n = 47), with predominant processing speed deficits and (iii) high performing (HP, n = 13), with above-average cognitive performance. GI patients showed a 'later neurodevelopmental' pattern, with normal ICV, significant decline from premorbid to current IQ, higher total GM and lower total WM (with respect to total brain volume) versus SI and HC (p = 0.003). GI patients had higher left frontal pole GM versus HC (p < 0.05, FWE corrected). CONCLUSIONS A globally impaired patient subgroup is identifiable in first episode BDI, possibly characterized by unique neurodevelopmental pathologic processes proximal to illness onset.
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Affiliation(s)
- Trisha Chakrabarty
- 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 Substance Use Services, Vancouver, BC, Canada
| | - Weizhong W Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Kamyar Keramatian
- 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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Atagun MI, Drukker M, Hall MH, Altun IK, Tatli SZ, Guloksuz S, van Os J, van Amelsvoort T. Meta-analysis of auditory P50 sensory gating in schizophrenia and bipolar disorder. Psychiatry Res Neuroimaging 2020; 300:111078. [PMID: 32361172 DOI: 10.1016/j.pscychresns.2020.111078] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/15/2022]
Abstract
The ability of the brain to reduce the amount of trivial or redundant sensory inputs is called gating function. Dysfunction of sensory gating may lead to cognitive fragmentation and poor real-world functioning. The auditory dual-click paradigm is a pertinent neurophysiological measure of sensory gating function. This meta-analysis aimed to examine the subcomponents of abnormal P50 waveforms in bipolar disorder and schizophrenia to assess P50 sensory gating deficits and examine effects of diagnoses, illness states (first-episode psychosis vs. schizophrenia, remission vs. episodes in bipolar disorder), and treatment status (medication-free vs. medicated). Literature search of PubMed between Jan 1st 1980 and March 31st 2019 identified 2091 records for schizophrenia, 362 for bipolar disorder. 115 studies in schizophrenia (4932 patients), 16 in bipolar disorder (975 patients) and 10 in first-degree relatives (848 subjects) met the inclusion criteria. P50 sensory gating ratio (S2/S1) and S1-S2 difference were significantly altered in schizophrenia, bipolar disorder and their first-degree relatives. First-episode psychosis did not differ from schizophrenia, however episodes altered P50 sensory gating in bipolar disorder. Medications improve P50 sensory gating alterations in schizophrenia significantly and at trend level in bipolar disorder. Future studies should examine longitudinal course of P50 sensory gating in schizophrenia and bipolar disorder.
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Affiliation(s)
- Murat Ilhan Atagun
- Department of Psychiatry, Ankara Yildirim Beyazit University Medical School, Universities Region, Ihsan Dogramaci Boulevard. No: 6, Bilkent, Cankaya, Ankara Turkey.
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - Mei Hua Hall
- Psychosis Neurobiology Laboratory, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA
| | - Ilkay Keles Altun
- Department of Psychiatry, Bursa Higher Education Training and Education Hospital, Bursa, Turkey
| | | | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; King's Health Partners Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, United Kingdom; Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
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9
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Tremain H, Fletcher K, Murray G. Number of episodes in bipolar disorder: The case for more thoughtful conceptualization and measurement. Bipolar Disord 2020; 22:231-244. [PMID: 31730294 DOI: 10.1111/bdi.12872] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Number of mood episodes (NoE) may be an important prognostic indicator in bipolar disorder, with implications for treatment. However, NoE has been conceptualized and measured inconsistently throughout the literature. This review examines the construct of NoE in bipolar disorder, with the aim of enhancing its conceptualization and measurement. METHODS A critical evaluation of literatures on important correlates of NoE, conceptually and phenomenologically overlapping features, and previous studies considering and measuring this construct was undertaken. RESULTS The literature indicates that despite frequent use, NoE has been inconsistently defined and measured. Multiple studies have linked NoE with important clinical factors, including relapse, functioning, cognitive impairment and the effectiveness of both pharmacological and psychosocial interventions, yet conclusions are limited by its inconsistent treatment. Additionally, it seems evident that that NoE may best be treated as a fuzzy construct (rather than precise figure), with yet to be defined overlaps with clinical variables such as age at onset and severity. Attempts to measure this construct have varied in comprehensiveness and structure. CONCLUSIONS The NoE construct may have important implications for individuals with bipolar disorders. However, more consistent and systematic definition and assessment of NoE is required to advance this literature and clarify its role. Recommendations aimed at advancing the conceptualization and the measurement of NoE are provided. Conceptualization may be advanced by considering and exploring relationships between NoE and factors with which it overlaps, while measurement may best be improved with increased consistency and balancing accuracy with feasibility.
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Affiliation(s)
- Hailey Tremain
- Faculty of Health Arts and Design, Centre for Mental Health, Swinburne University, Melbourne, Australia
| | - Kathryn Fletcher
- Faculty of Health Arts and Design, Centre for Mental Health, Swinburne University, Melbourne, Australia
| | - Greg Murray
- Faculty of Health Arts and Design, Centre for Mental Health, Swinburne University, Melbourne, Australia
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10
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Porter RJ, Inder M, Douglas KM, Moor S, Carter JD, Frampton CM, Crowe M. Improvement in cognitive function in young people with bipolar disorder: Results from participants in an 18-month randomised controlled trial of adjunctive psychotherapy. Aust N Z J Psychiatry 2020; 54:272-281. [PMID: 31735057 DOI: 10.1177/0004867419887794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the effects of 18 months of intensive stabilisation with medication management and Interpersonal and Social Rhythm Therapy or Non-specific Supportive Clinical Management on cognitive function in young people with bipolar disorder. Determinants of change in cognitive function over the 18 months of the trial were also examined. METHOD Patients aged 15-36 years with Bipolar I Disorder, Bipolar II Disorder and Bipolar Not Otherwise Specified were recruited. From a battery of cognitive tests, change scores for pre-defined domains of cognitive function were created based on performance at baseline and follow-up. Change was compared between the two therapy groups. Regression analysis was used to determine the impact of a range of clinical variables on change in cognitive performance between baseline and follow-up. RESULTS One hundred participants were randomised to Interpersonal and Social Rhythm Therapy (n = 49) or Non-specific Supportive Clinical Management (n = 51). Seventy-eight patients underwent cognitive testing at baseline and 18 months. Across both groups, there were significant improvements in a Global Cognitive Composite score, Executive Function and Psychomotor Speed domains from baseline to 18 months. Lower scores at baseline on all domains were associated with greater improvement over 18 months. Overall, there was no difference between therapies in change in cognitive function, either in a global composite score or change in domains. CONCLUSION While there was no difference between therapy groups, intensive stabilisation with psychological therapy was associated with improved cognitive function, particularly in those patients with poorer cognitive function at baseline. However, this was not compared with treatment as usual so cannot be attributed necessarily to the therapies.
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Affiliation(s)
- Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Stephanie Moor
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Christopher Ma Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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11
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Szmulewicz A, Valerio MP, Martino DJ. Longitudinal analysis of cognitive performances in recent-onset and late-life Bipolar Disorder: A systematic review and meta-analysis. Bipolar Disord 2020; 22:28-37. [PMID: 31541587 DOI: 10.1111/bdi.12841] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Neurocognitive deficits have been widely reported in euthymic Bipolar Disorder (BD) patients and contribute to functional disability. However, the longitudinal trajectory of these deficits remains a subject of debate. Although most research to this date shows that neurocognitive deficits tend to be stable among middle-age BD patients, it remains plausible that deterioration occurs at either early or late stages of this condition. METHODS We conducted a comprehensive meta-analysis of studies that reported longitudinal neurocognitive performance among individuals with BD either within the year of their diagnosis or among late-life BD patients. Pooled effects of standardized mean differences (SMDs) for changes in neuropsychological scores over follow-up were estimated using random effects model. We also examined effect moderators, such as length of follow-up, mood state, or pharmacological load. RESULTS Eight studies met inclusion criteria for recent-onset and four studies for late-life BD analysis. No evidence for a deterioration in neurocognitive functioning was observed among recent-onset BD patients (8 studies, 284 patients, SMD: 0.12, 95% CI -0.06 to 0.30, mean follow-up: 17 months) nor for late-life BD patients (4 studies, 153 patients, SMD: -0.35, 95% CI -0.84 to 0.15, mean follow-up: 33 months). None of the moderators were shown to be significant. CONCLUSIONS These results, when appraised together with the findings in middle-life BD patients and individuals at genetic risk for BD, suggest that neurodevelopmental factors might play a significant role in cognitive deficits in BD and do not support the notion of progressive cognitive decline in most patients with BD.
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Affiliation(s)
- Alejandro Szmulewicz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina
- Department of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina
| | - Marina P Valerio
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina
- National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
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12
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Torres IJ, Qian H, Basivireddy J, Chakrabarty T, Wong H, Lam RW, Yatham LN. Three-year longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Acta Psychiatr Scand 2020; 141:98-109. [PMID: 31840225 DOI: 10.1111/acps.13141] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The longitudinal course of neuropsychological functioning after the first manic episode in bipolar disorder is unknown. The present study evaluated cognitive change in bipolar disorder in the first 3 years after the initial manic episode. METHODS Ninety-one newly diagnosed patients with bipolar disorder and 61 demographically similar healthy participants received a neuropsychological evaluation assessing multiple cognitive domains at baseline, 1-year, and 3-year time points. Patients also received clinical assessments including mood ratings at all time points. RESULTS Patients showed deficits in all domains at baseline, but similar longitudinal trajectories across time relative to healthy participants in most cognitive domains. For processing speed, patients showed more gains than controls from baseline to 1 year, but these gains stabilized thereafter. Patients with alcohol/substance abuse showed an initial delay but subsequent recovery in executive functioning. Patients who discontinued antipsychotic treatment showed better cognitive outcomes in verbal memory. CONCLUSION Appropriately treated patients with bipolar disorder showed favorable cognitive outcome in the first 3 years after experiencing an initial manic episode, arguing against cognitive neuroprogression at this stage of the illness. Discontinuation of antipsychotic treatment may be associated with better cognitive outcomes, but clarification of the role of antipsychotics on cognitive functioning requires further investigation.
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Affiliation(s)
- I J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - H Qian
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - J Basivireddy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - T Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - H Wong
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - R W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - L N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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13
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Sachs G, Berg A, Jagsch R, Lenz G, Erfurth A. Predictors of Functional Outcome in Patients With Bipolar Disorder: Effects of Cognitive Psychoeducational Group Therapy After 12 Months. Front Psychiatry 2020; 11:530026. [PMID: 33329078 PMCID: PMC7719635 DOI: 10.3389/fpsyt.2020.530026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/29/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Cognitive deficits are known as a core feature in bipolar disorder. Persisting neurocognitive impairment is associated with low psychosocial functioning. The aim of this study was to identify potential cognitive, clinical and treatment-dependent predictors for functional impairment, symptom severity and early recurrence in bipolar patients, as well as to analyze neurocognitive performance compared to healthy controls. Methods: Forty three remitted bipolar patients and 40 healthy controls were assessed with a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed. Results: Compared to healthy controls, bipolar patients showed lower performance in executive function (perseverative errors p < 0.01, categories correct p < 0.001), sustained attention (total hits p < 0.001), verbal learning (delayed recall p < 0.001) and verbal fluency (p-words p < 0.002). Cognitive psychoeducational group therapy and attention predicted occupational functioning with a hit ratio of 87.5%. Verbal memory recall was found to be a predictor for symptom severity (hit ratio 86.8%). Recurrence in the follow-up period was predicted by premorbid IQ and by years of education (hit ratio 77.8%). Limitations: Limitations of the present study result mainly from a small sample size. The extent of cognitive impairment appears to impact occupational disability, clinical outcome as well as recurrence rate. This result must be interpreted with caution because statistical analysis failed to show higher significance. Conclusions: Bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. Deficits in sustained attention have an impact on occupational impairment. Implications for treatment strategies are discussed. Further evaluation in larger studies is needed.
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Affiliation(s)
- Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Berg
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Reinhold Jagsch
- Department for Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Gerhard Lenz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Erfurth
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.,First Department of Psychiatry and Psychotherapeutic Medicine, Klinik Hietzing, Vienna, Austria
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14
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Sánchez-Morla EM, López-Villarreal A, Jiménez-López E, Aparicio AI, Martínez-Vizcaíno V, Roberto RJ, Vieta E, Santos JL. Impact of number of episodes on neurocognitive trajectory in bipolar disorder patients: a 5-year follow-up study. Psychol Med 2019; 49:1299-1307. [PMID: 30043716 DOI: 10.1017/s0033291718001885] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The neurocognitive trajectory in bipolar disorder (BD) is variable, with controversial findings, and most evidence come from cross-sectional studies. We aimed to examine the course of neurocognitive functioning in a sample of euthymic BD patients in comparison with a control group during a 5-year follow-up. METHODS Ninety-nine euthymic bipolar patients and 40 healthy controls were assessed using a comprehensive neurocognitive battery (six neurocognitive domains) at baseline (T1) and then at 5-year follow-up (T2) in a longitudinal study. RESULTS No evidence of a progression in neurocognitive dysfunction was found either in cognitive composite index or in any of the neurocognitive domains for the whole cohort. However, there was a negative correlation between number of manic episodes and hospitalisations due to manic episodes and change in neurocognitive composite index (NCI) during the follow-up. Moreover, patients with higher number of manic and hypomanic episodes have a greater decrease in NCI, working memory and visual memory. History of psychotic symptoms was not related to the trajectory of neurocognitive impairment. CONCLUSIONS Our results suggest that, although the progression of cognitive decline is not a general rule in BD, BD patients who have a greater number of manic or hypomanic episodes may constitute a subgroup characterised by the progression of neurocognitive impairment. Prevention of manic and hypomanic episodes could have a positive impact on the trajectory of cognitive function.
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Affiliation(s)
| | | | | | | | | | | | - Eduard Vieta
- CIBERSAM (Biomedical Research Networking Centre in Mental Health),Spain
| | - José-Luis Santos
- CIBERSAM (Biomedical Research Networking Centre in Mental Health),Spain
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15
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Bonnín CDM, Reinares M, Martínez-Arán A, Jiménez E, Sánchez-Moreno J, Solé B, Montejo L, Vieta E. Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. Int J Neuropsychopharmacol 2019; 22:467-477. [PMID: 31093646 PMCID: PMC6672628 DOI: 10.1093/ijnp/pyz018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022] Open
Abstract
People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described.
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Affiliation(s)
- Caterina del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,Correspondence: Anabel Martínez-Arán, PhD, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Catalonia ()
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Sánchez-Moreno
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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16
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Sheffield JM, Karcher NR, Barch DM. Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective. Neuropsychol Rev 2018; 28:509-533. [PMID: 30343458 DOI: 10.1007/s11065-018-9388-2] [Citation(s) in RCA: 254] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022]
Abstract
Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Nashville, TN, 37212, USA.
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO, 63130, USA.,Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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17
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Torrent C, Reinares M, Martinez-Arán A, Cabrera B, Amoretti S, Corripio I, Contreras F, Sarró S, González-Pinto A, Lobo A, Cuesta MJ, Sánchez-Torres A, Bergé D, Castro-Fornieles J, Moreno C, Bernardo M, Vieta E. Affective versus non-affective first episode psychoses: A longitudinal study. J Affect Disord 2018; 238:297-304. [PMID: 29902733 DOI: 10.1016/j.jad.2018.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to assess (1) whether there were clinical, neuropsychological and functional differences between and within affective and non-affective psychoses at baseline and two years-follow-up and (2) to explore clinical and neuropsychological predictors of psychosocial functioning in the whole sample. METHOD This is a subanalysis from a multicentre, naturalistic, longitudinal prospective study ('Phenotype-genotype and environmental interaction. Application of a predictive model in first psychotic episodes'). The sample consisted of 192 patients with a first psychotic episode (FEP): 142 with non-affective psychoses and 50 with affective psychoses. Student t-tests, paired t-tests, Pearson correlations, ANOVAs and regression analyses were performed. RESULTS At baseline, the groups differed in perseverative errors (WCST), Premorbid Adjustment Scale (PAS), family history of psychiatric disorder, negative (PANSS) and manic symptoms (YMRS). At two years follow-up, the groups differed in all the PANSS subscales and in depressive symptoms assessed by the MADRS. When the whole sample was considered, the regression model which best explained the estimated variance in functioning at follow-up (41%) was composed by PANSS total score and verbal fluency assessed by the FAS (COWAT). CONCLUSIONS We found clinical and neurocognitive differences at baseline which decreased in the follow-up. Reduced performances at baseline in executive functions in combination with symptom severity (PANSS) were predictors of FEP patients' poor functional outcome.
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Affiliation(s)
- C Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Reinares
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martinez-Arán
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Cabrera
- Barcelona Clínic Schizophrenia Unit, Hospital Clinic de Barcelona, CIBERSAM, Barcelona, Spain
| | - S Amoretti
- Barcelona Clínic Schizophrenia Unit, Hospital Clinic de Barcelona, CIBERSAM, Barcelona, Spain
| | - I Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Santa Creu and Sant Pau Hospital; Autonomous University of Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - F Contreras
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - S Sarró
- FIDMAG Research Foundation Germanes Hospitalàries, CIBERSAM, Barcelona, Spain
| | - A González-Pinto
- Department of Psychiatry, University Hospital of Alava-Santiago, Vitoria, Spain
| | - A Lobo
- Department of Medicine and Psychiatry. Universidad de Zaragoza. Instituto de Investigación Aragón, CIBERSAM, Zaragoza, Spain
| | - M J Cuesta
- Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain, IdiSNA
| | - A Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain, IdiSNA
| | - D Bergé
- Hospital del Mar Medical Research Institute (IMIM), Autonomous University of Barcelona and CIBERSAM, Barcelona, Spain
| | - J Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology. Institut Clínic of Neurosciences, IDIBAPS, Hospital Clínic de Barcelona, CIBERSAM, Barcelona, Spain
| | - C Moreno
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM. Madrid, Spain
| | - M Bernardo
- Barcelona Clínic Schizophrenia Unit, Hospital Clinic de Barcelona, CIBERSAM, Barcelona, Spain
| | - E Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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18
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Smucny J, Lesh TA, Iosif AM, Niendam TA, Tully LM, Carter CS. Longitudinal stability of cognitive control in early psychosis: Nondegenerative deficits across diagnoses. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:781-788. [PMID: 29781657 DOI: 10.1037/abn0000356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cognitive impairment, particularly in the domain of cognitive control, is characteristic of schizophrenia (SZ) spectrum and bipolar disorders (BDs). The longitudinal trajectory of these impairments, however, remains unclear. Indeed, some studies have observed degeneration and others stability or even improvement over time in these illnesses. Here we examined the longitudinal stability of the AX-Continuous Performance Task (AX-CPT), a cognitive control task, in 52 patients with recent-onset SZ (<2 years from first study measurement), 20 patients with recent-onset BD Type I with psychotic features, and 70 healthy control subjects. Subjects performed the AX-CPT at 2 time points separated by an average of 365 days (range 270-620). Previously identified deficits in cognitive control were replicated in both patient groups. No effects of time or interactions between time and diagnosis were observed. Intraclass correlation coefficients also suggested AX-CPT performance was stable across time for all diagnostic groups. Although performance was stable on average, a positive association was noted between change in cognitive control and change in disorganization symptom severity across patient groups. In conclusion, the present findings suggest that deficits in cognitive control are present in both disorders and stable over the early course of psychotic illness. No evidence was observed for progression or deterioration of cognitive control or differential recovery in SZ compared to BD. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Jason Smucny
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Tyler A Lesh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis
| | - Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Laura M Tully
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
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19
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Sagar R, Sahu A, Pattanayak RD, Chatterjee B. Assessment of cognitive functions in bipolar I disorder: A 1-year naturalistic follow-up study. Bipolar Disord 2018; 20:248-259. [PMID: 29314557 DOI: 10.1111/bdi.12584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Available findings from cross-sectional studies have demonstrated cognitive impairments in bipolar I disorder (BD-I) during various phases of illness. However, very little is known about the longitudinal course of these cognitive impairments. The purpose of the study was to explore the longitudinal pattern of changes in cognitive functioning of BD-I patients. METHODS A total of 129 BD-I subjects (manic, depressed and euthymic groups) and 49 healthy controls were recruited using predefined selection criteria. All four study groups were assessed on various clinical and cognitive parameters (for attention, memory, executive functions and working memory) at study intake and at 3-monthly intervals over the next year. RESULTS All three patient groups performed poorly compared to controls on all cognitive measures at study intake and on some cognitive measures at the 3-, 6-, 9- and 12-month assessments. No significant time effects were observed for any cognitive test. A significant group by time interaction effect was found for executive functions (β = -44.74; P = .018) and working memory (β = 0.77; P ≤ .019) in the depressed group at 12 months; for visual memory (β = 1.21; P = .039) and working memory (β = 1.17; P ≤ .029) in the manic group at 12 months; and for working memory (β = -0.52; P ≤ .036) in the euthymic group at 12 months. CONCLUSION The patient groups showed significant impairments in all or some test domains relative to controls at all time-points. The cognitive functions largely remained stable in all patient groups, with slight improvement over time in a few tests. Further investigation is warranted in larger samples in longitudinal studies.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anamika Sahu
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Biswadip Chatterjee
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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20
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Demmo C, Lagerberg TV, Kvitland LR, Aminoff SR, Hellvin T, Simonsen C, Haatveit B, Andreassen OA, Melle I, Ueland T. Neurocognitive functioning, clinical course and functional outcome in first-treatment bipolar I disorder patients with and without clinical relapse: A 1-year follow-up study. Bipolar Disord 2018; 20:228-237. [PMID: 29121444 DOI: 10.1111/bdi.12569] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Due to limited research on the association between recurrence of mood episodes and the longitudinal course of neurocognitive functioning in early phase bipolar I disorder (BD I), the impact of recurrence on neurocognition remains unclear. Further, a strong correlation between neurocognitive impairment and functional impairment has been demonstrated. The longitudinal relationship between neurocognitive impairment and functional outcome in relation to recurrence is, however, not established. METHODS The current study investigated the longitudinal relationship between neurocognition, recurrence of mood episodes and functional outcome in a sample of first-treatment (FT) BD I patients (N = 42), with and without relapse, during a 1-year follow-up period. The longitudinal course of neurocognitive functioning in the patients was also compared to that of a group of healthy controls (N = 143). RESULTS Compared to both patients with relapse and healthy controls, no-relapse patients showed neurocognitive improvements. The polarity of the relapse episodes was mostly depressive, and for the no-relapse patients, reduction of symptoms was associated with neurocognitive improvement. No-relapse patients showed better global and occupational functioning. CONCLUSIONS The current study found different neurocognitive and functional trajectories in FT BD I patients with and without relapse, with differences at follow-up to some degree being mediated by current symptoms. The current findings highlight the importance of treatment focusing on neurocognition and symptom states with the aim of improving functional recovery.
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Affiliation(s)
- Christine Demmo
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Trine V Lagerberg
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Levi R Kvitland
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sofie R Aminoff
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Specialized Inpatient Treatment, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Tone Hellvin
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Beathe Haatveit
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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21
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Fu L, Xiang D, Xiao J, Yao L, Wang Y, Xiao L, Wang H, Wang G, Liu Z. Reduced Prefrontal Activation During the Tower of London and Verbal Fluency Task in Patients With Bipolar Depression: A Multi-Channel NIRS Study. Front Psychiatry 2018; 9:214. [PMID: 29892235 PMCID: PMC5985469 DOI: 10.3389/fpsyt.2018.00214] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023] Open
Abstract
Background: The Tower of London (TOL) task is one of the most commonly used tests for evaluating executive functions, and can indicate planning and problem-solving abilities. The aim of this study was to evaluate hemodynamic changes between the task period and rest period in patients with bipolar depression during the TOL task and the verbal fluency task (VFT) using near-infrared spectroscopy (NIRS). Methods: Forty-three patients with bipolar depression and 32 healthy controls (HCs) matched for sex, age, handedness, and years of education were enrolled in this study. All participants were aged between 16 and 50. All patients in our study were taking medications such as antidepressants, antipsychotics and mood stabilizers at the time of measurement. Changes in oxygenated hemoglobin (oxy-Hb) levels in frontal areas during the TOL task and VFT were evaluated using a 41-channel NIRS system. Results: During the TOL task, the patients with bipolar depression exhibited significantly smaller changes in the bilateral dorsal-lateral prefrontal cortex (DLPFC) than the HCs. During the VFT task, the patients with bipolar depression exhibited significantly smaller changes in the right ventrolateral prefrontal cortex (VLPFC), the right DLPFC and both the right and left prefrontal cortex (PFC) than the HCs. Limitations: Our sample size was small, and the effects of medication cannot be excluded. Conclusions: These results indicate that planning and problem solving dysfunction is related to the impairment of the prefrontal cortex in patients with bipolar depression, and NIRS can be used to assess planning and problem solving abilities, which are essential to daily life in patients with bipolar disorder.
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Affiliation(s)
- Linyan Fu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiawei Xiao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ying Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Xiao
- Institute of Neuropsychiatry, Renmin Hospital, Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.,Institute of Neuropsychiatry, Renmin Hospital, Wuhan University, Wuhan, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.,Institute of Neuropsychiatry, Renmin Hospital, Wuhan University, Wuhan, China
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22
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Martino DJ, Igoa A, Marengo E, Scápola M, Strejilevich SA. Longitudinal relationship between clinical course and neurocognitive impairments in bipolar disorder. J Affect Disord 2018; 225:250-255. [PMID: 28841488 DOI: 10.1016/j.jad.2017.08.011] [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: 05/01/2017] [Revised: 06/23/2017] [Accepted: 08/10/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to estimate the relationship between clinical course and trajectory of neurocognitive functioning during a follow-up period in a sample of euthymic bipolar patients. METHODS Fifty-one patients with BD performed two-neurocognitive assessment separated by a period of at least 48 months. The clinical course during the follow-up period was documented by: three measures 1) number of affective episodes, 2) time spent ill, and 3) mood instability. RESULTS Patients were followed-up for a mean period of 73.21 months. Neurocognitive performance tended to be stable throughout the follow-up. Performance in verbal memory and executive functions at the end of study were related with the number of hypo/manic episodes and time spent with hypo/manic symptoms during the follow-up. None of the clinical measures considered were related to changes in neurocognitive performance over the follow-up period. LIMITATIONS The relatively small sample size limits the value of subgroup analysis. The study design does not rule out some risk of selection bias. CONCLUSIONS Although there may be a positive relationship between number of episodes and neurocognitive deficits in patients with bipolar disorder, successive episodes do not seem to modify the trajectory of neurocognitive functioning over time. Theoretical implications of these findings are discussed.
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Affiliation(s)
- Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.
| | - Ana Igoa
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Eliana Marengo
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - María Scápola
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
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23
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Bora E, Özerdem A. Meta-analysis of longitudinal studies of cognition in bipolar disorder: comparison with healthy controls and schizophrenia. Psychol Med 2017; 47:2753-2766. [PMID: 28585513 DOI: 10.1017/s0033291717001490] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bipolar disorder (BP) is associated with significant cognitive impairment. Recent evidence suggests that cognitive deficits are already evident after first-episode mania. However, it is not clear whether BP is associated with further decline in cognitive functions in individuals with established illness. Aim of this meta-analytic review was to examine longitudinal neurocognitive changes in BP and to compare trajectory of cognitive deficits in BP with schizophrenia and healthy controls. METHODS Electronic databases were searched for the studies published between January 1987 and November 2016. In total 22 reports were included in the current meta-analysis. The main analysis assessed the longitudinal change in cognition in 643 patients with BP. Further analyses were conducted in studies investigating cognitive changes in BP along with healthy controls (459 BP and 367 healthy controls) and schizophrenia (172 BP and 168 schizophrenia). RESULTS There was no cognitive decline overtime neither in short-term (mean duration = 1.5 years) nor in long-term (mean duration = 5.5 years) follow-up studies in BP. In contrast, there was evidence for modest improvements in task performance in memory and working memory at follow-up. The trajectory of cognitive functioning in BP was not significantly different from changes in schizophrenia and healthy controls. CONCLUSIONS Together with the findings in early BP and individuals at genetic risk for BP, current findings suggest that neurodevelopmental factors might play a significant role in cognitive deficits in BP and do not support the notion of progressive cognitive decline in most patients with BP.
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Affiliation(s)
- E Bora
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,Izmir,Turkey
| | - A Özerdem
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,Izmir,Turkey
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24
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Sanchez-Moreno J, Bonnín C, González-Pinto A, Amann BL, Solé B, Balanzá-Martínez V, Arango C, Jimenez E, Tabarés-Seisdedos R, Garcia-Portilla MP, Ibáñez A, Crespo JM, Ayuso-Mateos JL, Vieta E, Martinez-Aran A, Torrent C. Do patients with bipolar disorder and subsyndromal symptoms benefit from functional remediation? A 12-month follow-up study. Eur Neuropsychopharmacol 2017; 27:350-359. [PMID: 28126401 DOI: 10.1016/j.euroneuro.2017.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/15/2016] [Accepted: 01/05/2017] [Indexed: 01/28/2023]
Abstract
We analyzed the efficacy of functional remediation, in a sample of patients with bipolar disorder who presented with subsyndromal symptoms. From a total sample of 239 patients with bipolar I and II disorder, according to DSM-IV-TR diagnostic criteria, entering a randomized clinical trial, those patients who presented with subsyndromal symptoms were selected based on a method already described by Berk and colleagues was applied. It consists of using the Clinical Global Impression-Bipolar version (CGI-BP) to establish the scores of the Hamilton Depression Rating Scale (HAM-D) and of the Young Mania Rating Scale (YMRS) that correspond with 1 in the CGI-BP. Functional outcome and mood symptoms were assessed at 6 and at 12-month follow-up. A total of 99 patients were selected for this post-hoc analysis, allocated as follows: functional remediation (n=33); psychoeducation (n=37) and treatment as usual (TAU,n=29). The repeated-measures analyses at 12-month follow-up revealed a significant group x time interaction in favour of the patients who received functional remediation when compared to psychoeducation and TAU (F=2.93; p=0.02) at improving psychosocial functioning. Finally, mood symptoms did not significantly change in any of the three groups at any time of follow-up, as shown by the non-significant group x time interaction effect in HAM-D scores (F=1.57; p=0.18) and YMRS scores (F=1.51; p=0.20). Bipolar patients with subsyndromal symptoms improve their functional outcome when exposed to functional remediation regardless of the persistence of mood symptomatology.
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Affiliation(s)
- Jose Sanchez-Moreno
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Caterina Bonnín
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ana González-Pinto
- Álava University Hospital, CIBERSAM, University of the Basque Country, BIOARABA, Vitoria, Spain
| | - Benedikt L Amann
- FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona, Spain
| | - Brisa Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Vicent Balanzá-Martínez
- Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia, Spain; Department of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Esther Jimenez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | | | - Angela Ibáñez
- Department of Psychiatry, University Hospital Ramon y Cajal, University of Alcala, IRYCIS, CIBERSAM, Madrid, Spain
| | - Jose Manuel Crespo
- Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona, Spain
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, IIS-IP, CIBERSAM, Madrid, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Anabel Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Carla Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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25
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Bond DJ, Torres IJ, Lee SS, Kozicky JM, Silveira LE, Dhanoa T, Lam RW, Yatham LN. Lower cognitive functioning as a predictor of weight gain in bipolar disorder: a 12-month study. Acta Psychiatr Scand 2017; 135:239-249. [PMID: 27995622 DOI: 10.1111/acps.12674] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In cross-sectional studies, elevated body mass index (BMI) is associated with cognitive impairment in bipolar disorder (BD). We investigated the direction of this association by prospectively examining changes in BMI and cognition. METHOD We measured BMI and performance in six cognitive domains over 12 months in 80 adolescent and young adult BD patients and 46 healthy comparison subjects (HS). Ninety-three percent of patients received pharmacotherapy and 84% were euthymic. We used repeated-measures ancova and longitudinal mixed models to investigate whether (i) higher BMI and increasing BMI over time predicted lower subsequent cognitive functioning, and (ii) lower cognitive functioning and changes in cognition predicted increasing BMI. RESULTS Neither baseline BMI nor BMI change predicted lower cognitive functioning. Lower baseline scores in attention, verbal memory, working memory, and a composite measure of global cognition predicted increasing BMI in patients and HS. In patients, lower cognitive functioning remained associated with increasing BMI when clinical and treatment variables were adjusted for. Improvement in working memory predicted a smaller subsequent BMI increase in patients. CONCLUSION Lower cognitive functioning in specific domains predicts increasing BMI in patients with BD and healthy young adults. Targeting cognition may be important for minimizing weight gain in BD.
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Affiliation(s)
- D J Bond
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - I J Torres
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - S S Lee
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J-M Kozicky
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - L E Silveira
- Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - T Dhanoa
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - R W Lam
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - L N Yatham
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
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26
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Demmo C, Lagerberg TV, Aminoff SR, Hellvin T, Kvitland LR, Simonsen C, Haatveit B, Andreassen OA, Melle I, Ueland T. Course of neurocognitive function in first treatment bipolar I disorder: One-year follow-up study. Psychiatry Res 2017; 249:286-292. [PMID: 28142102 DOI: 10.1016/j.psychres.2016.12.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/09/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
Neurocognitive impairment has been found to be a marked feature in bipolar disorder (BD), also in the early phase of the illness. The longitudinal course of neurocognitive functioning, however, remains sparsely investigated. The aims of the study were to investigate the course of neurocognitive function in BD I, and to what degree neurocognitive change or stability is observed also on the individual level. Forty-two patients and 153 comparable healthy controls were assessed at baseline and one-year follow-up. Compared to the healthy control (HC) group BD I patients perform significantly poorer at both baseline and follow-up across all neurocognitive domains and on most neurocognitive subtests. Neurocognitive impairment remained stable for most patients from baseline to follow-up, both on a group level and when investigating individual trajectories, indicative of a relatively stable course of neurocognitive functioning in the early phase of BD I.
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Affiliation(s)
- Christine Demmo
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway.
| | - Trine Vik Lagerberg
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Sofie R Aminoff
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway; Department of Specialized Inpatient Treatment, Division of Mental Health Services, Akershus University Hospital, Norway
| | - Tone Hellvin
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Levi R Kvitland
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Carmen Simonsen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Beathe Haatveit
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Torill Ueland
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway
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27
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Deconstructing Bipolar Disorder and Schizophrenia: A cross-diagnostic cluster analysis of cognitive phenotypes. J Affect Disord 2017; 209:71-79. [PMID: 27888723 PMCID: PMC6655479 DOI: 10.1016/j.jad.2016.11.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bipolar disorder (BD) and schizophrenia (SZ) show substantial overlap. It has been suggested that a subgroup of patients might contribute to these overlapping features. This study employed a cross-diagnostic cluster analysis to identify subgroups of individuals with shared cognitive phenotypes. METHOD 143 participants (68 BD patients, 39 SZ patients and 36 healthy controls) completed a battery of EEG and performance assessments on perception, nonsocial cognition and social cognition. A K-means cluster analysis was conducted with all participants across diagnostic groups. Clinical symptoms, functional capacity, and functional outcome were assessed in patients. RESULTS A two-cluster solution across 3 groups was the most stable. One cluster including 44 BD patients, 31 controls and 5 SZ patients showed better cognition (High cluster) than the other cluster with 24 BD patients, 35 SZ patients and 5 controls (Low cluster). BD patients in the High cluster performed better than BD patients in the Low cluster across cognitive domains. Within each cluster, participants with different clinical diagnoses showed different profiles across cognitive domains. LIMITATIONS All patients are in the chronic phase and out of mood episode at the time of assessment and most of the assessment were behavioral measures. CONCLUSIONS This study identified two clusters with shared cognitive phenotype profiles that were not proxies for clinical diagnoses. The finding of better social cognitive performance of BD patients than SZ patients in the Lowe cluster suggest that relatively preserved social cognition may be important to identify disease process distinct to each disorder.
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28
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Hu C, Torres IJ, Qian H, Wong H, Halli P, Dhanoa T, Ahn S, Wang G, Bond DJ, Lam RW, Yatham LN. Trajectories of body mass index change in first episode of mania: 3-year data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). J Affect Disord 2017; 208:291-297. [PMID: 27794253 DOI: 10.1016/j.jad.2016.08.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/23/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Overweight/obesity is common in patients with bipolar disorder (BD). However, little is known about longitudinal trends in body mass index (BMI) in patients with BD. Furthermore, most studies on the association between BMI and clinical outcomes are restricted by retrospective and cross-sectional designs. This study uses prospectively-gathered data from a first episode mania (FEM) cohort to examine the trajectories of BMI change and analyze their association with clinical outcomes during a 3-year period. METHODS A total of 110 FEM patients receiving maintenance treatment and 57 healthy subjects were included. The comparisons of BMI trajectories were examined using linear mixed-effects models. The effects of BMI on time to any mood episode were assessed by Cox proportional-hazards models. RESULTS The estimated mean BMI in FEM patients significantly increased from 24.0kg/m2 to 25.4kg/m2 within 6 months. FEM patients had a significant BMI increase trend over the entire 3 years follow-up, which was not observed in the control group. No significant difference in BMI trajectory between patient subgroups (baseline normal-weight vs. overweight/obese; male vs. female) was observed. BMI increase predicted an increased risk of recurrence during follow-up visits (HR=1.50, 95% CI: 1.06-2.13; p=0.02). LIMITATIONS Naturalistic design does not allow the accurate assessments of the impact of pharmacologic treatments on BMI. CONCLUSIONS FEM patients showed a significantly increased BMI trajectory compared to healthy subjects. Furthermore, BMI increase is independently associated with an increased risk of recurrence to a new mood episode during 3-year follow-up. Thus, weight control prevention is needed in the early course of BD.
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Affiliation(s)
- Chen Hu
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada; Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ivan J Torres
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Priyanka Halli
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Taj Dhanoa
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Sharon Ahn
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Gang Wang
- Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - David J Bond
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Raymond W Lam
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada.
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MacQueen GM, Memedovich KA. Cognitive dysfunction in major depression and bipolar disorder: Assessment and treatment options. Psychiatry Clin Neurosci 2017; 71:18-27. [PMID: 27685435 DOI: 10.1111/pcn.12463] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/02/2016] [Accepted: 09/23/2016] [Indexed: 12/19/2022]
Abstract
Cognitive dysfunction is a recognized feature of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). Cognitive impairment is associated with poor overall functional outcome and is therefore an important feature of illness to optimize for patients' occupational and academic outcomes. While generally people with BD appear to have a greater degree of cognitive impairment than those with MDD, direct comparisons of both patient groups within a single study are lacking. There are a number of methods for the assessment of cognitive function, but few are currently used in clinical practice. Current symptoms, past course of illness, clinical features, such as the presence of psychosis and comorbid conditions, may all influence cognitive function in mood disorders. Despite the general lack of assessment of cognitive function in clinical practice, clinicians are increasingly targeting cognitive symptoms as part of comprehensive treatment strategies. Novel pharmacological agents may improve cognitive function, but most studies of standard mood stabilizers, such as lithium and the anticonvulsants, have focused on whether or not the medications impair cognition. Non-pharmacological strategies, such as cognitive remediation and exercise, are increasingly studied in patients with mood disorders. Despite the growing interest in strategies to manage cognitive function, there is a paucity of high-quality trials examining either pharmacological or non-pharmacological modes of intervention.
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Affiliation(s)
- Glenda M MacQueen
- Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Katherine A Memedovich
- Bachelor's of Health Sciences Program, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Daglas R, Allott K, Yücel M, Pantelis C, Macneil CA, Berk M, Cotton SM. The trajectory of cognitive functioning following first episode mania: A 12-month follow-up study. Aust N Z J Psychiatry 2016; 50:1186-1197. [PMID: 26698823 DOI: 10.1177/0004867415622272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cognitive deficits are apparent in the early stages of bipolar disorder; however, the timing and trajectory of cognitive functioning following a first episode of mania remains unclear. The aim of this study was to assess the trajectory of cognitive functioning in people following a first episode of mania over a 12-month period, relative to healthy controls. METHOD The cohort included 61 participants who had recently stabilised from a first treated manic episode, and 21 demographically similar healthy controls. These groups were compared on changes observed over time using an extensive cognitive battery, over a 12-month follow-up period. RESULTS A significant group by time interaction was observed in one measure of processing speed (Trail Making Test - part A,) and immediate verbal memory (Rey Auditory Verbal Learning Test - trial 1), with an improved performance in people following a first episode of mania relative to healthy controls. On the contrary, there was a significant group by time interaction observed on another processing speed task pertaining to focussed reaction time (Go/No-Go, missed go responses), with first episode of mania participants performing significantly slower in comparison with healthy controls. Furthermore, a significant group by time interaction was observed in inhibitory effortful control (Stroop effect), in which healthy controls showed an improvement over time relative to first episode of mania participants. There were no other significant interactions of group by time related to other measures of cognition over the 12-month period. CONCLUSION Our findings revealed cognitive change in processing speed, immediate memory and one measure of executive functioning over a 12-month period in first episode of mania participants relative to healthy controls. There was no evidence of change over time for all other cognitive domains. Further studies focussed on the at-risk period, subgroup analysis, and the effects of medication on the cognitive trajectory following first episode of mania are needed.
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Affiliation(s)
- Rothanthi Daglas
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia .,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Murat Yücel
- Brain & Mental Health Laboratory (BMH), School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia
| | | | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia.,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,Barwon Health and the Geelong Clinic, Swanston Centre, Geelong, VIC, Australia
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Martino DJ, Samamé C, Strejilevich SA. Stability of facial emotion recognition performance in bipolar disorder. Psychiatry Res 2016; 243:182-4. [PMID: 27416537 DOI: 10.1016/j.psychres.2016.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/27/2016] [Accepted: 06/18/2016] [Indexed: 01/19/2023]
Abstract
The aim of this study was to assess the performance in emotional processing over time in a sample of euthymic patients with bipolar disorder (BD). Performance in the facial recognition of the six basic emotions (surprise, anger, sadness, happiness, disgust, and fear) did not change during a follow-up period of almost 7 years. These preliminary results suggest that performance in facial emotion recognition might be stable over time in BD.
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Affiliation(s)
- Diego J Martino
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Ciudad Autónoma de Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Cecilia Samamé
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Ciudad Autónoma de Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Ciudad Autónoma de Buenos Aires, Argentina; Institute of Cognitive Neurology (INECO), Ciudad Autónoma de Buenos Aires, Argentina
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Brietzke E, Rosa AR, Pedrini M, Noto MN, Kapczinski F, Scott J. Challenges and developments in research of the early stages of bipolar disorder. ACTA ACUST UNITED AC 2016; 38:329-337. [PMID: 27533022 PMCID: PMC7111347 DOI: 10.1590/1516-4446-2016-1975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/09/2016] [Indexed: 01/02/2023]
Abstract
Recently, attention in the field of bipolar disorder (BD) has focused on prevention, including early detection and intervention, as these strategies have the potential to delay, lessen the severity, or even prevent full-blown episodes of BD. Although knowledge of the neurobiology of BD has advanced substantially in the last two decades, most research was conducted with chronic patients. The objective of this paper is to comprehensively review the literature regarding the early stages of BD, to explore recent discoveries on the neurobiology of these stages, and to discuss implications for research and clinical care. The following databases were searched: PubMed, PsycINFO, Cochrane Library, and SciELO. Articles published in English from inception to December 2015 were retrieved. Several research approaches were used, including examination of offspring studies, retrospective studies, prospective studies of clinical high-risk populations, and exploration of the progression after the first manic episode. Investigations with neuroimaging, cognition assessments, and biomarkers provide promising (although not definitive) evidence of alterations in the neural substrate during the at-risk stage. Research on BD should be expanded to encompass at-risk states and aligned with recent methodological progress in neuroscience.
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Affiliation(s)
- Elisa Brietzke
- Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LINC), UNIFESP, São Paulo, SP, Brazil.,Programa de Intervenção em Estados Mentais de Risco (PRISMA), Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Adriane R Rosa
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia - Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina, Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil.,Departamento de Farmacologia, UFRGS, Porto Alegre, RS, Brazil
| | - Mariana Pedrini
- Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LINC), UNIFESP, São Paulo, SP, Brazil.,Programa de Intervenção em Estados Mentais de Risco (PRISMA), Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Mariane N Noto
- Grupo de Pesquisa em Neurociência Comportamental e Molecular do Transtorno Bipolar, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LINC), UNIFESP, São Paulo, SP, Brazil.,Programa de Intervenção em Estados Mentais de Risco (PRISMA), Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Flavio Kapczinski
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia - Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Medicina, Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK.,Centre for Affective Disorders, Institute of Psychiatry, King's College London, London, UK
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Cardenas SA, Kassem L, Brotman MA, Leibenluft E, McMahon FJ. Neurocognitive functioning in euthymic patients with bipolar disorder and unaffected relatives: A review of the literature. Neurosci Biobehav Rev 2016; 69:193-215. [PMID: 27502749 DOI: 10.1016/j.neubiorev.2016.08.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurocognitive deficits are present in bipolar disorder (BD) patients and their unaffected (nonbipolar) relatives, but it is not clear which domains are most often impaired and the extent of the impairment resulting from shared genetic factors. In this literature review, we address these issues and identify specific neurocognitive tasks most sensitive to cognitive deficits in patients and unaffected relatives. METHOD We conducted a systematic review in Web of Science, PubMed/Medline and PsycINFO databases. RESULTS Fifty-one articles assessing cognitive functioning in BD patients (23 studies) and unaffected relatives (28 studies) were examined. Patients and, less so, relatives show impairments in attention, processing speed, verbal learning/memory, and verbal fluency. CONCLUSION Studies were more likely to find impairment in patients than relatives, suggesting that some neurocognitive deficits may be a result of the illness itself and/or its treatment. However, small sample sizes, differences among relatives studied (e.g., relatedness, diagnostic status, age), and differences in assessment instruments may contribute to inconsistencies in reported neurocognitive performance among relatives. Additional studies addressing these issues are needed.
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Affiliation(s)
- Stephanie A Cardenas
- National Institutes of Health, 10 Center Drive, RM 3D54, MSC 1264, Bethesda, MD 20814-1264, USA.
| | - Layla Kassem
- National Institutes of Health, 35 Convent Drive, RM 1A202, MSC 3719, Bethesda, MD 20892-3719, USA.
| | - Melissa A Brotman
- National Institutes of Health, 15K North Drive, Room 211, Bethesda, MD 20892, USA.
| | - Ellen Leibenluft
- National Institutes of Health, 15K North Drive, RM 210, MSC 2670 Bethesda, MD 20892-2670, USA.
| | - Francis J McMahon
- National Institutes of Health, 35 Convent Drive, RM 1A201, MSC 3719, Bethesda, MD, 20892-3719, USA.
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Volkert J, Schiele MA, Kazmaier J, Glaser F, Zierhut KC, Kopf J, Kittel-Schneider S, Reif A. Cognitive deficits in bipolar disorder: from acute episode to remission. Eur Arch Psychiatry Clin Neurosci 2016; 266:225-37. [PMID: 26611783 DOI: 10.1007/s00406-015-0657-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Abstract
Considerable evidence demonstrates that neuropsychological deficits are prevalent in bipolar disorder during both acute episodes and euthymia. However, it is less clear whether these cognitive disturbances are state- or trait-related. We here present the first longitudinal study employing a within-subject pre- and post-testing examining acutely admitted bipolar patients (BP) in depression or mania and during euthymia, aiming to identify cognitive performance from acute illness to remission. Cognitive performance was measured during acute episodes and repeated after at least 3 months of remission. To do so, 55 BP (35 depressed, 20 hypo-/manic) and 55 healthy controls (HC) were tested with a neuropsychological test battery (attention, working memory, verbal memory, executive functioning). The results showed global impairments in acutely ill BP compared to HC: depressed patients showed a characteristic psychomotor slowing, while manic patients had severe deficits in executive functioning. Twenty-nine remitted BP could be measured in the follow-up (dropout rate 48 %), whose cognitive functions partially recovered, whereas working memory and verbal memory were still impaired. However, we found that subthreshold depressive symptoms and persisting sleep disturbances in euthymic BP were associated with reduced speed, deficits in attention and verbal memory, while working memory was correlated with psychotic symptoms (lifetime). This result indicates working memory as trait related for a subgroup of BP with psychotic symptoms. In contrast, attention and verbal memory are negatively influenced by state factors like residual symptoms, which should be more considered as possible confounders in the search of cognitive endophenotypes in remitted BP.
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Affiliation(s)
- J Volkert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt am Main, Germany.
| | - M A Schiele
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Würzburg, Germany
| | - Julia Kazmaier
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Würzburg, Germany
| | - Friederike Glaser
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Würzburg, Germany
| | - K C Zierhut
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Würzburg, Germany
| | - J Kopf
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt am Main, Germany
| | - S Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt am Main, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt am Main, Germany
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Bora E, Pantelis C. Meta-analysis of Cognitive Impairment in First-Episode Bipolar Disorder: Comparison With First-Episode Schizophrenia and Healthy Controls. Schizophr Bull 2015; 41:1095-104. [PMID: 25616505 PMCID: PMC4535631 DOI: 10.1093/schbul/sbu198] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Neurocognitive deficits are evident both in established schizophrenia and bipolar disorder (BP). However, it has been suggested that schizophrenia, but not BP, is characterized by neurodevelopmental abnormalities that can lead to cognitive deficits at the earliest stages of the illness. The aim of this meta-analytic review was to compare neurocognitive deficits in first-episode BP (FEBP) with healthy controls and first-episode schizophrenia (FES) patients. The current meta-analysis included a total of 22 adult studies and involved comparisons of 533 FEBP patients with 1417 healthy controls and 605 FEBP and 822 FES patients. FEBP patients were significantly impaired in all cognitive domains (d = 0.26-0.80) and individual tasks (d = 0.22-0.66) investigated. FES patients significantly underperformed FEBP patients in most cognitive domains (d = 0.05-0.63) and on individual tasks (d = 0.13-0.77). Neuropsychological impairment, which is comparable to chronic BP, was evident in FEBP. Similar to chronic patients, cognitive functions in FEBP lie intermediate between FES and healthy controls. Neurodevelopmental factors are likely to play a significant role not only in schizophrenia but also in BP.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Victoria, Australia
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Ohtani T, Nishimura Y, Takahashi K, Ikeda-Sugita R, Okada N, Okazaki Y. Association between longitudinal changes in prefrontal hemodynamic responses and social adaptation in patients with bipolar disorder and major depressive disorder. J Affect Disord 2015; 176:78-86. [PMID: 25702603 DOI: 10.1016/j.jad.2015.01.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with affective disorders exhibit changes in regional brain function and show abnormal social adaptation. However, to our knowledge, no near-infrared spectroscopy (NIRS) study has examined the relationship between these two phenomena longitudinally. This study examined the region-specific functional abnormality associated with bipolar disorder (BD) and major depressive disorder (MDD), and the association between particular longitudinal changes in regional activation and social adaptation. METHODS We evaluated frontotemporal functioning during a verbal fluency test (VFT) for patients with BD (N=18), those with MDD (N=10), and healthy controls (HCs; N=14) using NIRS. NIRS measurements and the Social Adaptation Self-evaluation Scale (SASS) were administered twice with an interval of approximately 6 months. RESULTS The BD and MDD groups showed lesser activation than the HCs in the bilateral ventro-lateral prefrontal cortex and the anterior part of the temporal cortex (VLPFC/aTC). Longitudinal changes in SASS scores were positively associated with the extent of change in left VLPFC/aTC activation in the BD group and with right VLPFC/aTC activation in the MDD group. LIMITATIONS Our small sample size limited statistical power, and the effect of medication and multiple comparisons cannot be excluded, although these effects were considered in the interpretation of the present results. CONCLUSION Longitudinal increases of VLPFC/aTC activation were associated with improvement in social adaptation in patients with BD and those with MDD. NIRS measurement could be a useful tool for objective evaluation of changes in social adaptation in BD and MDD.
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Affiliation(s)
- Toshiyuki Ohtani
- Department of Clinical Laboratory, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan; Safety and Health Organization, Chiba University, Chiba 263-8522, Japan.
| | - Yukika Nishimura
- Department of Clinical Laboratory, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan; Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan; Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Katsuyoshi Takahashi
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan
| | - Reina Ikeda-Sugita
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan
| | - Naohiro Okada
- Department of Clinical Laboratory, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan; Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan; Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuji Okazaki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya-ku, Tokyo 156-0057, Japan; Michino-o Hospital, Nagasaki 852-8055, Japan
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Daglas R, Yücel M, Cotton S, Allott K, Hetrick S, Berk M. Cognitive impairment in first-episode mania: a systematic review of the evidence in the acute and remission phases of the illness. Int J Bipolar Disord 2015; 3:9. [PMID: 25914866 PMCID: PMC4408302 DOI: 10.1186/s40345-015-0024-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/10/2015] [Indexed: 01/24/2023] Open
Abstract
There is evidence of cognitive impairment that persists in the remission phase of bipolar disorder; however, the extent of the deficits that occur from the first onset of the disorder remains unclear. This is the first systematic review on cognitive functioning in the early stages of bipolar I disorder. The aim of the study was to identify the patterns and degree of cognitive impairment that exists from first-episode mania. Three electronic databases (MEDLINE, PsycINFO and PubMed) were systematically searched for studies published from January 1980 to June 2014. Eligible studies were separated into two groups: acute and remission. The Newcastle-Ottawa quality assessment scale was utilised to measure the quality of the included studies. A total of seven studies (three acute and four remission), including 230 first-episode mania and 345 healthy control participants, were eligible for the review. The studies in the acute phase only examined aspects of executive functioning, with impairments identified in cognitive flexibility, though not in response inhibition and verbal fluency relative to healthy controls. The most consistent finding during the remission phase was a deficit in working memory, whereas in the other domains, the findings were equivocal. Non-verbal memory and verbal fluency were not impacted in remission from first-episode mania. In conclusion, deficits are present in some but not all areas of cognitive functioning during the early stages of bipolar I disorder. Further research is warranted to understand the longitudinal trajectory of change from first-episode mania.
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Affiliation(s)
- Rothanthi Daglas
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Murat Yücel
- Monash Clinical and Imaging Neuroscience (MCIN), School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, VIC 3168 Australia
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Sarah Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia ; IMPACT Strategic Research Centre, School of Medicine, Deakin University, 288-299 Ryrie Street, PO Box 281, Geelong, VIC 3220 Australia ; Barwon Health and the Geelong Clinic, Swanston Centre, 288-299 Ryrie Street, P O Box 281, Geelong, VIC 3220 Australia ; Florey Institute for Neuroscience and Mental Health, Kenneth Myer Building, Royal Parade, Parkville, VIC 3220 Australia
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Balanzá-Martínez V, Crespo-Facorro B, González-Pinto A, Vieta E. Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates. Front Physiol 2015; 6:108. [PMID: 25904869 PMCID: PMC4387475 DOI: 10.3389/fphys.2015.00108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/17/2015] [Indexed: 12/20/2022] Open
Abstract
Bipolar disorder (BD) and alcohol use disorders (AUDs) are usually comorbid, and both have been associated with significant neurocognitive impairment. Patients with the BD-AUD comorbidity (dual diagnosis) may have more severe neurocognitive deficits than those with a single diagnosis, but there is paucity of research in this area. To explore this hypothesis more thoroughly, we carried out a systematic literature review through January 2015. Eight studies have examined the effect of AUDs on the neurocognitive functioning of BD patients. Most studies found that BD patients with current or past history of comorbid AUDs show more severe impairments, especially in verbal memory and executive cognition, than their non-dual counterparts. Greater neurocognitive dysfunction is another facet of this severe comorbid presentation. Implications for clinical practice and research are discussed. Specifically, the application of holistic approaches, such as clinical staging and systems biology, may open new avenues of discoveries related to the BD-AUD comorbidity.
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Affiliation(s)
- Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry, Deparment of Medicine, School of Medicine, La Fe University and Polytechnic Hospital, University of Valencia, CIBERSAM, ISNPR Valencia, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria-IDIVAL, CIBERSAM Santander, Spain
| | - Ana González-Pinto
- Álava University Hospital, CIBERSAM, University of the Basque Country Kronikgune, Vitoria, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM Barcelona, Spain
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The trajectory of neuropsychological dysfunctions in bipolar disorders: a critical examination of a hypothesis. J Affect Disord 2015; 175:396-402. [PMID: 25678172 DOI: 10.1016/j.jad.2015.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/14/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The hypothesis of a progressive nature of neuropsychological deficits in bipolar disorders is often accepted as an axiom by many clinicians and researchers in the field. However, contradictory pieces of data and a number of methodological concerns put it under debate. METHOD We reviewed findings from three different approaches to the study of the trajectory of cognitive features in bipolar disorders: longitudinal evaluation of cognition in affected subjects, cross-sectional neuropsychological assessment of patients belonging to different age groups, and exploration of the risk of dementia in bipolar subjects. RESULTS An increased risk of developing dementia was found in bipolar subjects. However, evidence from cross-sectional studies did not show more severe cognitive deficits in patients with longer illness duration. Furthermore, longitudinal studies revealed that bipolar subjects׳ cognitive performance did not change between different points in time. CONCLUSIONS After a thorough discussion of these findings and the limitations of the different approaches, we argue that, at present, there is no consistent evidence supporting that bipolar disorders, as a group, have a progressively deteriorating course of cognitive functions. Furthermore, we highlight the possible influence of psychotropic agents and metabolic factors on neuropsychological outcomes. Finally, we discuss the clinical implications of these findings and propose targets for forthcoming research.
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Neurocognitive functioning in the premorbid stage and in the first episode of bipolar disorder: a systematic review. Psychiatry Res 2015; 226:23-30. [PMID: 25618475 DOI: 10.1016/j.psychres.2014.12.044] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/04/2014] [Accepted: 12/30/2014] [Indexed: 12/25/2022]
Abstract
It is well known that patients with bipolar disorder (BD) have cognitive impairments even during periods of euthymia. However, to date it remains unclear the moment when these deficits onset. Therefore, the aim of this study was to review the evidence focusing on the cognitive status of patients with BD in their premorbid stage and in their first episode. An extensive search was conducted through the online databases Pubmed/PsychInfo, covering the period between 1980 and 2014. A total of 23 studies were selected for the review (nine studies explored premorbid stage of people who lately develop BD and 14 examined first-episodes in bipolar patients). There is evidence that general intelligence is not impaired in the premorbid stage. Impairments in verbal memory, attention, and executive functions tend to be present during and after the first episode. Preliminary evidence suggests that these deficits in specific cognitive domains might precede the onset of illness.
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Bora E. Developmental trajectory of cognitive impairment in bipolar disorder: comparison with schizophrenia. Eur Neuropsychopharmacol 2015; 25:158-68. [PMID: 25261263 DOI: 10.1016/j.euroneuro.2014.09.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/12/2014] [Accepted: 09/03/2014] [Indexed: 01/28/2023]
Abstract
Both schizophrenia and bipolar disorder (BP) are associated with neurocognitive deficits. However, it has been suggested that schizophrenia, but not BP, is characterised by premorbid cognitive impairments and neurodevelopmental abnormalities. In this paper, studies investigating neurocognitive deficits in premorbid, high-risk and first-episode BP were reviewed and these findings were compared with outcome of studies in schizophrenia. Available evidence suggests that cognitive deficits are evident in first-episode BP and such deficits can be evident even years before the onset of the illness in some patients. Trajectory of cognitive deficits from childhood to adulthood can be very similar in schizophrenia and many patients with BP. Developmental lag in acquisition of cognitive skills is a risk factor for both disorders. However, unlike schizophrenia, not only impaired cognition but also supranormal premorbid cognitive/scholastic performance predict BP. Neurodevelopmental cognitive impairment is evident in some but not all patients with BP. A model suggesting that only BP patients who share common genetic risk factors with schizophrenia have premorbid neurodevelopmental cognitive deficits is proposed. In this model, combination of absence of neurodevelopmental abnormalities and BP-related temperamental characteristics explains the relationship between supranormal cognition and risk for BP.
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Affiliation(s)
- Emre Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia.
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Sparding T, Silander K, Pålsson E, Östlind J, Sellgren C, Ekman CJ, Joas E, Hansen S, Landén M. Cognitive functioning in clinically stable patients with bipolar disorder I and II. PLoS One 2015; 10:e0115562. [PMID: 25614986 PMCID: PMC4304812 DOI: 10.1371/journal.pone.0115562] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/25/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Bipolar disorder is accompanied by cognitive impairments, which persists during euthymic phases. The purpose of the present study was to identify those neuropsychological tests that most reliably tell euthymic bipolar patients and controls apart, and to clarify the extent to which these cognitive impairments are clinically significant as judged from neuropsychological norms. METHODS Patients with bipolar disorder (type I: n = 64; type II: n = 44) and controls (n = 86) were examined with a comprehensive neuropsychological test battery yielding 47 measures of executive functioning, speed, memory, and verbal skills. Multivariate analysis was used to build a model of cognitive performance with the ability to expose underlying trends in data and to reveal cognitive differences between patients and controls. RESULTS Patients with bipolar disorder and controls were partially separated by one predictive component of cognitive performance. Additionally, the relative relevance of each cognitive measure for such separation was decided. Cognitive tests measuring set shifting, inhibition, fluency, and searching (e.g., Trail Making Test, Color-Word) had strongest discriminating ability and most reliably detected cognitive impairments in the patient group. CONCLUSIONS Both bipolar disorder type I and type II were associated with cognitive impairment that for a sizeable minority is significant in a clinical neuropsychological sense. We demonstrate a combination of neuropsychological tests that reliably detect cognitive impairment in bipolar disorder.
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Affiliation(s)
- Timea Sparding
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Katja Silander
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Erik Pålsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefin Östlind
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Sellgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Ekman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Joas
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Hansen
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Tsitsipa E, Fountoulakis KN. The neurocognitive functioning in bipolar disorder: a systematic review of data. Ann Gen Psychiatry 2015; 14:42. [PMID: 26628905 PMCID: PMC4666163 DOI: 10.1186/s12991-015-0081-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND During the last decades, there have been many different opinions concerning the neurocognitive function in Bipolar disorder (BD). The aim of the current study was to perform a systematic review of the literature and to synthesize the data in a comprehensive picture of the neurocognitive dysfunction in BD. METHODS Papers were located with searches in PubMed/MEDLINE, through June 1st 2015. The review followed a modified version of the recommendations of the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses statement. RESULTS The initial search returned 110,403 papers. After the deletion of duplicates, 11,771 papers remained for further evaluation. Eventually, 250 were included in the analysis. CONCLUSION The current review supports the presence of a neurocognitive deficit in BD, in almost all neurocognitive domains. This deficit is qualitative similar to that observed in schizophrenia but it is less severe. There are no differences between BD subtypes. Its origin is unclear. It seems it is an enduring component and represents a core primary characteristic of the illness, rather than being secondary to the mood state or medication. This core deficit is confounded (either increased or attenuated) by the disease phase, specific personal characteristics of the patients (age, gender, education, etc.), current symptomatology and its treatment (especially psychotic features) and long-term course and long-term exposure to medication, psychiatric and somatic comorbidity and alcohol and/or substance abuse.
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Affiliation(s)
| | - Konstantinos N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos street (1st Parodos, Ampelonon str.) 55536 Pournari Pylaia, Thessaloniki, Greece
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Silveira LE, Kozicky JM, Muralidharan K, Bücker J, Torres IJ, Bond DJ, Kapczinski F, Kauer-Sant’Anna M, Lam RW, Yatham LN. Neurocognitive functioning in overweight and obese patients with bipolar disorder: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:639-48. [PMID: 25702364 PMCID: PMC4304583 DOI: 10.1177/070674371405901205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Obesity is frequent in people with bipolar I disorder (BD I) and has a major impact on the course of the illness. Although obesity negatively influences cognitive function in patients with BD, its impact in the early phase of the disorder is unknown. We investigated the impact of overweight and obesity on cognitive functioning in clinically stable patients with BD recently recovered from their first manic episode. METHOD Sixty-five patients with BD (25 overweight or obese and 40 normal weight) recently remitted from a first episode of mania and 37 age- and sex-matched healthy control. subjects (9 overweight or obese and 28 normal weight) were included in this analysis from the Systematic Treatment Optimization Program for Early Mania (commonly referred to as STOP-EM). All subjects had their cognitive function assessed using a standard neurocognitive battery. We compared cognitive function between normal weight patients, overweight-obese patients, and normal weight healthy control subjects. RESULTS There was a negative affect of BD diagnosis on the domains of attention, verbal memory, nonverbal memory, working memory, and executive function, but we were unable to find an additional effect of weight on cognitive functioning in patients. There was a trend for a negative correlation between body mass index and nonverbal memory in the patient group. CONCLUSIONS These data suggest that overweight-obesity does not negatively influence cognitive function early in the course of BD. Given that there is evidence for a negative impact of obesity later in the course of illness, there may be an opportunity to address obesity early in the course of BD.
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Affiliation(s)
- Leonardo E Silveira
- Clinical and Research Fellow, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Student, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia, for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil; Student, Postgraduate Program in Medicine: Psychiatry, Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jan-Marie Kozicky
- Postdoctoral Fellow, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Kesavan Muralidharan
- Associate Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Joana Bücker
- Research Fellow, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Student, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil; Student, Postgraduate Program in Medicine: Psychiatry, Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ivan J Torres
- Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Professor, British Columbia Mental Health and Addictions Services, Vancouver, British Columbia
| | - David J Bond
- Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Professor, Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Flavio Kapczinski
- Professor, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcia Kauer-Sant’Anna
- Professor, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raymond W Lam
- Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Lakshmi N Yatham
- Professor of Psychiatry, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
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Muralidharan K, Torres IJ, Silveira LE, Kozicky JM, Bücker J, Fernando N, Yatham LN. Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM). Br J Psychiatry 2014; 205:36-43. [PMID: 24764544 DOI: 10.1192/bjp.bp.113.135525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although manic episodes reportedly contribute to cognitive deficits in bipolar I disorder, the contribution of depressive episodes is poorly researched. AIMS We investigated the impact of depressive episodes on cognitive function early in the course of bipolar I disorder. METHOD A total of 68 patients and 38 controls from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM) first-episode mania programme were examined. We conducted (a) a cross-sectional analysis of the impact of prior depressive episodes on baseline cognitive function and (b) a prospective analysis assessing the contribution of depression recurrence within 1 year following a first episode of mania on cognitive functioning. RESULTS The cross-sectional analysis showed no significant differences between patients with past depressive episodes compared with those without, on overall or individual domains of cognitive function (all P>0.09). The prospective analysis failed to reveal a significant group×time interaction for cognitive decline from baseline to 1 year (P = 0.99) in patients with a recurrence of depressive episodes compared with those with no recurrence. However, impaired verbal memory at baseline was associated with a depression recurrence within 1 year. CONCLUSIONS Although deficits in all domains of cognitive function are seen in patients early in the course of bipolar disorder, depressive episodes do not confer additional burden on cognitive function. However, poorer verbal memory may serve as a marker for increased susceptibility to depression recurrence early in the course of illness.
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Affiliation(s)
- Kesavan Muralidharan
- Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ivan J Torres
- Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leonardo E Silveira
- Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jan-Marie Kozicky
- Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joana Bücker
- Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadeesha Fernando
- Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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