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Luo Y, Bai Y, Wei K, Bi B. Toward a neurocircuit-based sequential transcranial magnetic stimulation treatment of pediatric bipolar II disorder. J Affect Disord 2024; 363:99-105. [PMID: 39009309 DOI: 10.1016/j.jad.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/03/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Abnormalities in large-scale neuronal networks-the frontoparietal central executive network (CEN)-are consistent findings in bipolar disorder and potential therapeutic targets for transcranial magnetic stimulation (TMS). OBJECTIVE The present study aimed to assess the effects of CEN neurocircuit-based sequential TMS on the clinical symptoms and cognitive functions of adolescents with bipolar II disorder. METHODS The study was a single-blinded, randomized, placebo-control trial. Participants with DSM-5-defined bipolar disorder II were recruited and randomized to receive either a sham treatment (n = 20) or an active TMS treatment (n = 22). The active group patients were taking medication, with intermittent theta burst stimulation (iTBS) treatment provided as adjunctive treatment targeting the left DLPFC, the left ITG, and the left PPC nodes consecutively. Patients completed the measurements of HAMD and the Das-Naglieri Cognition Assessment System at baseline and 3 weeks after the intervention. RESULTS A significant group-by-time interaction was observed in the HAMD, total cognition, and planning. Post-hoc analysis revealed that patients in the active group significantly improved HAMD scores following neurostimulation. Moreover, within-subject analysis indicated that the active group significantly improved in scores of total cognition and planning, while the sham group did not. No significant differences were seen in the other cognitive measures. CONCLUSION The neurocircuit-based sequential TMS protocol targeting three CEN nodes, in conjunction with medication, safely and effectively improved depressive symptoms and cognitive function in adolescents with bipolar II disorder.
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Affiliation(s)
- Yange Luo
- Department of Clinical Psychology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China
| | - Yuyin Bai
- Department of Clinical Psychology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China
| | - Kun Wei
- Department of Clinical Psychology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China
| | - Bo Bi
- Department of Clinical Psychology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China.
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2
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Huang D, Lai S, Zhong S, Zhang Y, He J, Yan S, Huang X, Lu X, Duan M, Song K, Ye K, Chen Y, Ye S, Lai J, Zhong Q, Song X, Jia Y. Sex-differential cognitive performance on MCCB of youth with BD-II depression. BMC Psychiatry 2024; 24:345. [PMID: 38714952 PMCID: PMC11077867 DOI: 10.1186/s12888-024-05701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Recent evidences have shown sex-differential cognitive deficits in bipolar disorder (BD) and differences in cognitions across BD subtypes. However, the sex-specific effect on cognitive impairment in BD subtype II (BD-II) remains obscure. The aim of the current study was to examine whether cognitive deficits differ by gender in youth with BD-II depression. METHOD This cross-sectional study recruited 125 unmedicated youths with BD-II depression and 140 age-, sex-, and education-matched healthy controls (HCs). The Chinese version of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) was used to assess cognitive functions. Mood state was assessed using the 24-item Hamilton Depression Rating Scale (24-HDRS) and the Young Mania Rating Scale (YMRS). Multivariate analysis of covariance (MANCOVA) was conducted. RESULT Compared with HCs, patients with BD-II depression had lower scores on MCCB composite and its seven cognitive domains (all p < 0.001). After controlling for age and education, MANCOVA revealed significant gender-by-group interaction on attention/vigilance (F = 6.224, df = 1, p = 0.013), verbal learning (F = 9.847, df = 1, p = 0.002), visual learning (F = 4.242, df = 1, p = 0.040), and composite (F = 8.819, df = 1, p = 0.003). Post hoc analyses suggested that males performed worse in the above-mentioned MCCB tests than females in BD-II depression. CONCLUSION Our study demonstrated generalized cognitive deficits in unmedicated youths with BD-II depression. Male patients performed more serious cognitive impairment on attention/vigilance, verbal learning, and visual learning compared to female patients.
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Affiliation(s)
- Dong Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Jiali He
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shuya Yan
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaosi Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaodan Lu
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Manying Duan
- School of Management, Jinan University, Guangzhou, 510316, China
| | - Kailin Song
- School of Management, Jinan University, Guangzhou, 510316, China
| | - Kaiwei Ye
- School of Management, Jinan University, Guangzhou, 510316, China
| | - Yandi Chen
- School of Management, Jinan University, Guangzhou, 510316, China
| | - Suiyi Ye
- School of Management, Jinan University, Guangzhou, 510316, China
| | - Jiankang Lai
- School of Management, Jinan University, Guangzhou, 510316, China
| | - Qilin Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaodong Song
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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3
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Yang X, Feng F, Gao D, Cai L, Wan C, Zhou X, Zeng Z. Analysis of telomere length and the relationship with neurocognitive functions in euthymic bipolar disorder: A cross-sectional pilot study. J Affect Disord 2024; 347:630-634. [PMID: 38065483 DOI: 10.1016/j.jad.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/09/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Telomere shortening has been considered a potential biological marker related to disease susceptibility and aging in psychiatric disorders. However, the relationship between telomere length and bipolar disorder (BD-I and BD-II) is uncertain. Moreover, whether telomere shortening is an independent factor of cognitive impairment in BD patients is still inconclusive. METHODS We explore telomere length and cognitive function in patients with bipolar disorder and the relationship between them. We enrolled three groups (35 patients with euthymic BD-I, 18 with euthymic BD-II, and 38 healthy controls). Telomere length was measured by fluorescent quantitative polymerase chain reaction (q-PCR), and cognitive function was evaluated by the MATRICS Consensus Cognitive Battery (MCCB). SPSS 24.0 was used for statistical analysis. RESULTS The telomere length of euthymic patients with BD-I and BD-II was shorter than that of healthy controls (F = 8.228, P = 0.001, η2 = 0.176). Telomere length was not significantly different between BD-I and BD-II. Compared to HCs, poor performance was detected in attention and vigilance in BD-I patients (F = 3.473, P = 0.036). Working memory was positively correlated with telomere length in BD-II patients (Beta = 0.5, P = 0.041, Adjusted R2 = 0.2). CONCLUSIONS The current study provided evidence of shortened telomere length in euthymic BD patients, indicating that telomere shortening might be a promising biomarker of susceptibility to bipolar disorder. The telomere length predicted the working memory in BD-II patients. Further studies are needed to clarify the role of accelerated aging on cognitive functioning in a young group of patients with BD.
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Affiliation(s)
- Xi Yang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China.
| | - Fei Feng
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Dailin Gao
- The Second People's Hospital of Futian District Shenzhen, Shenzhen, China
| | - Luyao Cai
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Chao Wan
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Xudong Zhou
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Zhiwen Zeng
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
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4
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Ponsoni A, Branco LD, Cotrena C, Shansis FM, Fonseca RP. A longitudinal study of cognition, functional outcome and quality of life in bipolar disorder and major depression. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:757-763. [PMID: 34597199 DOI: 10.1080/23279095.2021.1979551] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cognitive impairments are known to be a frequent cause of disability in bipolar disorder (BD) and major depression (MDD). Yet there is no consensus regarding the particular cognitive functions whose impairments can lead to disability in each domain of functioning. The aim of this study was to perform a longitudinal evaluation of working memory, inhibition, cognitive flexibility and attention in BD and MDD, investigate the relationship of these cognitive functions to disability and quality of life, and evaluate the impact of variables related to cognitive reserve (education and daily cognitive stimulation) on cognitive performance. METHOD 31 participants (MDD = 12; BD = 19) were evaluated at baseline and after an average time of 2 years. RESULTS the BD group showed improvements in attention while patients with MDD improved on measures of attention and working memory. In BD working memory performance was associated with the cognition and mobility domains of functioning, and with physical and environmental quality of life. In MDD, cognitive flexibility was related to social relationships and environmental quality of life. CONCLUSION working memory and cognitive flexibility may be an interesting target for interventions aiming to improve everyday functioning and quality of life in BD and MDD.
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Affiliation(s)
- André Ponsoni
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Laura Damiani Branco
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Charles Cotrena
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Flávio Milman Shansis
- Medical Sciences Post Graduate Program, University of Vale do Taquari (Univates), Lajeado, Brazil
| | - Rochele Paz Fonseca
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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5
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Wu YK, Su YA, Zhu LL, Li JT, Li Q, Dai YR, Lin JY, Li K, Si TM. Intrinsic functional connectivity correlates of cognitive deficits involving sustained attention and executive function in bipolar disorder. BMC Psychiatry 2023; 23:584. [PMID: 37568112 PMCID: PMC10416380 DOI: 10.1186/s12888-023-05083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The neural correlate of cognitive deficits in bipolar disorder (BD) is an issue that warrants further investigation. However, relatively few studies have examined the intrinsic functional connectivity (FC) underlying cognitive deficits involving sustained attention and executive function at both the region and network levels, as well as the different relationships between connectivity patterns and cognitive performance, in BD patients and healthy controls (HCs). METHODS Patients with BD (n = 59) and HCs (n = 52) underwent structural and resting-state functional magnetic resonance imaging and completed the Wisconsin Card Sorting Test (WCST), the continuous performance test and a clinical assessment. A seed-based approach was used to evaluate the intrinsic FC alterations in three core neurocognitive networks (the default mode network [DMN], the central executive network [CEN] and the salience network [SN]). Finally, we examined the relationship between FC and cognitive performance by using linear regression analyses. RESULTS Decreased FC was observed within the DMN, in the DMN-SN and DMN-CEN and increased FC was observed in the SN-CEN in BD. The alteration direction of regional FC was consistent with that of FC at the brain network level. Decreased FC between the left posterior cingulate cortex and right anterior cingulate cortex was associated with longer WCST completion time in BD patients (but not in HCs). CONCLUSIONS These findings emphasize the dominant role of the DMN in the psychopathology of BD and provide evidence that cognitive deficits in BD may be associated with aberrant FC between the anterior and posterior DMN.
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Affiliation(s)
- Yan-Kun Wu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Lin-Lin Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Ji-Tao Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Qian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - You-Ran Dai
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Jing-Yu Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Ke Li
- PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Tian-Mei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
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6
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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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7
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Smedler E, Sparding T, Jonsson L, Hörbeck E, Landén M. Association of premorbid intelligence with level of functioning and illness severity in bipolar disorder. J Affect Disord 2023; 324:449-454. [PMID: 36608850 DOI: 10.1016/j.jad.2022.12.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/04/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bipolar disorder is a severe psychiatric syndrome defined by periodic mood shifts. Patients with bipolar disorder show cognitive impairments relative to healthy controls. The risk of developing schizophrenia, and partially also bipolar disorder, has previously been shown to increase with lower premorbid intelligence. It is not known if premorbid intelligence is associated with level of functioning and illness severity of people having developed bipolar disorder. METHODS We used multiple linear and ordinal regression to analyze how premorbid intelligence, as measured at conscription, associate with functional outcome and illness severity in Swedish male bipolar disorder patients (n = 788). RESULTS We found that lower premorbid intelligence is associated with lower percentage of time in work, after adjusting for age and bipolar subtype, and correcting for multiple comparisons. We also found a strong negative association with the total number of inpatient episodes and psychiatric comorbidity, but not with interepisodic remission, treatment with psychotherapy or lithium or the presence of any complicating socioeconomical factors. Adjusting for confounding genetic factors using polygenic risk scores for bipolar disorder and schizophrenia had no effect on the associations. LIMITATIONS This study lacks females and controls and may thus have lower generalizability. CONCLUSION In conclusion, premorbid intelligence is associated with both level of functioning and illness severity as well as comorbidity in bipolar disorder patients. Further research is needed to develop targeted interventions for this subgroup of bipolar disorder patients.
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Affiliation(s)
- Erik Smedler
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Timea Sparding
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Lina Jonsson
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Elin Hörbeck
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mikael Landén
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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8
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Kjærstad HL, Søhol K, Vinberg M, Kessing LV, Miskowiak KW. The trajectory of emotional and non-emotional cognitive function in newly diagnosed patients with bipolar disorder and their unaffected relatives: A 16-month follow-up study. Eur Neuropsychopharmacol 2023; 67:4-21. [PMID: 36462414 DOI: 10.1016/j.euroneuro.2022.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/03/2022] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
Cognitive impairments are evident in remitted patients with bipolar disorder (BD) and their unaffected relatives (UR) compared to healthy controls (HC). However, the temporal course of cognition, and whether cognition is marked by neuroprogressive changes, remain unclear. In a large prospective study of newly diagnosed patients with BD, we assessed patients with BD (n = 266), UR (n = 105) and HC (n = 190) using an extensive cognitive battery of non-emotional and emotional cognition at baseline and 16-months follow-up. Cognitive change across groups was examined with linear mixed-model analyses. Results showed no evidence of trajectory differences between patients with BD, UR, and HC in neurocognition and emotional cognition (ps≥.10). Patients with BD showed stable impairments in global neurocognitive functioning over time, as well as within the domains of 'working memory and executive function' and 'attention and psychomotor speed', compared to HC. Patients who relapsed during the follow-up time were less successful at down-regulating emotions in positive social scenarios compared to HC. Unaffected relatives also displayed stable deficits in 'working memory and executive function' over time, with performance at intermediate levels between BD probands and HC. Finally, poorer neurocognition and positive emotion regulation were associated with more subsyndromal symptoms and functional impairments. In conclusion, we found no evidence of a neuroprogressive origin of cognitive impairments in the newly diagnosed BD or in their UR. Patients' and UR's impairments in working memory and executive function may reflect a stable cognitive trait-marker of familial risk. Difficulties with positive emotion regulation may be associated with illness progression in BD.
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Affiliation(s)
- Hanne Lie Kjærstad
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Kristine Søhol
- Department of Psychology, University of Copenhagen, Denmark
| | - Maj Vinberg
- Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
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9
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Correa-Ghisays P, Vicent Sánchez-Ortí J, Balanzá-Martínez V, Fuentes-Durá I, Martinez-Aran A, Ruiz-Bolo L, Correa-Estrada P, Ruiz-Ruiz JC, Selva-Vera G, Vila-Francés J, Macias Saint-Gerons D, San-Martín C, Ayesa-Arriola R, Tabarés-Seisdedos R. MICEmi: A method to identify cognitive endophenotypes of mental illnesses. Eur Psychiatry 2022; 65:e85. [PMID: 36440538 PMCID: PMC9807453 DOI: 10.1192/j.eurpsy.2022.2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Characterizing neurocognitive endophenotypes of mental illnesses (MIs) could be useful for identifying at-risk individuals, increasing early diagnosis, improving disease subtyping, and proposing therapeutic strategies to reduce the negative effects of the symptoms, in addition to serving as a scientific basis to unravel the physiopathology of the disease. However, a standardized algorithm to determine cognitive endophenotypes has not yet been developed. The main objective of this study was to present a method for the identification of endophenotypes in MI research. METHODS For this purpose, a 14-expert working group used a scoping review methodology and designed a method that includes a scoring template with five criteria and indicators, a strategy for their verification, and a decision tree. CONCLUSIONS This work is ongoing since it is necessary to obtain external validation of the applicability of the method in future research.
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Affiliation(s)
- Patricia Correa-Ghisays
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Joan Vicent Sánchez-Ortí
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Vicent Balanzá-Martínez
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Inmaculada Fuentes-Durá
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Anabel Martinez-Aran
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,Bipolar Disorders Unit, Neurosciences Institute, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
| | - Lara Ruiz-Bolo
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Juan Carlos Ruiz-Ruiz
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Gabriel Selva-Vera
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Joan Vila-Francés
- Intelligent Data Analysis Laboratory (IDAL), University of Valencia, Spain
| | - Diego Macias Saint-Gerons
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Constanza San-Martín
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Rafael Tabarés-Seisdedos
- Center for Biomedical Research in Mental Health Network (CIBERSAM), ISCIII, Madrid, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,TMAP Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, Department of Medicine, University of Valencia, Valencia, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
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10
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Diao X, Luo D, Wang D, Lai J, Li Q, Zhang P, Huang H, Wu L, Lu S, Hu S. Lurasidone versus Quetiapine for Cognitive Impairments in Young Patients with Bipolar Depression: A Randomized, Controlled Study. Pharmaceuticals (Basel) 2022; 15:1403. [PMID: 36422533 PMCID: PMC9698487 DOI: 10.3390/ph15111403] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 08/22/2024] Open
Abstract
The clinical efficacy of lurasidone and quetiapine, two commonly prescribed atypical antipsychotics for bipolar depression, has been inadequately studied in young patients. In this randomized and controlled study, we aimed to compare the effects of these two drugs on cognitive function, emotional status, and metabolic profiles in children and adolescents with bipolar depression. We recruited young participants (aged 10-17 years old) with a DSM-5 diagnosis of bipolar disorder during a depressive episode, who were then randomly assigned to two groups and treated with flexible doses of lurasidone (60 to 120 mg/day) or quetiapine (300 to 600 mg/day) for consecutive 8 weeks, respectively. All the participants were clinically evaluated on cognitive function using the THINC-it instrument at baseline and week 8, and emotional status was assessed at baseline and the end of week 2, 4, and 8. Additionally, the changes in weight and serum metabolic profiles (triglyceride, cholesterol, and fasting blood glucose) during the trial were also analyzed. In results, a total of 71 patients were randomly assigned to the lurasidone group (n = 35) or the quetiapine group (n = 36), of which 31 patients completed the whole treatment course. After an 8-week follow-up, participants in the lurasidone group showed better performance in the Symbol Check Reaction and Accuracy Tests, when compared to those in the quetiapine group. No inter-group difference was observed in the depression scores, response rate, or remission rate throughout the trial. In addition, there was no significant difference in serum metabolic profiles between the lurasidone group and the quetiapine group, including triglyceride level, cholesterol level, and fasting blood glucose level. However, the quetiapine group presented a more apparent change in body weight than the lurasidone group. In conclusion, the present study provided preliminary evidence that quetiapine and lurasidone had an equivalent anti-depressive effect, and lurasidone appeared to be superior to quetiapine in improving the cognitive function of young patients with bipolar depression.
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Affiliation(s)
- Xiangyuan Diao
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Psychiatry, First Affiliated Hospital, Jiaxing University, Jiaxing 314001, China
| | - Dan Luo
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Psychosomatic, The Third People′s Hospital of Jiashan County, Jiaxing 314100, China
| | - Dandan Wang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jianbo Lai
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qunxiao Li
- Department of Psychiatry, Hangzhou Fuyang Third People’s Hospital, Hangzhou 311402, China
| | - Peifen Zhang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Huimin Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lingling Wu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shaojia Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Brain Research Institute, Zhejiang University, Hangzhou 310003, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, School of Brain Science and Brain Medicine, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, Zhejiang University School of Medicine, Hangzhou 310003, China
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11
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Ehrlich TJ, Ryan KA, Burdick KE, Langenecker SA, McInnis MG, Marshall DF. Cognitive subgroups and their longitudinal trajectories in bipolar disorder. Acta Psychiatr Scand 2022; 146:240-250. [PMID: 35690884 PMCID: PMC9545624 DOI: 10.1111/acps.13460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/04/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cognitive functioning in bipolar disorder is heterogeneous with evidence for multiple subgroups. However, cognitive subgroup change patterns over time remains unknown. While prior work suggests minimal differences in cognitive functioning patterns over time between those with bipolar disorder and controls, group-based analyses may obscure unique subgroup-based changes. MATERIAL AND METHODS Participants diagnosed with bipolar disorder (I, II, NOS; n = 568) and unaffected controls (n = 234) completed baseline, one- and five-year neuropsychological assessments. Data reduction techniques were used to limit the number of neuropsychological variables. Bipolar disorder participant baseline neuropsychological data were entered into hierarchical cluster analyses and resultant clusters were entered in multilevel models, which tested for differences in baseline and longitudinal cognitive changes in cognition among the cluster groups and with controls. RESULTS Results were consistent with bipolar disorder participants forming three subgroups with high (n = 209), mid (n = 259), and low (n = 100) cognition. These groups were associated with unique clinical characteristics. Multilevel models demonstrated that over a five-year period, the low group improved, relative to the high and mid groups, and with controls, in auditory memory. Over the five-year period, the mid group, in comparison with the high group, improved in visual memory; additionally, the high group remained stable, in comparison with a slight decline in the control group, in inhibitory control. CONCLUSION These results demonstrate that cognition-based subgroups of bipolar disorder participants have minimal differences in their longitudinal course in relation to each other and with unaffected controls.
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Affiliation(s)
- Tobin J. Ehrlich
- Heinz C Prechter Bipolar Research Program, Eisenberg Family Depression Center, and Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | - Kelly A. Ryan
- Heinz C Prechter Bipolar Research Program, Eisenberg Family Depression Center, and Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | - Katherine E. Burdick
- Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Melvin G. McInnis
- Heinz C Prechter Bipolar Research Program, Eisenberg Family Depression Center, and Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | - David F. Marshall
- Heinz C Prechter Bipolar Research Program, Eisenberg Family Depression Center, and Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
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12
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Jones G, Suchting R, Zanetti MV, Leung E, da Costa SC, Sousa RTD, Busatto G, Soares J, Otaduy MC, Gattaz WF, Machado-Vieira R. Lithium increases cortical and subcortical volumes in subjects with bipolar disorder. Psychiatry Res Neuroimaging 2022; 324:111494. [PMID: 35640450 DOI: 10.1016/j.pscychresns.2022.111494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Bipolar disorder (BD) is a highly variable and burdensome disease for patients and caregivers. A BD diagnosis almost triples the likelihood of developing dementia as the disease progresses. Neurocognitive reserve appears to be one of the most important influences on lifelong functional outcomes and quality of life in BD. Though several prior studies have assessed the effects of lithium on regional gray and white matter volumes in this population, representative cohorts are typically middle-aged, have a more severe pathology, and are not as commonly assessed in the depressive phase (which represents the majority of most patients' lifespans outside of remission). Here we have shown that positive adaptations with lithium can be observed throughout the brain after only six weeks of monotherapy at low-therapeutic serum levels. Importantly, these results remove some confounders seen in prior studies (patients were treatment free at time of enrollment and mostly treatment naïve). This cohort also includes underrepresented demographics in the literature (young adult patients, mostly bipolar II, and exclusively in the depressed phase). These findings bolster the extensive body of evidence in support of long-term lithium therapy in BD, furthering the possibility of its expanded use to wider demographics.
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Affiliation(s)
- Gregory Jones
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Marcus V Zanetti
- LIM27, Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Edison Leung
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | | | - Rafael T de Sousa
- LIM27, Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Geraldo Busatto
- LIM21, Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Jair Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Maria C Otaduy
- Department of Radiology, University of São Paulo, São Paulo, Brazil
| | - Wagner F Gattaz
- LIM27, Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Machado-Vieira
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77054, USA.
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13
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Baena-Oquendo S, García Valencia J, Vargas C, López-Jaramillo C. Neuropsychological aspects of bipolar disorder. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:218-226. [PMID: 36075855 DOI: 10.1016/j.rcpeng.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/10/2020] [Indexed: 06/15/2023]
Abstract
Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and aprevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in this review.
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Affiliation(s)
- Stephen Baena-Oquendo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Jenny García Valencia
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Cristian Vargas
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Carlos López-Jaramillo
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Liu S, Wang F, Zhang C, Zhang Q, Dang ZC, Ng CH, Xiang YT. Cognitive Impairment and Its Associated Factors in Older Adults Living in High and Low Altitude Areas: A Comparative Study. Front Psychiatry 2022; 13:871414. [PMID: 35815014 PMCID: PMC9259941 DOI: 10.3389/fpsyt.2022.871414] [Citation(s) in RCA: 4] [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: 02/09/2022] [Accepted: 05/23/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cognitive impairment is a major health concern in older adults. Few studies have examined the association between environmental factors and cognitive impairment, especially in high altitude areas. In this study, the prevalence of cognitive impairment in older adults living in high altitude was compared with those living in low altitude areas. METHODS This was a comparative study conducted at Qinghai (high altitude group), and Guangzhou (low altitude group), China. Cognition, depressive symptoms and quality of life (QOL) were assessed using the Montreal Cognitive Assessment (MoCA), Patient Health Questionnaire (PHQ-9) and WHO Quality of Life brief version-WHOQOL-BREF, respectively. RESULTS Altogether, 644 older adults (207 in Qinghai and 437 in Guangzhou) completed the assessment. The prevalence rate of cognitive impairment was 94.7% (95% CI: 91.6-97.7%) in older adults living in the high altitude area, while the corresponding figure was 89.2% (95% CI: 86.3-92.1%) in the low altitude area. After controlling for covariates, the high altitude group appeared more likely to have cognitive impairment (OR = 2.92, 95% CI: 1.23-6.91, P = 0.015) compared with the low altitude group. Within the high altitude group sample, multinomial logistic regression analysis revealed that older age (aged 74 and above) was significantly associated with higher risk of severe cognitive impairment (OR = 3.58, 95%CI: 1.44-8.93, P = 0.006), while higher education level (secondary school and above) was associated with decreased risk of moderate cognitive impairment (OR = 0.43, 95%CI: 0.22-0.85, P = 0.006). Within the high altitude group, QOL did not differ significantly between normal/mild, moderate and severe cognitive impairment subgroups across physical [F (1, 207) = 1.83, P = 0.163], psychological [F (1, 207) = 1.50, P = 0.225], social [F (1,207) = 2.22, P = 0.111] and environmental domains [F (1,207) = 0.49, P = 0.614]. CONCLUSION This study found that cognitive impairment was more common among older adults living in the high altitude area. Regular screening and appropriate interventions should be provided to older adults in need.
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Affiliation(s)
- Shou Liu
- Department of Public Health, Medical College, Qinghai University, Xining, China
| | - Fei Wang
- Guangdong Provincial People's Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng Zhang
- Department of Yong Ding lu Outpatient, Jingnan Medical Area, Chinese PLA General Hospital, Beijing, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhan-Cui Dang
- Department of Public Health, Medical College, Qinghai University, Xining, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
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15
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Samamé C, Cattaneo BL, Richaud MC, Strejilevich S, Aprahamian I. The long-term course of cognition in bipolar disorder: a systematic review and meta-analysis of patient-control differences in test-score changes. Psychol Med 2022; 52:217-228. [PMID: 34763735 DOI: 10.1017/s0033291721004517] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neuropsychological impairment represents a key aspect of bipolar disorder (BD) that is evident even in early-course patients and is a strong predictor of functional outcomes among those affected. Previous meta-analyses of longitudinal studies suggest that BD-related cognitive deficits may not progress along the course of the disorder. However, short test-retest periods were used in most primary studies and comparisons with healthy controls were limited. The aim of this review was to synthesize the findings of research reports comparing long-term neurocognitive trajectories between BD patients and healthy individuals. PubMed, PsycINFO, and Scopus databases were searched from inception through July 2021. Publications were considered for inclusion if they reported cognitive test scores of BD patients and healthy controls at two different time points, with a minimum test-retest interval of 5 years. Fifteen studies compared the long-term course of cognition in BD patients with that of healthy controls. Ten of these were included in the quantitative analysis and involved 540 BD patients and 644 healthy individuals (mean follow-up period: 8.9 years). Patient-control effect sizes (standardized mean differences) were calculated for test-score changes in 24 neuropsychological variables and combined by means of meta-analytic procedures. No significant differences were found between patients and controls regarding long-term cognitive outcomes. These findings are consistent with previous shorter-term longitudinal meta-analyses and do not provide evidence for progressive cognitive deterioration in most bipolar individuals. Future studies should address the longitudinal course of cognition in different subgroups of BD patients and its prognostic and therapeutic value.
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Affiliation(s)
- Cecilia Samamé
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Favaloro University, Buenos Aires, Argentina
| | | | | | - Sergio Strejilevich
- Favaloro University, Buenos Aires, Argentina
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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Is processing speed a valid neurocognitive endophenotype in bipolar disorder? Evidence from a longitudinal, family study. J Psychiatr Res 2021; 141:241-247. [PMID: 34256275 DOI: 10.1016/j.jpsychires.2021.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Substantial evidence supports the existence of neurocognitive endophenotypes in bipolar disorder (BD), but very few longitudinal studies have included unaffected relatives. In a 5-year, follow-up, family study, we have recently suggested that deficits in manual motor speed and visual memory could be endophenotype candidates for BD. We aimed to explore whether this also applies to processing speed. METHODS A sample of 348 individuals, including 163 BD patients, 65 unaffected first-degree relatives (BD-Rel) and 120 genetically unrelated healthy controls (HC), was assessed with the Digit Symbol Substitution Test (DSST) on two occasions over a 2-year period (T1, T2). DSST values were controlled for age, years of education, occupational status, and subsyndromic mood symptoms. Differences between groups were evaluated with ANCOVAs. RESULTS At T1 BD performed significantly worse than HC (p < 0.001; Cohen's d = 1.38) and BD-Rel (p < 0.001; Cohen's d = 0.82). BD-Rel showed an intermediate performance with significant differences with HC (p < 0.01; Cohen's d = 0.50). Similarly, at T2 BD performed significantly worse than HC (p < 0.001; Cohen's d = 1.44) and BD-Rel (p < 0.01; Cohen's d = 0.51). BD-Rel performance was intermediate and significantly lower than that of HC (p < 0.01; Cohen's d = 0.97). A Repeated Measures ANOVA revealed no significant between-group differences in performance over time (p > 0.05). CONCLUSIONS The results of this longitudinal, family study suggest that impaired processing speed may represent a suitable cognitive endophenotype for BD. Further research on the field is required to confirm these preliminary findings.
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17
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Mazumder AH, Barnett J, Isometsä ET, Lindberg N, Torniainen-Holm M, Lähteenvuo M, Lahdensuo K, Kerkelä M, Ahola-Olli A, Hietala J, Kampman O, Kieseppä T, Jukuri T, Häkkinen K, Cederlöf E, Haaki W, Kajanne R, Wegelius A, Männynsalo T, Niemi-Pynttäri J, Suokas K, Lönnqvist J, Tiihonen J, Paunio T, Vainio SJ, Palotie A, Niemelä S, Suvisaari J, Veijola J. Reaction Time and Visual Memory in Connection to Alcohol Use in Persons with Bipolar Disorder. Brain Sci 2021; 11:brainsci11091154. [PMID: 34573174 PMCID: PMC8467646 DOI: 10.3390/brainsci11091154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to explore the association of cognition with hazardous drinking and alcohol-related disorder in persons with bipolar disorder (BD). The study population included 1268 persons from Finland with bipolar disorder. Alcohol use was assessed through hazardous drinking and alcohol-related disorder including alcohol use disorder (AUD). Hazardous drinking was screened with the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) screening tool. Alcohol-related disorder diagnoses were obtained from the national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on A tablet computer: the 5-choice serial reaction time task, or reaction time (RT) test and the Paired Associative Learning (PAL) test. Depressive symptoms were assessed with the Mental Health Inventory with five items (MHI-5). However, no assessment of current manic symptoms was available. Association between RT-test and alcohol use was analyzed with log-linear regression, and eβ with 95% confidence intervals (CI) are reported. PAL first trial memory score was analyzed with linear regression, and β with 95% CI are reported. PAL total errors adjusted was analyzed with logistic regression and odds ratios (OR) with 95% CI are reported. After adjustment of age, education, housing status and depression, hazardous drinking was associated with lower median and less variable RT in females while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores in females. Our findings of positive associations between alcohol use and cognition in persons with bipolar disorder are difficult to explain because of the methodological flaw of not being able to separately assess only participants in euthymic phase.
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Affiliation(s)
- Atiqul Haq Mazumder
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, 90014 Oulu, Finland; (M.K.); (T.J.); (J.V.)
- Correspondence:
| | - Jennifer Barnett
- Cambridge Cognition, University of Cambridge, Cambridge CB25 9TU, UK;
| | - Erkki Tapio Isometsä
- Department of Psychiatry, University Hospital and University of Helsinki, 00029 Helsinki, Finland; (E.T.I.); (N.L.); (T.K.); (A.W.); (T.P.)
- Department of Psychiatry, University of Helsinki, 00014 Helsinki, Finland;
| | - Nina Lindberg
- Department of Psychiatry, University Hospital and University of Helsinki, 00029 Helsinki, Finland; (E.T.I.); (N.L.); (T.K.); (A.W.); (T.P.)
| | - Minna Torniainen-Holm
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland; (M.T.-H.); (E.C.); (J.S.)
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, 70240 Kuopio, Finland; (M.L.); (K.H.); (J.T.)
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
| | - Kaisla Lahdensuo
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
- Mehiläinen, Pohjoinen Hesperiankatu 17 C, 00260 Helsinki, Finland
| | - Martta Kerkelä
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, 90014 Oulu, Finland; (M.K.); (T.J.); (J.V.)
| | - Ari Ahola-Olli
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, 20014 Turku, Finland; (J.H.); (S.N.)
- Department of Psychiatry, Turku University Hospital, 20521 Turku, Finland
| | - Olli Kampman
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland;
- Department of Psychiatry, Pirkanmaa Hospital District, 33521 Tampere, Finland
| | - Tuula Kieseppä
- Department of Psychiatry, University Hospital and University of Helsinki, 00029 Helsinki, Finland; (E.T.I.); (N.L.); (T.K.); (A.W.); (T.P.)
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
- Mehiläinen, Pohjoinen Hesperiankatu 17 C, 00260 Helsinki, Finland
| | - Tuomas Jukuri
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, 90014 Oulu, Finland; (M.K.); (T.J.); (J.V.)
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
| | - Katja Häkkinen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, 70240 Kuopio, Finland; (M.L.); (K.H.); (J.T.)
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
| | - Erik Cederlöf
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland; (M.T.-H.); (E.C.); (J.S.)
| | - Willehard Haaki
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
- Department of Psychiatry, University of Turku, 20014 Turku, Finland; (J.H.); (S.N.)
| | - Risto Kajanne
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
| | - Asko Wegelius
- Department of Psychiatry, University Hospital and University of Helsinki, 00029 Helsinki, Finland; (E.T.I.); (N.L.); (T.K.); (A.W.); (T.P.)
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland; (M.T.-H.); (E.C.); (J.S.)
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
| | - Teemu Männynsalo
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
- Social Services and Health Care Sector, City of Helsinki, 00099 Helsinki, Finland
| | - Jussi Niemi-Pynttäri
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
- Social Services and Health Care Sector, City of Helsinki, 00099 Helsinki, Finland
| | - Kimmo Suokas
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland;
| | - Jouko Lönnqvist
- Department of Psychiatry, University of Helsinki, 00014 Helsinki, Finland;
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland; (M.T.-H.); (E.C.); (J.S.)
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, 70240 Kuopio, Finland; (M.L.); (K.H.); (J.T.)
- Department of Clinical Neuroscience, Karolinska Institute, 17177 Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, 11364 Stockholm, Sweden
| | - Tiina Paunio
- Department of Psychiatry, University Hospital and University of Helsinki, 00029 Helsinki, Finland; (E.T.I.); (N.L.); (T.K.); (A.W.); (T.P.)
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland; (M.T.-H.); (E.C.); (J.S.)
- Social Services and Health Care Sector, City of Helsinki, 00099 Helsinki, Finland
| | - Seppo Juhani Vainio
- Infotech Oulu, University of Oulu, 90014 Oulu, Finland;
- Northern Finland Biobank Borealis, Oulu University Hospital, 90220 Oulu, Finland
- Faculty of Biochemistry and Molecular Medicine, University of Oulu, 90014 Oulu, Finland
- Kvantum Institute, University of Oulu, 90014 Oulu, Finland
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (K.L.); (A.A.-O.); (W.H.); (R.K.); (T.M.); (J.N.-P.); (K.S.); (A.P.)
- Mehiläinen, Pohjoinen Hesperiankatu 17 C, 00260 Helsinki, Finland
- Stanley Center for Psychiatric Research, The Broad Institute of MIT (Massachusetts Institute of Technology) and Harvard, Cambridge, MA 02142, USA
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Solja Niemelä
- Department of Psychiatry, University of Turku, 20014 Turku, Finland; (J.H.); (S.N.)
- Department of Psychiatry, Turku University Hospital, 20521 Turku, Finland
| | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland; (M.T.-H.); (E.C.); (J.S.)
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, 90014 Oulu, Finland; (M.K.); (T.J.); (J.V.)
- Department of Psychiatry, Oulu University Hospital, 90220 Oulu, Finland
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18
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Lu Z, Wang Y, Xun G. Neurocognition Function of Patients With Bipolar Depression, Unipolar Depression, and Depression With Bipolarity. Front Psychiatry 2021; 12:696903. [PMID: 34393857 PMCID: PMC8355513 DOI: 10.3389/fpsyt.2021.696903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 01/21/2023] Open
Abstract
Much evidence shows that some Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-defined unipolar depression (UD) with bipolarity manifests bipolar diathesis. Little is known about the cognitive profiles of patients with depression with bipolarity (DWB). The study aimed to investigate the differences in cognitive profiles among patients with bipolar depression (BD), major depressive disorder (namely, UD), and DWB. Drug-naïve patients with BD, UD, and DWB and healthy controls (HC) were recruited (30 cases in each group). Cognitive function was evaluated by THINC-it (THINC-intelligent tool), Wisconsin Card Sorting Test (WCST), and continuous performance test (CPT). For THINC-it, no significant differences of the Z-scores in both objective and subjective factors were found between the DWB group and BD group, but the Z-scores in the BD group were significantly lower than those in the UD group. For WCST, significant differences were found between the BD group and DWB group in the number of responses, categories completed, trails to completed first category, perseverative responses, and perseverative errors. All the indices of WCST in the DWB group were significantly worse than those in the UD group except for trails to completed first category and total number of response correct. For CPT, only scores of leakage responses and false responses in the four-digit number in the BD group and DWB group were significantly higher than those in the UD group; no significant difference was found between the BD group and DWB group. The results indicated that patients with DWB might perform differently from those with UD but similarly to those with BD with cognition impairment.
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Affiliation(s)
- Zhe Lu
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Peking University Sixth Hospital, Institute of Mental Health, Peking University, Beijing, China
| | - Yingtan Wang
- Department of Mental Health, Jining Medical University, Jining, China
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19
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Chen WY, Huang MC, Lee YC, Chang CE, Lin SK, Chiu CC, Liu HC, Kuo CJ, Weng SH, Chen PY, Kuo PH. The Heterogeneity of Longitudinal Cognitive Decline in Euthymic Bipolar I Disorder With Clinical Characteristics and Functional Outcomes. Front Psychiatry 2021; 12:684813. [PMID: 34366918 PMCID: PMC8335543 DOI: 10.3389/fpsyt.2021.684813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022] Open
Abstract
We characterized the heterogeneity and risk factors of cognitive decline in euthymic bipolar disorder (BD), and their magnitude of associations with subjective daily functions. In this retrospective cohort, BD type I patients (N = 128) were followed for an average of 6.5 years. Intelligence quotient (IQ) at index date was recorded, and premorbid IQ was estimated. We used Brief Assessment of Cognition in Affective Disorders (BAC-A) to assess cognition at follow-up. We evaluated current functions with World Health Organization Disability Assessment Schedule 2.0. Clinical and sociodemographic factors were examined for their independent effects on longitudinal cognitive decline. In addition, we employed multivariate adaptive regression spline to detect inflection points for the nature of slope changes in cognitive decline among BD patients. During follow-up years, 21 BD patients (16.4%) showed longitudinal cognitive decline. In cognitive decline group, all cognitive domains of BAC-A were significantly worsened. We found that density of episodes with psychotic features was an independent risk factor for cognitive decline after adjusted for age, gender and dose of mood stabilizer. After the age of 42 years, a steeper cognitive change was observed in the cognitive decline group. The correlation pattern between cognitive domains and functional outcomes differed between patients with and without cognitive decline. The present study characterized cognitive heterogeneity longitudinally in BD patients. As density of episodes play roles for cognitive decline, our results emphasize the importance of relapse prevention. Our findings provide hints for future personalized interventions and facilitating genetic and biological studies for dissecting the heterogeneity of bipolar illness.
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Affiliation(s)
- Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ya-Chin Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chiao-Erh Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Ku Lin
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chian-Jue Kuo
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Han Weng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Po-Yu Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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20
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Sparding T, Joas E, Clements C, Sellgren CM, Pålsson E, Landén M. Long-term trajectory of cognitive performance in people with bipolar disorder and controls: 6-year longitudinal study. BJPsych Open 2021; 7:e115. [PMID: 34140054 PMCID: PMC8240122 DOI: 10.1192/bjo.2021.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cross-sectional studies have found impaired cognitive functioning in patients with bipolar disorder, but long-term longitudinal studies are scarce. AIMS The aims of this study were to examine the 6-year longitudinal course of cognitive functioning in patients with bipolar disorder and healthy controls. Subsets of patients were examined to investigate possible differences in cognitive trajectories. METHOD Patients with bipolar I disorder (n = 44) or bipolar II disorder (n = 28) and healthy controls (n = 59) were tested with a comprehensive cognitive test battery at baseline and retested after 6 years. We conducted repeated measures ANCOVAs with group as a between-subject factor and tested the significance of group and time interaction. RESULTS By and large, the change in cognitive functioning between baseline and follow-up did not differ significantly between participants with bipolar disorder and healthy controls. Comparing subsets of patients, for example those with bipolar I and II disorder and those with and without manic episodes during follow-up, did not reveal subgroups more vulnerable to cognitive decline. CONCLUSIONS Cognitive performance remained stable in patients with bipolar disorder over a 6-year period and evolved similarly to healthy controls. These findings argue against the notion of a general progressive decline in cognitive functioning in bipolar disorder.
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Affiliation(s)
- Timea Sparding
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Erik Joas
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Carl M Sellgren
- Department of Physiology and Pharmacology, Karolinska Institutet, Sweden
| | - Erik Pålsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
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21
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Sambataro F, Cattarinussi G, Lawrence A, Biaggi A, Fusté M, Hazelgrove K, Mehta MA, Pawlby S, Conroy S, Seneviratne G, Craig MC, Pariante CM, Miele M, Dazzan P. Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study. Transl Psychiatry 2021; 11:238. [PMID: 33976106 PMCID: PMC8113224 DOI: 10.1038/s41398-021-01351-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Postpartum psychosis (PP) is a severe mental disorder that affects women in the first few weeks after delivery. To date there are no biomarkers that distinguish which women at risk (AR) develop a significant psychiatric relapse postpartum. While altered brain connectivity may contribute to the risk for psychoses unrelated to the puerperium, this remains unexplored in PP. We followed up 32 AR and 27 healthy (HC) women from pregnancy to 8-week postpartum. At this point, we classified women as AR-unwell (n = 15) if they had developed a psychiatric relapse meeting DSM-IV diagnostic criteria, or impacting on daily functioning and requiring treatment, or AR-well (n = 17) if they remained asymptomatic. Women also underwent an fMRI scan at rest and during an emotional-processing task, to study within- and between-networks functional connectivity. Women AR, and specifically those in the AR-well group, showed increased resting connectivity within an executive network compared to HC. During the execution of the emotional task, women AR also showed decreased connectivity in the executive network, and altered emotional load-dependent connectivity between executive, salience, and default-mode networks. AR-unwell women particularly showed increased salience network-dependent modulation of the default-mode and executive network relative to AR-well, who showed greater executive network-dependent modulation of the salience network. Our finding that the executive network and its interplay with other brain networks implicated in goal-directed behavior are intrinsically altered suggest that they could be considered neural phenotypes for postpartum psychosis and help advance our understanding of the pathophysiology of this disorder.
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Affiliation(s)
- Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy.
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Andrew Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Montserrat Fusté
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Mitul A Mehta
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Gertrude Seneviratne
- South London and Maudsley NHS Foundation Trust Channi Kumar Mother and Baby Unit, Bethlem Royal Hospital, London, UK
| | - Michael C Craig
- National Female Hormone Clinic, Maudsley Hospital, SLaM NHS Foundation Trust, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, De Crespigny Park, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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22
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Baena-Oquendo S, Valencia JG, Vargas C, López-Jaramillo C. Neuropsychological Aspects of Bipolar Disorder. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(20)30092-5. [PMID: 33735035 DOI: 10.1016/j.rcp.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and a prevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in the review.
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Affiliation(s)
- Stephen Baena-Oquendo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Jenny García Valencia
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Cristian Vargas
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Carlos López-Jaramillo
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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23
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López-Villarreal A, Sánchez-Morla EM, Jiménez-López E, Martínez-Vizcaíno V, Aparicio AI, Mateo-Sotos J, Rodriguez-Jimenez R, Vieta E, Santos JL. Progression of the functional deficit in a group of patients with bipolar disorder: a cluster analysis based on longitudinal data. Eur Arch Psychiatry Clin Neurosci 2020; 270:947-957. [PMID: 31422453 DOI: 10.1007/s00406-019-01050-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/07/2019] [Indexed: 12/23/2022]
Abstract
We aimed to examine the trajectory of psychosocial functioning in a sample of euthymic patients with bipolar disorder (BD) throughout a 5-year follow-up. Ninety-nine euthymic bipolar patients and 40 healthy controls (HC) were included. A neurocognitive assessment (17 neurocognitive measures grouped in 6 domains) was carried out at baseline. The split version of the Global Assessment of Functioning scale (GAF-F) and the Functioning Assessment Short Test (FAST) were used to examine psychosocial functioning at baseline (T1), and after a 5-year follow-up (T2). The statistical analysis was performed through repeated measures ANOVA and hierarchical cluster analysis based on the GAF-F and the FAST scores at T1 and T2. Eighty-seven patients (87.9%) were evaluated at T2. The cluster analysis identified two groups of patients. The first group included 44 patients (50.6%) who did not show a progression of the functional impairment (BD-NPI). The second cluster, which included 43 patients (49.4%), was characterized by a progression of the functional impairment (BD-PI). The BD-PI had a higher number of relapses and a higher number of hospitalizations during the follow-up period, as well as worse neurocognitive functioning than the BD-NPI. The repeated measures ANOVA confirmed that the psychosocial performance of BD-NPI is stable while there was a progression of the functional deterioration in BD-PI. The trajectory of the psychosocial functioning of patients with BD is not homogeneous. Our results suggest that in at least one subset of patients with BD, which might account for half of the patients, the disease has a progressive course.
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Affiliation(s)
- Ana López-Villarreal
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Eva María Sánchez-Morla
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain. .,CogPsy-Group, Universidad Complutense de Madrid (UCM), Madrid, Spain. .,Department of Psychiatry, Hospital Universitario 12 de Octubre, Avda. Córdoba km. 5400, 28041, Madrid, Spain.
| | - Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain.,Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Ana Isabel Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Mateo-Sotos
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain.,CogPsy-Group, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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24
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Ahearn EP, Szymanski BR, Chen P, Sajatovic M, Katz IR, McCarthy JF. Increased Risk of Dementia Among Veterans With Bipolar Disorder or Schizophrenia Receiving Care in the VA Health System. Psychiatr Serv 2020; 71:998-1004. [PMID: 32517643 PMCID: PMC8011612 DOI: 10.1176/appi.ps.201900325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) provides a continuum of care over the life course. Among U.S. adults, bipolar disorder and schizophrenia are associated with increased risk of dementia. To inform service planning, this study assessed the incidence of dementia among veteran VHA patients with bipolar disorder or schizophrenia, with adjustment for comorbid medical conditions. METHODS Using data from the VHA Corporate Data Warehouse, the authors identified all veterans who received VHA care in 2004 and 2005 without a dementia diagnosis and who were alive and between ages 18 and 100 as of January 1, 2006. Individuals were categorized as having bipolar disorder, schizophrenia, or neither condition on the basis of diagnoses in 2004-2005. Among ongoing VHA users, incidence of dementia was assessed for up to 10 years (2006-2015). RESULTS The cohort included 3,648,852 individuals. After analyses controlled for baseline comorbid general medical conditions and substance use disorders, the incidence rate ratios (IRRs) for dementia were 2.92 for those with schizophrenia and 2.26 for those with bipolar disorder, compared with VHA patients with neither condition. CONCLUSIONS Among veterans receiving VHA care, diagnoses of bipolar disorder and schizophrenia were each associated with increased risk of receiving a new diagnosis of dementia, even when analyses controlled for baseline medical comorbidities. IRRs were elevated for patients with either condition, compared with those with neither condition, and highest for those with schizophrenia. VHA clinicians should evaluate patients for dementia when signs or symptoms of cognitive impairment are present.
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Affiliation(s)
- Eileen P Ahearn
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Benjamin R Szymanski
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Peijun Chen
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Martha Sajatovic
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Ira R Katz
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - John F McCarthy
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
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25
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López-Villarreal A, Sánchez-Morla EM, Jiménez-López E, Martínez-Vizcaíno V, Aparicio AI, Mateo-Sotos J, Rodriguez-Jimenez R, Vieta E, Santos JL. Predictive factors of functional outcome in patients with bipolar I disorder: a five-year follow-up. J Affect Disord 2020; 272:249-258. [PMID: 32553365 DOI: 10.1016/j.jad.2020.03.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/13/2020] [Accepted: 03/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional impairment is commonly encountered among patients with bipolar disorder (BD) during periods of remission. The distribution of the impairment of the functional outcome is heterogeneous. The objective of this current investigation was to identify neurocognitive and clinical predictors of psychosocial functioning in a sample of patients with BD. METHODS Seventy-six patients (59.2% females) and 40 healthy controls (50% females), aged 18 to 55 years, were assessed using a comprehensive neurocognitive battery (six neurocognitive domains), and the Functioning Assessment Short Test (FAST), at baseline and after a 5-year follow-up. Stepwise regression models were used to identify predictor variables related to psychosocial functioning. RESULTS The number of hospitalizations during the follow-up, the change occurred in the neurocognitive composite index (NCI change), and NCI at baseline explained 30.8% of the variance of functioning. The number of hospitalizations during the follow-up was the variable that explained a greater percentage of the variance (16.9%). Verbal memory at baseline and the change in sustained attention during the follow-up explained 10% and 5.9% of the variance of the psychosocial functioning, respectively. LIMITATIONS The interval of 5 years between the two assessments could be too short to detect a possible progression in functional outcome for the overall sample. CONCLUSIONS The clinical course during the follow-up is the factor that has a greater impact on psychosocial functioning in patients with BD. Thus, the interventions aimed to promote prevention of relapses should be considered as essential for avoiding functional impairment in these patients.
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Affiliation(s)
- Ana López-Villarreal
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Eva María Sánchez-Morla
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain.
| | - Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad Autónoma de Chile. Facultad de Ciencias de la Salud, Talca, Chile
| | - Ana Isabel Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Mateo-Sotos
- Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Eduard Vieta
- Department of Psychiatry, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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Velosa J, Delgado A, Finger E, Berk M, Kapczinski F, de Azevedo Cardoso T. Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta-analyses. Acta Psychiatr Scand 2020; 141:510-521. [PMID: 31954065 DOI: 10.1111/acps.13153] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess whether bipolar disorder (BD) increases the rate of dementia and whether lithium is related to a lower risk of dementia in BD. METHODS A total of 10 studies (6859 BD; 487 966 controls) were included in the meta-analysis to test whether BD is a risk factor for dementia. In addition, five studies (6483 lithium; 43 496 non-lithium) were included in the meta-analysis about the potential protective effect of lithium in BD. RESULTS BD increases the risk of dementia (odds ratio (OR): 2.96 [95% CI: 2.09-4.18], P < 0.001), and treatment with lithium decreases the risk of dementia in BD (OR: 0.51 [95% CI: 0.36-0.72], P < 0.0001). In addition, secondary findings from our systematic review showed that the risk of progression to dementia is higher in BD than in major depressive disorder (MDD). Moreover, the number of mood episodes predicted the development of dementia in BD. CONCLUSION Individuals with BD are at higher risk of dementia than both the general population or those with MDD. Lithium appears to reduce the risk of developing dementia in BD.
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Affiliation(s)
- J Velosa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Mental Health, Hospital Beatriz Angelo, Loures, Portugal
| | - A Delgado
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Mental Health, Hospital Beatriz Angelo, Loures, Portugal
| | - E Finger
- Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | - M Berk
- Barwon Health, School of Medicine, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - F Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - T de Azevedo Cardoso
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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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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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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Correa-Ghisays P, Sánchez-Ortí JV, Ayesa-Arriola R, Setién-Suero E, Balanzá-Martínez V, Selva-Vera G, Ruiz-Ruiz JC, Vila-Francés J, Martinez-Aran A, Vivas-Lalinde J, Conforte-Molina C, San-Martín C, Martínez-Pérez C, Fuentes-Durá I, Crespo-Facorro B, Tabarés-Seisdedos R. Visual memory dysfunction as a neurocognitive endophenotype in bipolar disorder patients and their unaffected relatives. Evidence from a 5-year follow-up Valencia study. J Affect Disord 2019; 257:31-37. [PMID: 31299402 DOI: 10.1016/j.jad.2019.06.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Scarce research has focused on Visual Memory (VM) deficits as a possible neurocognitive endophenotype of bipolar disorder (BD). The main aim of this longitudinal, family study with healthy controls was to explore whether VM dysfunction represents a neurocognitive endophenotype of BD. METHODS Assessment of VM by Rey-Osterrieth Complex Figure Test (ROCF) was carried out on a sample of 317 subjects, including 140 patients with BD, 60 unaffected first-degree relatives (BD-Rel), and 117 genetically-unrelated healthy controls (HC), on three occasions over a 5-year period (T1, T2, and T3). BD-Rel group scores were analyzed only at T1 and T2. RESULTS Performance of BD patients was significantly worse than the HC group (p < 0.01). Performance of BD-Rel was also significantly different from HC scores at T1 (p < 0.01) and T2 (p = 0.05), and showed an intermediate profile between the BD and HC groups. Only among BD patients, there were significant differences according to sex, with females performing worse than males (p = 0.03). Regarding other variables, education represented significant differences only in average scores of BD-Rel group (p = 0.01). LIMITATIONS Important attrition in BD-Rel group over time was detected, which precluded analysis at T3. CONCLUSIONS BD patients show significant deficits in VM that remain stable over time, even after controlling sociodemographic and clinical variables. Unaffected relatives also show stable deficits in VM. Accordingly, the deficit in VM could be considered a potential endophenotype of BD, which in turn may be useful as a predictor of the evolution of the disease. Further studies are needed to confirm these findings.
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Affiliation(s)
- Patricia Correa-Ghisays
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Faculty of Psychology, University of Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Joan Vicent Sánchez-Ortí
- Faculty of Psychology, University of Valencia, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; University Hospital Marqués de Valdecilla. Department of Psychiatry, IDIVAL, Santander, Spain; Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | - Esther Setién-Suero
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; University Hospital Marqués de Valdecilla. Department of Psychiatry, IDIVAL, Santander, Spain; Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | - Vicent Balanzá-Martínez
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Gabriel Selva-Vera
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; INCLIVA Health Research Institute, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | | | - Joan Vila-Francés
- IDAL - Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Anabel Martinez-Aran
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Bipolar Disorders Unit, Neurosciences Institute, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
| | | | | | - Constanza San-Martín
- TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Departament of Physioterapiy, University of Valencia, Valencia, Spain
| | | | | | - Benedicto Crespo-Facorro
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Spain
| | - Rafael Tabarés-Seisdedos
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; INCLIVA Health Research Institute, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain.
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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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Rubinsztein JS, Sahakian BJ, O'Brien JT. Understanding and managing cognitive impairment in bipolar disorder in older people. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SUMMARYBipolar disorder is less prevalent in older people but accounts for 8–10% of psychiatric admissions. Treating and managing bipolar disorder in older people is challenging because of medical comorbidity. We review the cognitive problems observed in older people, explore why these are important and consider current treatment options. There are very few studies examining the cognitive profiles of older people with bipolar disorder and symptomatic depression and mania, and these show significant impairments in executive function. Most studies have focused on cognitive impairment in euthymic older people: as in euthymic adults of working age, significant impairments are observed in tests of attention, memory and executive function/processing speeds. Screening tests are not always helpful in euthymic older people as the impairment can be relatively subtle, and more in-depth neuropsychological testing may be needed to show impairments. Cognitive impairment may be more pronounced in older people with ‘late-onset’ bipolar disorder than in those with ‘early-onset’ disorder. Strategies to address symptomatic cognitive impairment in older people include assertive treatment of the mood disorder, minimising drugs that can adversely affect cognition, optimising physical healthcare and reducing relapse rates.LEARNING OBJECTIVESAfter reading this article you will be able to:
•understand that cognitive impairment in euthymic older people with bipolar disorder is similar to that in working-age adults with the disorder, affecting attention, memory and executive function/processing speeds•recognise that cognitive impairment in older people is likely to be a major determinant of functional outcomes•Implement approaches to treat cognitive impairment in bipolar disorder.DECLARATION OF INTERESTB.J.S. consults for Cambridge Cognition, PEAK (www.peak.net) and Mundipharma.
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A systematic review on neuropsychological function in bipolar disorders type I and II and subthreshold bipolar disorders-something to think about. CNS Spectr 2019; 24:127-143. [PMID: 30859934 DOI: 10.1017/s1092852918001463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Neuropsychological dysfunction is a well-established finding in individuals with bipolar disorder type I (BP-I), even during euthymic periods; however, it is less clear whether this also pertains to bipolar disorder type II (BP-II) or those with subthreshold states (SBP; subthreshold bipolar disorder), such as bipolar not otherwise specified (BP-NOS). Herein, we compare the literature regarding neuropsychological performance in BP-II vs BP-I to determine the extent of relative impairment, and we present and review all related studies on cognition in SBP. After systematically searching PubMed, Medline, PsycINFO, and The Cochrane Library, we found 17 papers that comprise all the published studies relevant for this review. The areas that are consistently found to be impaired in BP are executive function, verbal memory, visual spatial working memory, and attention. More studies than not show no significant difference between BP-I and BP-II, particularly in euthymic samples. Preliminary evidence suggests that patients experiencing major depressive episodes who also meet criteria for SBP show similar profiles to BP-II; however, these results pertain only to a depressed sample. SBP were found to perform significantly better than both MDD and healthy controls in a euthymic sample. A consensus on mood state, patient selection, and neuropsychological testing needs to be agreed on for future research. Furthermore, no studies have used the most recent DSM-5 criteria for SBP; future studies should address this. Finally, the underlying bases of cognitive dysfunction in these diagnostic groups need to be further investigated. We suggest recommendations on all of the above current research challenges.
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Liu T, Zhong S, Wang B, Liao X, Lai S, Jia Y. Similar profiles of cognitive domain deficits between medication-naïve patients with bipolar II depression and those with major depressive disorder. J Affect Disord 2019; 243:55-61. [PMID: 30227315 DOI: 10.1016/j.jad.2018.05.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/26/2018] [Accepted: 05/27/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bipolar disorder (BD) II is more likely to be misdiagnosed as major depressive disorder (MDD) than other types of BD, leading to incorrect treatment and poor outcomes. Previous studies have shown inconsistent results regarding the differences in cognitive deficits between the two disorders. To eliminate the compounding effects of medication and aging, we sought to investigate changes in cognitive function in medication-naïve, non-late-life patients with BDII and MDD. METHODS Three subject groups were enrolled: 30 depressed BDII patients, 30 depressed MDD patients and 30 healthy controls. All subjects underwent a battery of cognitive tests to assess 8 cognitive domains. The cognitive domains were compared between the three subject groups. In BDII and MDD, the effect sizes were computed as evaluation parameters, weighing the degree of the cognitive deficits and the correlations between cognitive test deficits and clinical variables were also computed. RESULTS Compared with the controls, the BDII and MDD patients were characterized by similar deficits in psychomotor speed, working memory, visual memory, attention switching and verbal fluency. Moderate to severe deficits in the majority of cognitive tests were observed in the BDII and MDD patients. Furthermore, correlations between the modified Wisconsin Card Sorting Test total errors and age of onset in the BDII patients and between correct digit span responses (backward and total) and depressive severity were found in the MDD patients. CONCLUSIONS Our findings suggest that BDII and MDD patients may suffer from similar profiles of cognitive domain deficits that may not assist in distinguishing between the two disorders. In addition, cognitive deficits may be correlated with the age of onset and depressive severity in mood disorders.
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Affiliation(s)
- Tao Liu
- Guangzhou Huiai Hospital, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuming Zhong
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Bing Wang
- Department of Affective Disorder, Shenzhen Mental Health Center, Shenzhen, China
| | - Xiaoxiao Liao
- Department of Psychology, Jiangmen Central Hospital, Jiangmen, China
| | - Shunkai Lai
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanbin Jia
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Jiménez-López E, Sánchez-Morla EM, López-Villarreal A, Aparicio AI, Martínez-Vizcaíno V, Vieta E, Rodriguez-Jimenez R, Santos JL. Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up. Eur Psychiatry 2018; 56:60-68. [DOI: 10.1016/j.eurpsy.2018.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 01/09/2023] Open
Abstract
AbstractBackground:Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up.Methods:Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2).Results:The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration.Conclusions:We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.
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Yang T, Zhao G, Mao R, Huang J, Xu X, Su Y, Zhu N, Zhou R, Lin X, Xia W, Wang F, Liu R, Wang X, Huang Z, Wang Y, Hu Y, Cao L, Yuan C, Wang Z, Lam RW, Chen J, Fang Y. The association of duration and severity of disease with executive function: Differences between drug-naïve patients with bipolar and unipolar depression. J Affect Disord 2018; 238:412-417. [PMID: 29909305 DOI: 10.1016/j.jad.2018.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/20/2018] [Accepted: 05/28/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND The aims of this study were to investigate the differences in executive function and the relationship with clinical factors between drug-naïve patients with bipolar depression (BDD) and unipolar depression (UPD). METHODS Drug-naïve patients with BDD, UPD and healthy controls (HC) were recruited (30 cases in each group). All patients were assessed with Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression-17 (HAM-D), and Young Mania Rating Scale (YMRS). Executive function was evaluated by Stroop color-word test (CWT) and Wisconsin Card Sorting Test (WCST). RESULTS In the BDD group, only the CWT number of missing was higher than HCs (P = 0.047). In the UDP group, CWT number of correct was lower, CWT number of missing was higher, and the WCST indices were worse than the HC group (P < 0.05). The WCST percentage of errors (PE) and percentage of conceptual level responses (PCLR) in the UPD group were worse than the BDD group (P < 0.05). In the BDD group, no correlations between CWT and WCST indices and clinical features were detected after correcting for multiple comparisons (P > 0.05). In the UDP group, the WCST PE, PCLR, number of categories completed (CC), and the percentage of perseverative responses (PPR) were correlated to the number of mood episodes (P < 0.01). LIMITATION This was a small-sample cross-sectional study. The possibility of UPD transforming to bipolar disorder (BD) in future could not be ruled out. CONCLUSION Our results suggested only small differences in executive function between drug-naïve patients with BDD and UPD, but in this sample only the UPD group showed differences with HCs. The executive function of drug-naïve BDD patients may be associated with duration of current depressive episode, while for UDP patients executive function indices were significantly correlated with number of mood episodes.
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Affiliation(s)
- Tao Yang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Guoqing Zhao
- Department of Psychology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, PR China
| | - Ruizhi Mao
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Jia Huang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Xianrong Xu
- Hangzhou Normal University School of Medicine, Hangzhou 311121, PR China
| | - Yousong Su
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Na Zhu
- Shanghai Pudong New District Mental Health Center, Shanghai 200124, PR China
| | - Rubai Zhou
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Xiao Lin
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Weiping Xia
- Department of Medical Psychology, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, PR China
| | - Fan Wang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Rui Liu
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Xing Wang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Zhijia Huang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Yong Wang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Yingyan Hu
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Lan Cao
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Chengmei Yuan
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China
| | - Zuowei Wang
- Division of Mood Disorders, Shanghai Hongkou District Mental Health Center, Shanghai 200080, PR China
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jun Chen
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China.; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200030, PR China.; Shanghai Key Laboratory of Psychotic disorders, Shanghai 200030, PR China..
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine Shanghai 200030, PR China.; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200030, PR China.; Shanghai Key Laboratory of Psychotic disorders, Shanghai 200030, PR China..
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Sex-related variation of neurocognitive functioning in bipolar disorder: Focus on visual memory and associative learning. Psychiatry Res 2018; 267:499-505. [PMID: 29980130 DOI: 10.1016/j.psychres.2018.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/05/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
Bipolar disorder (BD) is associated with cognitive deficits in attention, verbal memory and executive functions. However, only few studies have examined sex effects on cognition despite their clinical relevance. Given that visual memory/ learning has been understudied the aim of our study was to investigate sex-related variation in cognition (executive functions and visual memory/ learning) in BD. Cognitive performance of 60 bipolar-I patients and 30 healthy controls was evaluated by using CANTAB battery tasks targeting spatial memory (SRM), paired associative learning (PAL) and executive functions. We fitted a multivariate analysis of covariance (MANCOVA), followed by task-specific ANCOVAs. A significant diagnosis by sex interaction effect was detected (MANCOVA); specifically, diagnosis-specific sex effects were found for SRM and PAL, as healthy males outperformed healthy females but this pattern was attenuated in BD patients. Patients' clinicodemographic characteristics, current psychopathology or medication status did not differ across sexes and were, therefore, unlikely to explain detected sex effects. Our study is one of few studies to assess sex-related variation in cognition in BD and the first to record a diagnosis-specific sex effect for two tasks of visuo-spatial memory/ learning, indicating that sex-related variation in healthy subjects is disrupted in BD.
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Cognitive Decline in a Case of Poorly Controlled Bipolar Disorder: A Diagnostic and Therapeutic Challenge. Harv Rev Psychiatry 2018; 25:80-88. [PMID: 28272132 DOI: 10.1097/hrp.0000000000000143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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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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Jiménez-López E, Sánchez-Morla EM, Aparicio AI, López-Villarreal A, Martínez-Vizcaíno V, Rodriguez-Jimenez R, Vieta E, Santos JL. Psychosocial functioning in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia. J Affect Disord 2018; 229:177-185. [PMID: 29316520 DOI: 10.1016/j.jad.2017.12.094] [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: 09/08/2017] [Revised: 11/21/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND More than 50% of individuals with bipolar disorder (BD) do not reach full psychosocial functioning, even during periods of euthymia. It has been suggested that history of psychotic symptoms is one of the factors which are associated with a worse functional outcome. The objective was to compare psychosocial functioning between patients with BD, with (BD-P), and without (BD-NP) a history of psychotic symptoms, and to examine whether the history of psychotic symptoms, or other clinical or neurocognitive variables predict psychosocial functioning. METHODS Psychosocial functioning and neurocognition were examined in 100 euthymic patients with bipolar I disorder (50 BD-P, and 50 BD-NP), compared to 50 stabilised patients with schizophrenia (SZ), and 51 healthy controls (HC). RESULTS 1) There were no differences between BD-P and BD-NP in the GAF-F score or in the FAST total score. 2) The two groups of patients with BD had better scores than SZ both in the GAF-F, and in all measures of the FAST, except for the subscale leisure time. 3) The neurocognitive composite index, verbal memory and subclinical depressive symptoms were the variables which explained a higher percentage of the variance of functional outcome. LIMITATIONS The cross-sectional design, and the relatively small sample size are the main limitations. CONCLUSIONS A history of psychotic symptoms has no relevant impact on the level of psychosocial functioning in BD. Neurocognitive dysfunction and subclinical depressive symptoms are the variables that best explain the functional impairment. These findings have important clinical implications.
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Affiliation(s)
- Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Eva María Sánchez-Morla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Ana Isabel Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad Autónoma de Chile. Facultad de Ciencias de la Salud, Talca, Chile
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 952] [Impact Index Per Article: 158.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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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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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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Lima IMM, Peckham AD, Johnson SL. Cognitive deficits in bipolar disorders: Implications for emotion. Clin Psychol Rev 2017; 59:126-136. [PMID: 29195773 DOI: 10.1016/j.cpr.2017.11.006] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
Prominent cognitive deficits have been documented in bipolar disorder, and multiple studies suggest that these deficits can be observed among non-affected first-degree relatives of those with bipolar disorder. Although there is variability in the degree of cognitive deficits, these deficits are robustly relevant for functional outcomes. A separate literature documents clear difficulties in emotionality, emotion regulation, and emotion-relevant impulsivity within bipolar disorder, and demonstrates that these emotion-relevant variables are also central to outcome. Although cognitive and emotion domains are typically studied independently, basic research and emergent findings in bipolar disorder suggest that there are important ties between cognitive deficits and the emotion disturbances observed in bipolar disorder. Understanding these relationships has relevance for fostering more integrative research, for clarifying relevant aspects related to functionality and vulnerability within bipolar disorder, and for the development of novel treatment interventions. Bipolar disorder (BD) is a severe psychiatric illness that has been ranked as one of the 20 leading medical causes of disability (WHO, 2011). BD has been shown to be the psychiatric disorder with the highest rates of completed suicide across two major cohort studies (Ilgen et al., 2010; Nordentoft, Mortensen, & Pedersen, 2011). In a cross-national representative sample, one in four persons diagnosed with bipolar I disorder reported a suicide attempt (Merikangas et al., 2011). Rates of relapse remain high despite available treatments (Gitlin, Swendsen, Heller, & Hammen, 1995), and in the year after hospitalization for manic episode, two-thirds of patients do not return to work (Strakowski et al., 1998). Poverty, homelessness, and incarceration are all too common (Copeland et al., 2009). Despite the often poor outcomes, there is also evidence for outstanding accomplishments and creativity among those with milder forms of the disorder and their family members (Coryell et al., 1989; Jamison, 1993; Murray & Johnson, 2010). Some individuals appear to achieve more than the general population, suggesting the importance of understanding the variables that predict differential outcome within bipolar disorder. Within this paper, we focus on two key predictors of outcomes within bipolar disorder: cognition and emotionality. We review evidence that problems in cognition and emotionality are prominent among those diagnosed with the disorder, are not artifacts of symptom state, and relate substantively to poorer outcomes. Although traditionally studied separately, new work points toward the idea that cognition and emotionality are intricately linked within bipolar disorder. Drawing from research within bipolar disorder as well as outside of bipolar disorder, we build a model of how cognition and emotionality might be tied within bipolar disorder. We then provide suggestions for future research. Before considering findings, it is worth noting that there are several forms of the disorder, defined by varying degrees and duration of manic symptoms (APA, 2013; WHO, 1993). Manic episodes are defined by abnormally elevated or irritable mood, accompanied by increased activity and at least three symptoms (four if mood is only irritable) such as decreased need for sleep, increased self-confidence, racing thoughts or flight of ideas, rapid speech, distractibility, goal-directed activity, and engagement in pleasurable activities without regard to potential negative consequences. To meet criteria for mania, these symptoms must persist for at least one week or require hospitalization, and must lead to difficulties with functioning. If functional impairment is not more than mild and duration is between 4 and 6 days, the episode is considered a hypomanic episode. Bipolar I disorder (BD I) is diagnosed on the basis of at least one lifetime manic episode within the DSM-5 and by at least two episodes within the ICD, whereas bipolar II disorder is diagnosed on the basis of at least one hypomanic episode (and no manic episodes) as well as major depressive episodes. Cyclothymic disorder is defined by chronic but milder fluctuations between manic and depressive symptoms. Most research focuses on BD I. In addition to diagnosed samples, research has focused on those at high risk for bipolar disorder, including first-degree relatives of those with BD. This work draws on the evidence for extremely high heritability of BD I, with estimates from community-based twin studies of 0.85 (Kieseppä, Partonen, Haukka, Kaprio, & Lönnqvist, 2014). Other research has considered high risk for BD by virtue of lifetime subsyndromal symptoms, as measured by scales such as the Hypomanic Personality Scale (Eckblad & Chapman, 1986) or the General Behavior Inventory (Depue, Krauss, Spoont, & Arbisi, 1989). The study of high-risk individuals provides a way to decipher whether deficits are present before the onset of the disorder, of importance given models suggesting that episodes of the disorder may change brain function (Chang, Steiner, & Ketter, 2000; Strakowski, 2012) as well as individuals' perceptions of their emotion regulation. Beyond defining BD, it is worth defining some of the many different neuropsychological tasks that have been widely studied in BD. Perhaps no area has received more attention than executive function. Executive function is related to three core functions: 1) inhibition, the ability to suppress irrelevant information in working memory in order to accomplish an established goal; 2) working memory, the ability to hold and manipulate information in mind; and 3) cognitive flexibility, the ability to shift strategies in response to feedback (Diamond, 2013; Miyake et al., 2000). Attention (defined as the process of selecting information reception from internal or external cues) is implicated in all three of these aspects of executive function. Much of the literature we will discuss focuses on response inhibition, or the ability to suppress a prepotent response, which is considered a subtype of inhibition. Some tests measure multiple facets of executive function; for example the Trails B test likely requires working memory and cognitive flexibility (Sánchez-Cubillo et al., 2009). Aside from executive function, multiple other facets of cognition have been widely studied in bipolar disorder. Verbal and non-verbal memory are related to the ability to register, store and retrieve verbal or visual information (Lezak, 1995). Verbal fluency is measured as the number of verbal responses a person can generate to a given target, such as a specific semantic category (e.g., animals, furniture) or phonetic category (e.g., words that begin with letter F) (Diamond, 2013). Although cognitive tasks have been designed to evaluate these specific functions, it is important to note that most measures are highly inter-correlated and may assess multiple overlapping functions to some extent (for example, the Trails B test is often described as an "executive function" task, although this task likely involves both working memory and cognitive flexibility. Not surprisingly, then, some authors label the function of certain tests differently, and this is particularly evident in meta-analyses of cognition. As we describe findings in this paper, we will use the terms proposed by the authors but will also identify key tests used to define a cognitive construct. With this background in mind, we turn to a discussion of cognitive deficits, then of emotion-related traits. Our hope is that those concise summaries provide evidence for the importance of both domains, but also specificity regarding the facets of emotion and cognition that are most impaired in BD. This specificity then guides our consideration of models that integrate cognition and emotion.
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Affiliation(s)
- Isabela M M Lima
- University of California, Berkeley, United States; CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
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Neurocognition in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia. J Affect Disord 2017; 222:169-176. [PMID: 28709024 DOI: 10.1016/j.jad.2017.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND It has been suggested that patients with bipolar disorder with psychotic symptoms (BD-P) have larger neurocognitive impairment than patients with bipolar disorder without a history of psychotic symptoms (BD-NP). The objective of this study was to compare neurocognitive performance of BD-P and BD-NP relative to a group of patients with schizophrenia (SZ), and healthy controls (HC). METHODS Neurocognitive function was examined in 100 subjects with bipolar I disorder (50 BD-P, 50 BD-NP), 50 SZ, and 51 HC. All patients with BD fulfilled criteria for euthymia, while all SZ patients were stabilised for at least the previous 3 months. RESULTS Patients with BD-P and BD-NP performed worse than HC in all neurocognitive measures, except for sustained attention. Differences between BD-P and BD-NP were subtle and circumscribed to the working memory domain (effect size: 0.29). SZ performed worse than BD-NP in the neurocognitive composite index (NCI) and in the working memory domain. There were no differences between SZ and BD-P in any neurocognitive measure. LIMITATIONS The relatively small sample size, the cross-sectional design and, that patients were receiving pharmacological treatment are the main limitations of this study. CONCLUSIONS Our findings show that the three groups of patients have a large neurocognitive impairment. Differences are quantitative and only present in some neurocognitive domains, such as working memory. These results suggest that patients with BD and SZ can benefit from the same strategies of cognitive remediation.
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History of Bipolar Disorder and the Risk of Dementia: A Systematic Review and Meta-Analysis. Am J Geriatr Psychiatry 2017; 25:357-362. [PMID: 28161155 PMCID: PMC5365367 DOI: 10.1016/j.jagp.2016.11.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We carried out a systematic review and meta-analysis to evaluate whether history of bipolar disorder (BD) increases the risk of dementia. METHODS We searched PubMed and Scopus to identify studies that evaluated the risk of dementia in individuals with a history of BD. A total of 6 studies including 3,026 individuals with history of BD and 191,029 non-BD individuals were included in the meta-analysis. RESULTS History of BD significantly increased the risk of diagnosis of dementia (pooled odds ratio: 2.36; 95% confidence interval: 1.36-4.09; z = 3.07, p < 0.001). Evidence of heterogeneity and of publication bias in the analysis was found. CONCLUSION History of BD is associated with significantly higher risk of dementia in older adults. Future studies are necessary to evaluate the potential mediators of this association and to evaluate interventions that may reduce the risk of dementia in this population.
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Aparicio A, Santos JL, Jiménez-López E, Bagney A, Rodríguez-Jiménez R, Sánchez-Morla EM. Emotion processing and psychosocial functioning in euthymic bipolar disorder. Acta Psychiatr Scand 2017; 135:339-350. [PMID: 28188631 DOI: 10.1111/acps.12706] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine emotion processing in euthymic bipolar patients (EBP) compared to healthy controls. In addition, to determine whether or not there is an association between emotion processing and psychosocial functioning. MATERIAL AND METHODS A sample of 60 EBP and 60 healthy controls matched for age, gender, education level, and premorbid intelligence were studied. All subjects were assessed using the MATRICS Consensus Cognitive Battery (MCCB) and two additional executive function measures: the Trail Making Test-Part B and the Stroop Test. Emotion processing was examined using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Psychosocial functioning was assessed using the Functional Assessment Short Test (FAST). RESULTS Euthymic bipolar patients obtained lower scores than controls in all MSCEIT measures except for the using emotions branch. Likewise, EBP obtained a worse performance than healthy controls in all neurocognitive domains. Correlation between MSCEIT strategic area measures and FAST total score was found (r = -0.311; P < 0.016). Regression analysis showed that residual depressive symptomatology explains a 9.1% of the variance in functional outcome. MSCEIT strategic area score explained an additional 8.6%. Neurocognition did not increase the percentage of the variance explained by emotion processing. CONCLUSIONS Euthymic bipolar patients exhibit deficits in emotion processing. Emotion processing is associated with social functioning in these patients.
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Affiliation(s)
- A Aparicio
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - J L Santos
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - E Jiménez-López
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - A Bagney
- Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain
| | - R Rodríguez-Jiménez
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain
| | - E M Sánchez-Morla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain.,Department of Medicine, School of Medicine, University of Alcalá, Madrid, Spain.,Department of Psychiatry, University Hospital of Guadalajara, Guadalajara, Spain
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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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Hinrichs KH, Easter RE, Angers K, Pester B, Lai Z, Marshall DF, Kamali M, McInnis M, Langenecker SA, Ryan KA. Influence of cognitive reserve on neuropsychological functioning in bipolar disorder: Findings from a 5-year longitudinal study. Bipolar Disord 2017; 19:50-59. [PMID: 28263040 DOI: 10.1111/bdi.12470] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 01/19/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The present study examined the 5-year longitudinal course of cognitive functioning in a large sample of well-characterized patients with bipolar disorder (BP), compared to healthy controls (HCs), and the influence of cognitive reserve factors (e.g., education and IQ) on cognitive change over time. METHODS Participants included 159 individuals diagnosed with BP and 54 HCs recruited as part of a longitudinal naturalistic study of BP who had completed neuropsychological testing at the time of their enrollment and again 5 years later. RESULTS The overall relative rate of change did not differ between the BP and HC groups. In total, 46.5% of the BP group and 37% of the HC group showed evidence of decline on at least one measure over time. T-test analyses did not find differences between BP 'decliners' and 'non-decliners' in cognitive reserve variables. However, we found that higher baseline intellectual ability was associated with more stability in cognitive test scores over time for the BP group. Results of linear regression modeling revealed that lower verbal IQ and education were related to increased cognitive decline in specific domains in the BP group. CONCLUSIONS This study has explored the influence of cognitive reserve on preservation of specific cognitive abilities over time in BP. The BP group did not demonstrate accelerated cognitive decline over 5 years compared to the HC group. Although the trajectory of cognitive change over time was similar between BP patients and HCs, higher overall intellectual ability may be a protective factor against cognitive decline, particularly for BP patients.
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Affiliation(s)
| | - Rebecca E Easter
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kaley Angers
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Bethany Pester
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Zongshan Lai
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Gkintoni E, Pallis EG, Bitsios P, Giakoumaki SG. Neurocognitive performance, psychopathology and social functioning in individuals at high risk for schizophrenia or psychotic bipolar disorder. J Affect Disord 2017; 208:512-520. [PMID: 27810272 DOI: 10.1016/j.jad.2016.10.032] [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: 06/21/2016] [Revised: 09/05/2016] [Accepted: 10/22/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although cognitive deficits are consistent endophenotypes of schizophrenia and bipolar disorder, findings in psychotic bipolar disorder (BDP) are inconsistent. In this study we compared adult unaffected first-degree relatives of schizophrenia and BDP patients on cognition, psychopathology, social functioning and quality of life. METHODS Sixty-six unaffected first-degree relatives of schizophrenia patients (SUnR), 36 unaffected first-degree relatives of BDP patients (BDPUnR) and 102 controls participated in the study. Between-group differences were examined and Discriminant Function Analysis (DFA) predicted group membership. RESULTS Visual memory, control inhibition, working memory, cognitive flexibility and abstract reasoning were linearly impaired in the relatives' groups. Poorer verbal fluency and processing speed were evident only in the SUnR group. The SUnR group had higher depressive and somatization symptoms while the BDPUnR group had higher anxiety and lower social functioning compared with the controls. Individuals with superior cognition were more likely to be classified as controls; those with higher social functioning, prolonged processing speed and lower anxiety were more likely to be classified as SUnR. LIMITATIONS The relatives' sample is quite heterogeneous; the effects of genetic or environmental risk-factors were not examined. CONCLUSIONS Cognitive functions mediated by a fronto-parietal network, show linear impairments in unaffected relatives of BDP and schizophrenia patients; processing speed and verbal fluency impairments were evident only in schizophrenia relatives. Self-perceived symptomatology and social functioning also differ between schizophrenia and BDP relatives. The continuum seen in patients in several indices was also seen in the cognitive impairments in unaffected relatives of schizophrenia and BDP patients.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece
| | - Eleftherios G Pallis
- Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Panos Bitsios
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Stella G Giakoumaki
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece.
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