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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R, Ghosh P. Residual symptoms in bipolar disorders: Findings from the bipolar Disorder course and outcome study from India (BiD-CoIN study). Psychiatry Res 2021; 302:113995. [PMID: 34157607 DOI: 10.1016/j.psychres.2021.113995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/08/2021] [Indexed: 11/17/2022]
Abstract
AIM To explore the prevalence of residual symptoms (both depressive and manic) and their correlates in subjects with bipolar disorder in clinical remission. METHODOLOGY This multicentric cross-sectional study included patients in clinical remission recruited across the 14 centers. The patients were evaluated on the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) for the prevalence of residual symptoms. A score of ≤7 on both scales defined the presence of residual symptoms. RESULTS Four-fifth (79.8%) of the participants had residual symptoms, with 130 (16.8%) having only residual depressive symptoms, 74 (9.6%) having only residual manic symptoms, and 413 (53.4%) having both depressive and manic residual symptoms, on HDRS and YMRS. The residual symptoms were related to the polarity of the most recent episode and the lifetime predominant polarity. Higher numbers of lifetime depressive episodes are associated with higher residual depressive symptoms, and higher numbers of lifetime manic episodes are associated with higher chances of having residual manic symptoms. CONCLUSIONS A large proportion of patients with bipolar disorder have residual symptoms during the remission phase. Clinicians need to make efforts to identify and address the same to improve the treatment outcome.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh.
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education & Research, Chandigarh
| | | | | | | | | | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai
| | | | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, Ambala
| | | | | | | | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad
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Knorr U, Miskowiak K, Akhøj M, Vinberg M, Forman J, Kessing LV. The impact of the trajectory of bipolar disorder on global cognitive function: A one-year clinical prospective case-control study. J Affect Disord 2021; 278:189-198. [PMID: 32961415 DOI: 10.1016/j.jad.2020.09.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between cognitive function and relapse of affective episodes in bipolar disorder (BD) is rarely studied. The aim of this prospective, longitudinal, case-control study was to assess the trajectory of cognitive function and mood occilations within a one-year period in patients with BD relative to healthy control (HC) individuals. METHODS The sample included 86 outpatients with BD in euthymia, and 44 gender-and-age-matched HC. All participants were evaluated with clinical assessement and neuropsychological testing at baseline and during euthymia after a year. Further patients with BD were reevaluated if they developed a new affective episode during follow-up. The patients´ affective states were recorded on a weekly basis as asymptomatic, subthreshold level, major depression or (hypo)mania. Cognitive changes over time were measured for a global cognitive score and for the four cognitive domains: 'working memory and executive skills', 'psychomotor speed', 'sustained attention', and 'verbal learning and memory' in patients and HC. RESULTS The study showed that cognitive performance in patients with BD was unaltered compared to baseline when they stabilised in euthymia following an affective episode and, at the one-year follow-up. Cognitive performance showed practice effect, thus improved within a year across patients with BD and HC. Furthermore, cognitive functions were not related to clinical subtypes BDI/II, prior psychosis, the polarity of the relapse and week-to-week mood fluctuations during follow-up. Functioning correlated weakly to moderately with week-to-week mood fluctuations. LIMITATIONS Modest sample size. CONCLUSION A one-year trajectory of BD seems to have no direct negative impact on cognitive function.
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Affiliation(s)
- Ulla Knorr
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Kamilla Miskowiak
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Morten Akhøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Julie Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Mwesiga EK, Akena D, Koen N, Senono R, Obuku EA, Gumikiriza JL, Robbins RN, Nakasujja N, Stein DJ. A systematic review of research on neuropsychological measures in psychotic disorders from low and middle-income countries: The question of clinical utility. Schizophr Res Cogn 2020; 22:100187. [PMID: 32874938 PMCID: PMC7451606 DOI: 10.1016/j.scog.2020.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Several studies of neuropsychological measures have been undertaken in patients with psychotic disorders from low- and middle-income countries (LMICs). It is, however, unclear if the measures used in these studies are appropriate for cognitive screening in clinical settings. We undertook a systematic review to determine if measures investigated in research on psychotic disorders in LMICs meet the clinical utility criteria proposed by The Working Group on Screening and Assessment. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses were employed. We determined if tests had been validated against a comprehensive test battery, the duration and scope of the tests, the personnel administering the tests, and the means of administration. RESULTS A total of 31 articles were included in the review, of which 11 were from Africa. The studies included 3254 participants with psychosis and 1331 controls. 3 studies reported on the validation of the test against a comprehensive cognitive battery. Assessments took 1 h or less to administer in 6/31 studies. The average number of cognitive domains assessed was four. Nonspecialized staff were used in only 3/31 studies, and most studies used pen and paper tests (17/31). CONCLUSION Neuropsychological measures used in research on psychotic disorders in LMICs typically do not meet the Working Group on Screening and Assessment clinical utility criteria for cognitive screening. Measures that have been validated in high-income countries but not in LMICs that do meet these criteria, such as the Brief Assessment of Cognition in Schizophrenia, therefore deserve further study in LMIC settings.
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Affiliation(s)
- Emmanuel K. Mwesiga
- Department of Psychiatry, Makerere University, Uganda
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Uganda
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Uganda
| | - Nastassja Koen
- SA MRC Research Unit on Risk & Resilience in Mental Disorders, South Africa
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
| | - Richard Senono
- Infectious Disease Institute, Makerere University, Uganda
| | - Ekwaro A. Obuku
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Uganda
| | | | - Reuben N. Robbins
- New York State Psychiatric Institute, Columbia University Irving Medical Center, United States of America
| | | | - Dan J. Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
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Liu YC, Tseng HH, Chang YH, Chang HH, Yang YK, Chen PS. The social cognitive ability in Han Chinese euthymic patients with bipolar I and bipolar II disorder. J Formos Med Assoc 2020; 120:S0929-6646(20)30472-1. [PMID: 34756401 DOI: 10.1016/j.jfma.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/13/2020] [Accepted: 10/11/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/PURPOSE Although social cognitive deficits were found in euthymic patients of bipolar disorder (BD), the characteristics of social cognition in Han Chinese euthymic BD patients remain obscure. This study aimed to examine social cognition in Han Chinese euthymic BD patients relative to healthy controls (HC). Moreover, we explore the differences in social cognition between euthymic BD I and BD II patients. METHODS 43 Han Chinese BD patients (BD-I:25, BD-II:18) and 28 HC were recruited. All patients were euthymic (Young Mania Rating Scale (YMRS) ≤ 7 and Hamilton Depression Rating Scale (HDRS) ≤ 7). Social cognitive ability was measured using Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), including 4 branches: perceiving emotions, facilitating emotions, understanding emotions, and managing emotions. Continuous performance Test (CPT) and Wisconsin Card Sorting Test (WCST) were used to examine attention and executive function. RESULTS Significant difference in understanding emotions branch of MSCEIT was found between BD patients and HCs (Mann-Whitney U test, p = 0.005). Besides, BD patients had significantly worse performance in WCST and CPT. However, the differences in WCST, CPT, MSCEIT total scores and its subscales were not significant between BD I and BD II patients. CONCLUSION Euthymic Han Chinese BD patients exhibit significant social cognitive deficits in understanding emotion and cognitive dysfunction in attention and executive function. Furthermore, Han Chinese BD I patients showed similar social cognitive and general cognitive ability as compared with BD II patients. Social cognitive rehabilitation on both euthymic BD I and II patients should be considered.
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Affiliation(s)
- Yu Chia Liu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, Tainan Municipal Hospital (managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Huai-Hsuan Tseng
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yun-Hsuan Chang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Clinical Psychological Center, Asia University Hospital, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Hui Hua Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan; School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
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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: 26] [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: 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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Boyce P, Irwin L, Morris G, Hamilton A, Mulder R, Malhi GS, Porter RJ. Long-acting injectable antipsychotics as maintenance treatments for bipolar disorder-A critical review of the evidence. Bipolar Disord 2018; 20 Suppl 2:25-36. [PMID: 30328222 DOI: 10.1111/bdi.12698] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The maintenance phase of bipolar disorder is arguably the most important. The aim of management during this time is to maintain wellness and prevent future episodes of illness. Medication is often the mainstay of treatment during this phase, but adherence to treatment is a significant problem. In recent years, long-acting injectable (LAI) solutions have been proposed, but these too have limitations. This paper discusses the options that are currently available and critically appraises the effectiveness of this strategy. METHOD The authors reviewed the small number of open-label and randomised studies on LAI medications in bipolar disorder and evaluated the efficacy and safety of these medications. RESULTS The studies reviewed show benefit of LAIs for the management of bipolar disorder but have several key limitations to the generalisability of findings to routine practice. CONCLUSIONS LAIs have an emerging role in the management of bipolar disorder and, although it is not without limitations, this strategy addresses some issues of long-term treatment and medication. Patients with bipolar disorder that are non-adherent or have an unstable illness with a predilection towards mania are possibly better suited to the use of LAIs, though more research is required to fully assess the effectiveness of this approach.
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Affiliation(s)
- Philip Boyce
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Lauren Irwin
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Grace Morris
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Amber Hamilton
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Roger Mulder
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Gin S Malhi
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Richard J Porter
- Sophisticated Mood Appraisal & Refinement of Treatment (SMART) Group.,Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
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