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Cattarinussi G, Gugliotta AA, Hirjak D, Wolf RC, Sambataro F. Brain mechanisms underlying catatonia: A systematic review. Schizophr Res 2024; 263:194-207. [PMID: 36404217 DOI: 10.1016/j.schres.2022.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Catatonia is a complex psychomotor disorder characterized by motor, affective, and behavioral symptoms. Despite being known for almost 150 years, its pathomechanisms are still largely unknown. METHODS A systematic research on PubMed, Web of Science, and Scopus was conducted to identify neuroimaging studies conducted on group or single individuals with catatonia. Overall, 33 studies employing structural magnetic resonance imaging (sMRI, n = 11), functional magnetic resonance imaging (fMRI, n = 10), sMRI and fMRI (n = 2), functional near-infrared spectroscopy (fNIRS, n = 1), single positron emission computer tomography (SPECT, n = 4), positron emission tomography (PET, n = 4), and magnetic resonance spectroscopy (MRS, n = 1), and 171 case reports were retrieved. RESULTS Observational sMRI studies showed numerous brain changes in catatonia, including diffuse atrophy and signal hyperintensities, while case-control studies reported alterations in fronto-parietal and limbic regions, the thalamus, and the striatum. Task-based and resting-state fMRI studies found abnormalities located primarily in the orbitofrontal, medial prefrontal, motor cortices, cerebellum, and brainstem. Lastly, metabolic and perfusion changes were observed in the basal ganglia, prefrontal, and motor areas. Most of the case-report studies described widespread white matter lesions and frontal, temporal, or basal ganglia hypoperfusion. CONCLUSIONS Catatonia is characterized by structural, functional, perfusion, and metabolic cortico-subcortical abnormalities. However, the majority of studies and case reports included in this systematic review are affected by considerable heterogeneity, both in terms of populations and neuroimaging techniques, which calls for a cautious interpretation. Further elucidation, through future neuroimaging research, could have great potential to improve the description of the neural motor and psychomotor mechanisms underlying catatonia.
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Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy
| | | | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert C Wolf
- Department of General Psychiatry at the Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
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Wang J, Tang L, Wang M, Wu G, Li W, Wang Y, Wang X, Wang H, Yang Z, Li Z, Chen Q, Zhang P, Wang Z. Fronto-temporal dysfunction in appetitive regulation of bulimia nervosa with affective disorders: A regional homogeneity and remote connectivity pattern analysis. J Affect Disord 2023; 340:280-289. [PMID: 37553018 DOI: 10.1016/j.jad.2023.08.036] [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: 03/25/2023] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE The aim of this study was to assess brain functional alterations in BN patients with affective disorders and their association with maladaptive eating behaviors. METHODS A total of 42 BN patients with affective disorders (anxiety and depression) and 47 healthy controls (HCs) were enrolled in this study. The resting-state fMRI data were analyzed for functional changes as indicated by regional homogeneity based on Kendall's coefficient of concordance (KCC-ReHo) and seed-based functional connectivity (FC). A principal component analysis (PCA) model was used to identify the commonalities within the behavioral questionnaires from the BN group. RESULTS Patients in the BN group showed decreased ReHo in the bilateral middle frontal gyrus (MFG) and right supramarginal gyrus (SMG). Additionally, the BN group showed increased FC between the left MFG and the right inferior temporal gyrus (ITG); decreased FC between the right MFG and the bilateral insula and the left middle temporal gyrus (MTG); and decreased FC between the right SMG and the left superior temporal gyrus (STG) and right inferior frontal gyrus (IFG). In the FC-behavior association analysis, the second principal component (PC2) was negatively correlated with FC between the left MFG and the right ITG. CONCLUSION Based on a brain functional analysis (ReHo and FC), this study revealed significant aberrant changes in the frontal-temporal regions of BN patients with affective disorders. These regions, which serve as fronto-temporal circuitry, are associated with restraint and emotional eating behaviors. Our findings shed new light on the neural mechanisms underlying the condition.
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Affiliation(s)
- Jiani Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lirong Tang
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing, China
| | - Miao Wang
- Chinese Institute for Brain Research, Beijing, China
| | - Guowei Wu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Weihua Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yiling Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuemei Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing, China
| | - Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhanjiang Li
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Kuang L, Gao W, Long Z, Cao W, Cui D, Guo Y, Jiao Q, Qiu J, Su L, Lu G. Common and Specific Characteristics of Adolescent Bipolar Disorder Types I and II: A Combined Cortical Thickness and Structural Covariance Analysis. Front Psychiatry 2021; 12:750798. [PMID: 35126192 PMCID: PMC8814452 DOI: 10.3389/fpsyt.2021.750798] [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: 07/31/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND By calculating cortical thickness (CT) and cortical structural covariance (SC), we aimed to investigate cortical morphology and cortical inter-regional correlation alterations in adolescent bipolar disorder type I (BD-I) and type II (BD-II) patients. METHODS T1-weighted images from 36 BD-I and 22 BD-II patients and 19 healthy controls (HCs) were processed to estimate CT. CT values of the whole brain were compared among three groups. Cortical regions showing CT differences in groups were regarded as seeds for analyzing cortical SC differences between groups. The relationship between CT and clinical indices was further assessed. RESULTS Both BD groups showed cortical thinning in several frontal and temporal areas vs. HCs, and CT showed no significant difference between two BD subtypes. Compared to HCs, both BD groups exhibited reduced SC connections between left superior frontal gyrus (SFG) and right postcentral gyrus (PCG), left superior temporal gyrus (STG) and right pars opercularis, and left STG and right PCG. Compared with HCs, decreased SC connections between left STG and right inferior parietal gyrus (IPG) and right pars opercularis and right STG were only observed in the BD-I group, and left PCG and left SFG only in the BD-II group. CT of right middle temporal gyrus was negatively correlated with number of episodes in BD-II patients. CONCLUSIONS Adolescent BD-I and BD-II showed commonly decreased CT while presenting commonly and distinctly declined SC connections. This study provides a better understanding of cortical morphology and cortical inter-regional correlation alterations in BD and crucial insights into neuroanatomical mechanisms and pathophysiology of different BD subtypes.
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Affiliation(s)
- Liangfeng Kuang
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiliang Long
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Weifang Cao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Dong Cui
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Yongxin Guo
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Qing Jiao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Linyan Su
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, China
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Sadana D, Gupta RK, Jain S, Kumaran SS, G S R, Thennarasu K, Rajeswaran J. Neurocognitive profile of patients with Bipolar Affective Disorder in the euthymic phase. Asian J Psychiatr 2019; 44:121-126. [PMID: 31369947 DOI: 10.1016/j.ajp.2019.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 01/16/2023]
Abstract
UNLABELLED Bipolar disorder is a chronic psychiatric condition characterized by episodes of elevated/irritable and depressed moods resulting in the loss of more disability-adjusted life years (DALYs) than other major conditions. The neurocognitive impairments in these patients interfere with sustained goal-directed performance and achievement even during the euthymic phase of the illness. METHODOLOGY The study aimed to explore the neurocognitive profile of patients in their euthymic phase. We matched 30 patients diagnosed with Bipolar Affective Disorder (BD) in the age range of 20-40 years with 30 healthy controls (with no axis I or II diagnosis, assessed on MINI) matched on age, gender, and education. The neurocognitive profile was assessed using NIMHANS Neuropsychology Battery. RESULTS Euthymic phase patients with bipolar disorder had statistically significant low scores on the speed of processing information as compared to healthy controls. Although impaired in BD group, no statistically significant difference was found between the two groups on executive functions and memory. CONCLUSION The findings of the study suggest that cognitive retraining aimed at ameliorating these deficits can be a used as an essential intervention in rehabilitation programs to successfully reintegrate patients with the bipolar affective disorder into the society. The research also indicates that despite the symptomatic recovery between the episodes, impairments in the speed of processing information continue to disrupt performance in patients with Bipolar Disorder.
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Affiliation(s)
- Divya Sadana
- Mazumdar Shaw Center, Narayana Health City, Bengaluru, India
| | - Rajnish Kumar Gupta
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - S Senthil Kumaran
- Department of NMR & MRI Facility, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ravi G S
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
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Saito S, Fujii K, Ozeki Y, Ohmori K, Honda G, Mori H, Kato K, Kuroda J, Aoki A, Asahi H, Sato H, Shimoda K, Akiyama K. Cognitive function, treatment response to lithium, and social functioning in Japanese patients with bipolar disorder. Bipolar Disord 2017; 19:552-562. [PMID: 28691278 DOI: 10.1111/bdi.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/07/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Patients with bipolar disorder often suffer from cognitive impairment that significantly influences their functional outcome. However, it remains unknown whether lithium has a central role in cognition and functional outcome. We examined whether cognition and functional outcome were predicted by demographic and clinical variables, including the response to lithium, in lithium-treated patients with bipolar disorder. METHODS We evaluated 96 lithium-treated euthymic patients with bipolar disorder and 196 age- and-gender-matched healthy controls, using the Brief Assessment of Cognition in Schizophrenia (BACS). The patients were also assessed using the Social Functioning Scale (SFS) and "The Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" (Alda) scale, which was evaluated as either a continuous measure of the total scale or a dichotomous criterion. RESULTS Multiple regression analysis revealed two key findings: first, that the premorbid intelligence quotient, age, and number of mood episodes were predictors of the BACS composite score; and, second, that the BACS composite score, negative symptoms, and continuous measure on the total Alda scale (but not its dichotomy) predicted the total SFS score. Structural equation modeling (SEM) was used to confirm these findings, and additionally revealed that the Alda scale was significantly associated with negative symptoms and also the number of mood episodes, regardless of how it was evaluated. CONCLUSIONS SEM delineated how demographic and clinical variables, cognitive performance, and response to lithium treatment were causally associated with, and converged on, social function. The putative role of the Alda scale for social function warrants further study.
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Affiliation(s)
- Satoshi Saito
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan.,Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kumiko Fujii
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Yuji Ozeki
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kenichi Ohmori
- Shiseikai, Takizawa Hospital, Utsunomiya, Tochigi, Japan
| | - Gyo Honda
- Seiseido Kohseikai, Mori Hospital, Utsunomiya, Tochigi, Japan
| | - Harunobu Mori
- Seiseido Kohseikai, Mori Hospital, Utsunomiya, Tochigi, Japan
| | - Kazuko Kato
- Sakura La Mental Clinic, Utsunomiya, Tochigi, Japan
| | | | - Akiko Aoki
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | | | | | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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Şentürk Cankorur V, Demirel H, Atbaşoğlu C. Cognitive Functioning in Euthymic Bipolar Patients on Monotherapy with Novel Antipsychotics or Mood Stabilizers. ACTA ACUST UNITED AC 2017; 54:244-250. [PMID: 29033637 DOI: 10.5152/npa.2017.15883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/11/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Bipolar disorder is associated with cognitive dysfunction in several domains. Medication effect is a potential confounder that can only be statistically controlled in many studies. The cognitive profile in bipolar disorder during remission on maintenance antipsychotics or mood stabilizers medication has not been compared before. METHODS We compared the cognitive profile of bipolar disorder patients euthymic for 2 month or more on monotherapy with novel antipsychotics (AP) (n=16), lithium carbonate (Li) (n=25) or valproic acid (VPA; n=26). Forty-two individuals were assessed as controls. The cognitive battery included Wechsler Adult Intelligence Scale-Revised (WAIS-R) subtests, the Wechsler Memory Scale (WMS), and Wisconsin Card Sorting Test (WCST). RESULTS All three patient groups compared to controls performed poorly on the working memory and verbal memory tasks (F=3.59, df=3, p=0.02 for WAIS-R Arithmetic and F=123.64, df=3, p<0.01 for WMS Logical Memory). The differences remained significant after controlling for age. Across patients, the only significant difference was between the Li and AP groups in terms of working memory. The Li group performed better (F=3.59, df=2, p=0.02) and the difference survived correction for age and clinical features. CONCLUSIONS The findings of this study suggest that working memory impairment in bipolar patients on monotherapy with atypical AP, whereas verbal memory impairment might be related to bipolar disorder itself. Working memory might be a state marker, whereas verbal memory could be a trait marker of bipolar disorder. Atypical AP might have an adverse effect on cognition in bipolar disorder. These findings cannot be generalized to all bipolar patients, particularly the poor responders to monotherapy.
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Affiliation(s)
| | | | - Cem Atbaşoğlu
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey
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7
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Corréard N, Consoloni JL, Raust A, Etain B, Guillot R, Job S, Loftus J, Médecin I, Bougerol T, Polosan M, Fredembach B, Gard S, M’Bailara K, Kahn JP, Roux P, Homassel AS, Carminati M, Matos L, Olié E, Bellivier F, Courtet P, Henry C, Leboyer M, Azorin JM, Belzeaux R. Neuropsychological functioning, age, and medication adherence in bipolar disorder. PLoS One 2017; 12:e0184313. [PMID: 28873468 PMCID: PMC5584797 DOI: 10.1371/journal.pone.0184313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/22/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives Poor adherence to medication is frequent in bipolar disorder (BD) and has been associated with several factors. To date, the relationship between low adherence and neuropsychological functioning in BD is still unclear. As age and neuropsychological functioning might have opposing influences on adherence, our aim was to investigate this link with a particular focus on the effect of age. Methods In a cross-sectional study, we included 353 patients divided into two age-groups (16–46; 47–71) from a French cohort diagnosed with BD (type I, II, NOS) and strictly euthymic. All patients had a standardized clinical and neuropsychological assessment and were categorized as high (n = 186) or low (n = 167) adherent based on their score from the Medication Adherence Rating Scale. Clinical information was collected based on a standardized interview and clinical validated scales. Neuropsychological performances were evaluated with an established standardized neuropsychological battery for bipolar disorder patients. After univariate analysis, neuropsychological and clinical predictors of low adherence were included in two age-specific stepwise multiple logistic regressions. Results A smaller number of hospitalizations (OR = 0.846, p = 0.012), a shorter illness duration (OR = 0.937, p = 0.003) and higher adverse effects (OR = 1.082, p<0.001) were associated with a greater risk of low adherence in the younger patients. In the older patients, low adherence was also predicted by a smaller number of hospitalizations (OR = 0.727, p = 0.008) and higher adverse effects (OR = 1.124, p = 0.005). Interestingly poor inhibition performance was also a significant predictor of low adherence in older patients (OR = 0.924, p = 0.030). Conclusions We found an age-specific relationship between cognitive functioning and adherence in patients with BD. Poor inhibition performances predicted low adherence in older patients only. Our results highlight the need to provide age-adapted therapeutic interventions to improve adherence in patients with BD.
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Affiliation(s)
- Nadia Corréard
- Department of Psychiatry, AP-HM, Marseille, France
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
| | - Julia-Lou Consoloni
- Department of Psychiatry, AP-HM, Marseille, France
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- CRN2M-UMR7286, Aix-Marseille University, CNRS, Marseille, France
| | - Aurélie Raust
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- AP-HP, Academic Hospital Henri Mondor, Psychiatric and Addictology pole, Créteil, France
| | - Bruno Etain
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- AP-HP, Fernand Widal Hospital, Department of Addictology-Toxicology-Psychiatry and University Paris-7, Paris, France
| | - Romain Guillot
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry and Clinical Psychology, Psychotherapeutic Centre of Nancy, Laxou, France
| | - Sophie Job
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry and Clinical Psychology, Psychotherapeutic Centre of Nancy, Laxou, France
| | - Joséphine Loftus
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - Isabelle Médecin
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - Thierry Bougerol
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry, Academic Hospital of Grenoble, Grenoble, France
| | - Mircea Polosan
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry, Academic Hospital of Grenoble, Grenoble, France
- U1216 INSERM-UGA – Brain stimulation and Systems neuroscience, Grenoble Institute of Neurosciences, La Tronche, France
| | - Benjamin Fredembach
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry, Academic Hospital of Grenoble, Grenoble, France
| | - Sébastien Gard
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Charles-Perrens Hospital, Department of clinical and academic Psychiatry, Bordeaux, France
| | - Katia M’Bailara
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Charles-Perrens Hospital, Department of clinical and academic Psychiatry, Bordeaux, France
- University of Bordeaux, Laboratory of psychology, Bordeaux, France
| | - Jean-Pierre Kahn
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry and Clinical Psychology, Psychotherapeutic Centre of Nancy, Laxou, France
- French Addictovigilance network (CEIP-A) CHRU of Nancy, Nancy, France
- University of Lorraine, Nancy, France
| | - Paul Roux
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry for adults, Academic Hospital of Versailles, UFR of Health Sciences Simone Veil, University of Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Anne-Sophie Homassel
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- Department of Psychiatry for adults, Academic Hospital of Versailles, UFR of Health Sciences Simone Veil, University of Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Mathilde Carminati
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- AP-HP, Fernand Widal Hospital, Department of Addictology-Toxicology-Psychiatry and University Paris-7, Paris, France
| | - Lucile Matos
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- CHRU Lapeyronie, Department of Emergency Psychiatry and Post-Acute Care, Montpellier, France
| | - Emilie Olié
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- CHRU Lapeyronie, Department of Emergency Psychiatry and Post-Acute Care, Montpellier, France
- Inserm, U1061, University of Montpellier, Montpellier, France
| | - Frank Bellivier
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- AP-HP, Fernand Widal Hospital, Department of Addictology-Toxicology-Psychiatry and University Paris-7, Paris, France
| | - Philippe Courtet
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- CHRU Lapeyronie, Department of Emergency Psychiatry and Post-Acute Care, Montpellier, France
- Inserm, U1061, University of Montpellier, Montpellier, France
| | - Chantal Henry
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- AP-HP, Academic Hospital Henri Mondor, Psychiatric and Addictology pole, Créteil, France
- Inserm, U955, Translational Psychiatry, Mondor Institute, Créteil, France
| | - Marion Leboyer
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- AP-HP, Academic Hospital Henri Mondor, Psychiatric and Addictology pole, Créteil, France
- Inserm, U955, Translational Psychiatry, Mondor Institute, Créteil, France
| | - Jean-Michel Azorin
- Department of Psychiatry, AP-HM, Marseille, France
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- CNRS, UMR 7289, Institute of Neurosciences Timone, Marseille, France
| | - Raoul Belzeaux
- Department of Psychiatry, AP-HM, Marseille, France
- FondaMental foundation, Foundation of scientific cooperation, Créteil, France
- CRN2M-UMR7286, Aix-Marseille University, CNRS, Marseille, France
- * E-mail:
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Verbal fluency in bipolar disorders: A systematic review and meta-analysis. J Affect Disord 2017; 207:359-366. [PMID: 27744224 DOI: 10.1016/j.jad.2016.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/29/2016] [Accepted: 09/27/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND One of the main features of bipolar disorder (BD), besides mood dysregulation, is an alteration of the structure of language. Bipolar patients present changes in semantic contents, impaired verbal associations, abnormal prosody and abnormal speed of language highlighted with various experimental tasks. Verbal fluency tasks are widely used to assess the abilities of bipolar patients to retrieve and produce verbal material from the lexico-semantic memory. Studies using these tasks have however yielded discrepant results. The aim of this study was thus to determine the extent of the verbal fluency impairment in BD patients and to evaluate if the deficits are affected by the type of task or by mood states. METHODS A systematic literature search was conducted in MEDLINE, EBSCOHost and Google Scholar and relevant data were submitted to a meta-analysis. RESULTS Thirty-nine studies were retained providing data for 52 independent groups of BD patients. The overall meta-analysis revealed a moderate verbal fluency impairment in BD compared to healthy controls (effect size d=0.61). Comparisons between mood states showed significant differences only between euthymic and manic patients and only on category fluency performances. LIMITATIONS This review is limited by the heterogeneity between studies for the characteristics of BD populations. Also, few of the retained studies examined depressive or mixed episodes. CONCLUSIONS This work confirms that BD patients present with moderate verbal fluency impairments, and underlines the specific effect of mood state on category fluency. This emphasizes the need to distinguish semantic from phonological processes in verbal fluency assessments in BD.
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9
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Longitudinal change in neurocognition and its relation to symptomatic and functional changes over 2years in individuals at clinical high-risk for psychosis. Schizophr Res 2016; 174:50-57. [PMID: 27068568 DOI: 10.1016/j.schres.2016.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Negative symptoms and functional disability represent the core of schizophrenia and both are associated with cognitive impairments. We explored the course of cognitive change and its relation to symptomatic and functional changes in individuals at clinical high-risk (CHR) for psychosis to identify cognitive indicators of long-term course. Such attempts may offer insight into the pathological changes associated with the development of illness in the prodromal state. METHODS Forty-seven CHR individuals completed neurocognitive, clinical, and functional assessments at baseline and 2-year follow-up; twenty-eight healthy controls were assessed for neurocognitive and functional measures at baseline and 2-year follow-up. The delta values of CHR individuals in neurocognitive, clinical, and functional domains were determined from differences between baseline and follow-up scores to estimate the degree of change. RESULTS Although overall longitudinal cognitive performance of CHR individuals improved, the magnitude of improvement was not statistically different from that of normal controls at the group level. However, the individual data yielded two groups of CHR subjects showing opposite trajectories of cognitive change in semantic fluency (i.e., improvement or decline), which was significantly associated with changes in negative symptoms and functioning. Moreover, the relationships between negative symptoms and functioning were more strengthened over time than baseline. CONCLUSIONS Our findings show that semantic fluency seems to be a neurocognitive indicator reflecting clinical courses in CHR individuals. The longitudinal relationship of negative symptoms and functioning with semantic fluency may represent ongoing pathological processes in neural systems involving aberrant fronto-temporal interaction in the early phase of schizophrenia.
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Kuswanto C, Chin R, Sum MY, Sengupta S, Fagiolini A, McIntyre RS, Vieta E, Sim K. Shared and divergent neurocognitive impairments in adult patients with schizophrenia and bipolar disorder: Whither the evidence? Neurosci Biobehav Rev 2016; 61:66-89. [DOI: 10.1016/j.neubiorev.2015.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
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11
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Baez S, Ibanez A. The effects of context processing on social cognition impairments in adults with Asperger's syndrome. Front Neurosci 2014; 8:270. [PMID: 25232301 PMCID: PMC4153041 DOI: 10.3389/fnins.2014.00270] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/11/2014] [Indexed: 12/16/2022] Open
Abstract
Social cognition—the basis of all communicative and otherwise interpersonal relationships—is embedded in specific contextual circumstances which shape intrinsic meanings. This domain is compromised in the autism spectrum disorders (ASDs), including Asperger's syndrome (AS) (DSM-V). However, the few available reports of social cognition skills in adults with AS have largely neglected the effects of contextual factors. Moreover, previous studies on this population have also failed to simultaneously (a) assess multiple social cognition domains, (b) examine executive functions, (c) follow strict sample selection criteria, and (d) acknowledge the cognitive heterogeneity typical of the disorder. The study presently reviewed (Baez et al., 2012), addressed all these aspects in order to establish the basis of social cognition deficits in adult AS patients. Specifically, we assessed the performance of AS adults in multiple social cognition tasks with different context-processing requirements. The results suggest that social cognition deficits in AS imply a reduced ability to implicitly encode and integrate contextual cues needed to access social meaning. Nevertheless, the patients' performance was normal when explicit social information was presented or when the situation could be navigated with abstract rules. Here, we review the results of our study and other relevant data, and discuss their implications for the diagnosis and treatment of AS and other neuropsychiatric conditions (e.g., schizophrenia, bipolar disorder, frontotemporal dementia). Finally, we analyze previous results in the light of a current neurocognitive model of social-context processing.
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Affiliation(s)
- Sandra Baez
- Institute of Cognitive Neurology (INECO) and Institute of Neuroscience, Favaloro University Buenos Aires, Argentina ; UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University Santiago, Chile ; National Scientific and Technical Research Council (CONICET) Buenos Aires, Argentina
| | - Agustin Ibanez
- Institute of Cognitive Neurology (INECO) and Institute of Neuroscience, Favaloro University Buenos Aires, Argentina ; UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University Santiago, Chile ; National Scientific and Technical Research Council (CONICET) Buenos Aires, Argentina ; Universidad Autónoma del Caribe Barranquilla, Colombia ; Australian Research Council, Centre of Excellence in Cognition and its Disorders Sydney NSW, Australia
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Wu G, Wang Y, Mwansisya TE, Pu W, Zhang H, Liu C, Yang Q, Chen EYH, Xue Z, Liu Z, Shan B. Effective connectivity of the posterior cingulate and medial prefrontal cortices relates to working memory impairment in schizophrenic and bipolar patients. Schizophr Res 2014; 158:85-90. [PMID: 25043264 DOI: 10.1016/j.schres.2014.06.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/22/2014] [Accepted: 06/24/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schizophrenia (SZ) and bipolar I disorder (BD) share many overlapping clinical features, confounding the current diagnostic systems. Recent studies suggest the posterior cingulate (PCC) and medial prefrontal (MPFC) cortices that are involved in SZ and BD pathophysiology. However, the roles of PCC and MPFC in providing specific distinctive and shared neural substrates between these two disorders remain largely unknown. Examining the neurophysiologic mechanism of these diseases may help explain the clinical observations and differentiate the two disorders. METHODS We used the Dynamic Casual Modeling (DCM), which is capable of eliciting hidden neuronal dynamics and reveal cross-regulation of multiple neuronal systems, to characterize the pattern of disrupted effective connectivity in the left PCC-MPFC circuit during working memory tasks in 36 SZ and 20 BD patients as well as 29 healthy controls. RESULTS Compared to the healthy controls, both SZ and BD patient groups exhibited significant negative effective connectivity from the left MPFC to PCC. The negative effective connectivity was more remarkable in schizophrenic patients. Only patients with BD differed from healthy controls with positive effective connectivity from the left PCC to MPFC. CONCLUSIONS Whole brain analysis revealed deactivation of the left PCC and MPFC across all patient groups. This study provides new insight that changes in effective connectivity of the left MPFC to left PCC circuit during working memory processing may be a core pathophysiological feature distinguishing SZ from BD.
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Affiliation(s)
- Guowei Wu
- Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Yunxia Wang
- Key Laboratory of Nuclear Radiation and Nuclear Energy Technology, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China; National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Tumbwene E Mwansisya
- Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; College of Health Sciences, University of Dodoma, P.O. Box 395, Dodoma, Tanzania
| | - Weidan Pu
- Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Huiran Zhang
- Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Chang Liu
- Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Qing Yang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Zhimin Xue
- Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Zhening Liu
- Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan 410011, China.
| | - Baoci Shan
- Key Laboratory of Nuclear Radiation and Nuclear Energy Technology, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China; Beijing Engineering Research Center of Radiographic Techniques and Equipment, Beijing 100049, China.
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Melcher T, Wolter S, Falck S, Wild E, Wild F, Gruber E, Falkai P, Gruber O. Common and disease-specific dysfunctions of brain systems underlying attentional and executive control in schizophrenia and bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2014; 264:517-32. [PMID: 24061607 DOI: 10.1007/s00406-013-0445-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022]
Abstract
Schizophrenia and bipolar disorder broadly overlap in multiple areas involving clinical phenomenology, genetics, and neurobiology. Still, the investigation into specific elementary (sub-)processes of executive functioning may help to define clear points of distinction between these categorical diagnoses to validate the nosological dichotomy and, indirectly, to further elucidate their pathophysiological underpinnings. In the present behavioral study, we sought to separate common from diagnosis-specific deficits in a series of specific elementary sub-functions of executive processing in patients with schizophrenia and bipolar disorder. For our purpose, we administered a modern and multi-purpose neuropsychological task paradigm to equal-sized and matched groups of schizophrenia patients, patients with bipolar disorder, and healthy control subjects. First, schizophrenia patients compared to the bipolar group exhibited a more pronounced deficit in general measures of task performance comprising both response speed and accuracy. Additionally, bipolar patients showed increased advance task preparation, i.e., were better able to compensate for response speed deficits when longer preparation intervals were provided. Set-shifting, on the other hand, was impaired to a similar degree in both patient groups. Finally, schizophrenia patients exhibited a specific deficit in conflict processing (inhibitory control) and the shielding of task-relevant processing from distraction (i.e., attentional maintenance). The present investigation suggests that specific neuropsychological measures of elementary executive functions may represent important points of dissociation between schizophrenia and bipolar disorder, which may help to differentiate the pathophysiological underpinnings of these major psychiatric disorders. In this context, the present findings highlight the measures of inhibitory control and attentional maintenance as promising candidates.
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Affiliation(s)
- Tobias Melcher
- Centre for Translational Research in Systems Neuroscience and Clinical Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany,
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Sedeño L, Moya Á, Baker P, Ibáñez A. Cognición social contexto-dependiente y redes frontotemporo-insulares. INTERNATIONAL JOURNAL OF SOCIAL PSYCHOLOGY 2014. [DOI: 10.1174/021347413807719085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Lucas Sedeño
- Laboratorio de Psicología Experimental y Neurociencias (LPEN), Instituto de Neurología Cognitiva (INECO), Buenos Aires, Argentina
- Universidad Favaloro, Buenos Aires, Argentina
- Universidad Diego Portales, Santiago, Chile
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Álvaro Moya
- Laboratorio de Psicología Experimental y Neurociencias (LPEN), Instituto de Neurología Cognitiva (INECO), Buenos Aires, Argentina
| | - Phil Baker
- Laboratorio de Psicología Experimental y Neurociencias (LPEN), Instituto de Neurología Cognitiva (INECO), Buenos Aires, Argentina
| | - Agustín Ibáñez
- Laboratorio de Psicología Experimental y Neurociencias (LPEN), Instituto de Neurología Cognitiva (INECO), Buenos Aires, Argentina
- Universidad Favaloro, Buenos Aires, Argentina
- Universidad Diego Portales, Santiago, Chile
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Monotherapy with lithium or valproate or respectively combination therapy with quetiapine have similar effect on cognitive functions in Chinese euthymic patients with bipolar disorder: a cross-sectional survey. J Clin Psychopharmacol 2013; 33:817-9. [PMID: 23963059 DOI: 10.1097/jcp.0b013e31829c96e9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Baez S, Herrera E, Villarin L, Theil D, Gonzalez-Gadea ML, Gomez P, Mosquera M, Huepe D, Strejilevich S, Vigliecca NS, Matthäus F, Decety J, Manes F, Ibañez AM. Contextual social cognition impairments in schizophrenia and bipolar disorder. PLoS One 2013; 8:e57664. [PMID: 23520477 PMCID: PMC3592887 DOI: 10.1371/journal.pone.0057664] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/23/2013] [Indexed: 01/09/2023] Open
Abstract
Background The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. Methodology/Principal Findings This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks. Conclusions/Significance Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.
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Affiliation(s)
- Sandra Baez
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Eduar Herrera
- Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Lilian Villarin
- Interdisciplinary Center for Scientific Computing, University of Heidelberg, Heidelberg, Germany
| | | | - María Luz Gonzalez-Gadea
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Pedro Gomez
- CARI University Hospital, Barranquilla, Colombia
| | | | - David Huepe
- Laboratory of Cognitive and Social Neuroscience, Universidad Diego Portales, Santiago, Chile
| | - Sergio Strejilevich
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
| | - Nora Silvana Vigliecca
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Instituto de Humanidades (IDH) de la Facultad de Filosofía y Humanidades, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Franziska Matthäus
- Interdisciplinary Center for Scientific Computing, University of Heidelberg, Heidelberg, Germany
| | - Jean Decety
- Departments of Psychology and Psychiatry, and Center for Cognitive and Social Neuroscience, University of Chicago, Chicago, Illinois, United States of America
| | - Facundo Manes
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
| | - Agustín M. Ibañez
- Institute of Cognitive Neurology (INECO) & Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Laboratory of Cognitive and Social Neuroscience, Universidad Diego Portales, Santiago, Chile
- * E-mail:
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Brambilla P, Perlini C, Bellani M, Tomelleri L, Ferro A, Cerruti S, Marinelli V, Rambaldelli G, Christodoulou T, Jogia J, Dima D, Tansella M, Balestrieri M, Frangou S. Increased salience of gains versus decreased associative learning differentiate bipolar disorder from schizophrenia during incentive decision making. Psychol Med 2013; 43:571-580. [PMID: 22687364 DOI: 10.1017/s0033291712001304] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Abnormalities in incentive decision making, typically assessed using the Iowa Gambling Task (IGT), have been reported in both schizophrenia (SZ) and bipolar disorder (BD). We applied the Expectancy-Valence (E-V) model to determine whether motivational, cognitive and response selection component processes of IGT performance are differentially affected in SZ and BD. METHOD Performance on the IGT was assessed in 280 individuals comprising 70 remitted patients with SZ, 70 remitted patients with BD and 140 age-, sex- and IQ-matched healthy individuals. Based on the E-V model, we extracted three parameters, 'attention to gains or loses', 'expectancy learning' and 'response consistency', that respectively reflect motivational, cognitive and response selection influences on IGT performance. RESULTS Both patient groups underperformed in the IGT compared to healthy individuals. However, the source of these deficits was diagnosis specific. Associative learning underlying the representation of expectancies was disrupted in SZ whereas BD was associated with increased incentive salience of gains. These findings were not attributable to non-specific effects of sex, IQ, psychopathology or medication. CONCLUSIONS Our results point to dissociable processes underlying abnormal incentive decision making in BD and SZ that could potentially be mapped to different neural circuits.
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Affiliation(s)
- P Brambilla
- DISM, Inter-University Centre for Behavioural Neurosciences (ICBN), University of Udine, Italy
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Oliveira S, Kapczinski F, Camey S, Trentini C. Assessment of Executive Functions in a Brazilian Sample of Bipolar Subjects. SPANISH JOURNAL OF PSYCHOLOGY 2013; 14:859-68. [DOI: 10.5209/rev_sjop.2011.v14.n2.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research has demonstrated impairments in executive functions in Bipolar Mood Disorder patients. Evidence shows that this impairment is present in both periods of active symptoms of the disorder, as well as euthymic stages, and is compounded by mood episodes, especially manic phases. The purpose of this study was to compare the executive performance of a sample of Brazilian bipolar patients in depressive episodes, (44 participants), euthymia (37 participants), and in controls (43 participants). The main instrument for evaluation was the Wisconsin Card Sorting Test. Significant differences were found in performance on the Wisconsin Card Sorting Test between Bipolar subjects (Type I) (both in depression and euthymia) and the controls. No significant correlations were found between the number of manic episodes and the performance on execute measurement variables. The findings suggest that the executive dysfunctions in Bipolar Disorder may be related to both transitory and permanent deficits.
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Christodoulou T, Messinis L, Papathanasopoulos P, Frangou S. The impact of familial risk for schizophrenia or bipolar disorder on cognitive control during episodic memory retrieval. Psychiatry Res 2012; 197:212-6. [PMID: 22417935 DOI: 10.1016/j.psychres.2011.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 12/24/2022]
Abstract
Episodic memory impairment is a robust correlate of familial risk for schizophrenia (SZ) and bipolar disorder (BD); still much is unknown about the processes that underlie this deficit and how they may be implicated in BD and SZ. We examined the possibility that (a) episodic memory impairment may arise from abnormalities in the cognitive control of interference between task-relevant and task-irrelevant memories during retrieval; inability to suppress task-irrelevant representations could give rise to intrusions of inappropriate memories and increased rate of forgetting, (b) cognitive control deficits during retrieval may be differentially affected by familial predisposition to SZ or BD. We examined episodic memory in relatives of patients with SZ (SZ-R) (n=15) or BD (BD-R) (n=17) compared to healthy controls (n=23) using the California Verbal Learning Test (CVLT) and the Doors and People Test (DPT). All relatives were free of any psychiatric morbidity and were matched to controls on age, sex, educational achievement and general intellectual ability. During the CVLT, both relatives' groups made significantly more perseverative recall errors than controls. However, intrusion errors were significantly increased in SZ-R only. SZ-R also showed increased rate of forgetting in the DPT while BD-R were comparable to controls. Familial predisposition to SZ, compared to that of BD, was associated with significantly greater impairment in cognitive control processes during episodic memory retrieval with some evidence of specificity for SZ in connection with mechanisms relating to increased forgetting.
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Affiliation(s)
- Tessa Christodoulou
- Section of Neurobiology of Psychosis, Institute of Psychiatry, King's College London, UK.
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20
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Dissociable and common deficits in inhibitory control in schizophrenia and bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2012; 262:125-30. [PMID: 21512857 DOI: 10.1007/s00406-011-0213-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/07/2011] [Indexed: 01/30/2023]
Abstract
Current research focuses on delineating the neurobiological boundaries between familial risk for schizophrenia (SZ) and bipolar disorder (BD). Available evidence suggests that inhibitory control may be affected in both disorders. Inhibitory control relies on the dual processes of contextual information maintenance and response inhibition. This study investigated the effect of familial risk of SZ or BD on these two aspects of inhibitory control. Seventeen healthy first-degree relatives of patients with BD (BD-R), 15 healthy relatives of patients with SZ (SZ-R) and 23 demographically matched controls were compared in terms of their performance during Controlled Oral Word Association (COWA), which measures contextually driven response selection, and during the Hayling Sentence Completion Test (HSCT), which assesses contextual response selection and inhibition. Compared to controls and BD-R, SZ-R showed deficits in contextual information processing that resulted in spontaneous errors in the COWA as well as deficits in response inhibition during the HSCT that resulted in higher error rates. BD-R also showed deficits in response inhibition during the HSCT relative to controls, which were, however, less pronounced than for SZ-R. Both relatives groups had longer response times. Our results suggest that failure in contextual maintenance is primarily associated with familial risk for SZ, while response inhibition may be a shared marker of familial risk for both disorders.
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Torres I, Solé B, Vieta E, Martinez-Aran A. Neurocognitive impairment in the bipolar spectrum. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sole B, Bonnin CM, Torrent C, Martinez-Aran A, Popovic D, Tabarés-Seisdedos R, Vieta E. Neurocognitive impairment across the bipolar spectrum. CNS Neurosci Ther 2011; 18:194-200. [PMID: 22128808 DOI: 10.1111/j.1755-5949.2011.00262.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Bipolar disorder is a severe mental illness that affects nearly 4.4% of the general population when bipolar spectrum disorders are taken into account. Neurocognitive impairment is thought to be a core deficit of this illness since it is present during euthymia. In fact, 40-60% of euthymic patients present with neurocognitive disturbances. Not only the clinical factors but also disturbances in neurocognition can influence the functional outcome of BD patients. Hence, further research is needed in order to clarify the relationship between these variables. Despite the growing body of evidence that has emerged during the last decade, no unique neurocognitive profile has been proposed yet for either BD subtype. The majority of the studies recluted heterogeneous samples (including both bipolar I and II) or focused on BD-I patients only. The aim of this review is to give an overall picture of the main neurocognitive disturbances found in the bipolar spectrum and particularly in BD-II, where the findings are more ambiguous. An extensive review of all the literature has been done regarding this subtype (from 1980 until July 2009). Data available until now suggest that deficits are present across the bipolar spectrum (BD-I and BD-II), but they seem slightly more severe in BD-I. The extent to which either subtype share-or not-some similarities is still unknown. More studies are required but it would also be interesting to reach a consensus in the neuropsychological assessment of BD to facilitate comparisons between the different studies.
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Affiliation(s)
- B Sole
- Bipolar Disorders Programme, Institute of Clinical Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Giakoumaki SG, Roussos P, Pallis EG, Bitsios P. Sustained attention and working memory deficits follow a familial pattern in schizophrenia. Arch Clin Neuropsychol 2011; 26:687-95. [PMID: 21813556 DOI: 10.1093/arclin/acr060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Cognitive deficits are core features of schizophrenia and considered putative endophenotypes. This study assessed the familial pattern of deficits in sustained attention, working memory and executive function in remitted-schizophrenia patients and their unaffected siblings. Sixteen patients, 16 unaffected siblings, and 17 healthy control subjects underwent a battery of neuropsychological tasks that have so far yielded mixed findings in performance differences. Both groups had prolonged reaction times compared with controls in sustained attention tasks; the siblings made more false alarms in the working memory task, but only the patients' performance was poorer in the executive function tasks. These findings further support sustained attention and working memory deficits as potential endophenotypes of schizophrenia. Reaction time and false alarm rates are suggested as additional useful endophenotypic measures that could potentially account for differences in performance in tasks that are not purported to examine the specific measures per se.
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Diwadkar VA, Goradia D, Hosanagar A, Mermon D, Montrose DM, Birmaher B, Axelson D, Rajarathinem R, Haddad L, Amirsadri A, Zajac-Benitez C, Rajan U, Keshavan MS. Working memory and attention deficits in adolescent offspring of schizophrenia or bipolar patients: comparing vulnerability markers. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1349-54. [PMID: 21549798 PMCID: PMC3126676 DOI: 10.1016/j.pnpbp.2011.04.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND Working memory deficits abound in schizophrenia and attention deficits have been documented in schizophrenia and bipolar disorder. Adolescent offspring of patients may inherit vulnerabilities in brain circuits that subserve these cognitive domains. Here we assess impairments in offspring of schizophrenia (SCZ-Offspring) or bipolar (BP-Offspring) patients compared to controls (HC) with no family history of mood or psychotic disorders to the second degree. METHODS Three groups (n=100 subjects; range: 10-20 yrs) of HC, SCZ-Offspring and BP-Offspring gave informed consent. Working memory was assessed using a delayed spatial memory paradigm with two levels of delay (2s & 12s); sustained attention processing was assessed using the Continuous Performance Task-Identical Pairs version. RESULTS SCZ-Offspring (but not BP-Offspring) showed impairments in working memory (relative to HC) at the longer memory delay indicating a unique deficit. Both groups showed reduced sensitivity during attention but only BP-Offspring significantly differed from controls. CONCLUSIONS These results suggest unique (working memory/dorsal frontal cortex) and potentially overlapping (attention/fronto-striatal cortex) vulnerability pathways in adolescent offspring of patients with schizophrenia and bipolar disorder. Working memory and attention assessments in these offspring may assist in the clinical characterization of the adolescents vulnerable to SCZ or BP.
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Affiliation(s)
- Vaibhav A. Diwadkar
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM,Dept of Psychiatry, University of Pittsburgh SOM,Address Correspondence to: Vaibhav A. Diwadkar, PhD, Division of Brain Research & Imaging Neuroscience, Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM, UHC 9B, 4201 St. Antoine Blvd, Detroit MI 48301, U.S.A., Ph: 1.313.577.0164, Fax: 1.313.577.5900,
| | - Dhruman Goradia
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | | | - Diana Mermon
- Dept of Psychiatry, University of Pittsburgh SOM
| | | | | | | | - R. Rajarathinem
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Luay Haddad
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Ali Amirsadri
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | | | - Usha Rajan
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
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Brambilla P, Cerruti S, Bellani M, Perlini C, Ferro A, Marinelli V, Giusto D, Tomelleri L, Rambaldelli G, Tansella M, Diwadkar VA. Shared impairment in associative learning in schizophrenia and bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1093-9. [PMID: 21420463 DOI: 10.1016/j.pnpbp.2011.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Schizophrenia (SCZ) and bipolar disorder (BD) share some cognitive commonalities. However, the role of associative learning, which is a cornerstone of human cognition mainly relying on hippocampus, has been under-investigated. We assessed behavioral performance during associative learning in a group of SCZ, BD and healthy controls (HC). METHODS Nineteen patients with SCZ (36 ± 8.1 years; 13 males, 6 females; all Caucasians), 14 patients with BD (41 ± 9.6 years; 5 males, 9 females; all Caucasians) and 45 HC (27.7 ± 6.9 years; 18 males, 27 females; all Caucasians) were studied. Learning was assessed using an established object-location paired-associative learning paradigm. Subjects learned associations between nine equi-familiar common objects and locations in a nine-location grid. Performance data were analyzed in a repeated measures analysis of variance with time (repeated) and group as factors. RESULTS Learning curves (performance = (1-e(-k x time)) fitted to average performance data in the three groups revealed lower learning rates in SCZ and BD (k = 0.17 and k = 0.34) than HC (k = 0.78). Significant effects of group (F = 11.05, p < 0.001) and time (F = 122.06, p < 0.001) on learning performance were observed. CONCLUSIONS Our study showed that associative learning is impaired in both SCZ and BD, being potentially not affected by medication. Future studies should investigate the neural substrates of learning deficits in SCZ and BD, particularly focusing on hippocampus function and glutamatergic transmission.
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Affiliation(s)
- Paolo Brambilla
- DISM, Inter-University Centre for Behavioural Neurosciences, University of Udine, Udine, Italy.
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Abstract
The purpose of the study was to compare the cognitive functioning of persons with a recent onset of psychosis with schizophrenia-spectrum disorders and bipolar disorder and nonpsychiatric controls. A total of 56 persons with a schizophrenia-spectrum disorder and 60 with bipolar disorder, all with a recent onset psychosis, and 312 nonpsychiatric controls were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Wisconsin Card Sorting Test (WCST). Comparison of the three groups through analysis of covariance indicated a significant difference among the groups for all of the cognitive variables. Pairwise contrasts of the two recent onset groups showed a significant difference favoring the bipolar disorder group on RBANS Language (p = 0.020) and Total (p = 0.050) and a marginally significant difference on RBANS Immediate Memory (p = 0.053) but not on the other RBANS variables or on the WCST. Cognitive performance is broadly impaired in recent onset psychosis, with a cognitive advantage to bipolar disorder patients compared with schizophrenia-spectrum patients.
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Oribe N, Onitsuka T, Hirano S, Hirano Y, Maekawa T, Obayashi C, Ueno T, Kasai K, Kanba S. Differentiation between bipolar disorder and schizophrenia revealed by neural oscillation to speech sounds: an MEG study. Bipolar Disord 2010; 12:804-12. [PMID: 21176027 DOI: 10.1111/j.1399-5618.2010.00876.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Psychiatrists have long debated whether bipolar disorder (BP) and schizophrenia (SZ) are the clinical outcomes of discrete or shared causative processes. SZ shows significantly delayed peak latencies of the evoked neural oscillation (eNO) power and reduced eNO power to speech sounds in the left hemisphere in comparison to normal controls (NC), suggesting deficits in the fast mechanism for identifying speech sounds for SZ. The current study tested the hypothesis that the eNO to speech sounds could be differentiated between BP and SZ patients. METHODS The magnetoencephalographic data of 11 BP, 12 SZ, and 15 NC subjects were evaluated, and we analyzed the eNO power and phase-locking in 20-45 Hz to speech sounds and pure tones in the left hemisphere. RESULTS The major findings were that: (i) BP subjects exhibited larger eNO power to speech sounds compared to NC and SZ; (ii) SZ subjects showed delayed eNO and phase-locking to speech sounds specifically in the left hemisphere; and (iii) no significant differences were observed in the response to pure tones among the three groups. CONCLUSIONS The present study showed that different patterns in eNO to speech sounds are present in BP, SZ, and NC subjects. The eNO to speech sounds in the left hemisphere is a potential index to distinguish BP and SZ.
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Affiliation(s)
- Naoya Oribe
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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28
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Stefanopoulou E, Manoharan A, Landau S, Geddes JR, Goodwin G, Frangou S. Cognitive functioning in patients with affective disorders and schizophrenia: a meta-analysis. Int Rev Psychiatry 2010; 21:336-56. [PMID: 20374148 DOI: 10.1080/09540260902962149] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is considerable evidence for cognitive dysfunction in schizophrenia and affective disorders, but the pattern of potential similarities or differences between diagnostic groups remains uncertain. The objective of this study was to conduct a quantitative review of studies on cognitive performance in schizophrenia and affective disorders. Relevant articles were identified through literature search in major databases for the period between January 1980 and December 2005. Meta-analytic treatment of the original studies revealed widespread cognitive deficits in patients with schizophrenia and affective disorders in intellectual ability and speed of information processing, in encoding and retrieval, rule discovery and in response generation and response inhibition. Differences between diagnostic groups were quantitative rather than qualitative.
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Affiliation(s)
- Evgenia Stefanopoulou
- Section of Neurobiology of Psychosis, Institute of Psychiatry and Biomedical Research Centre for Mental Health, King's College London, London, UK
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29
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Jäger M, Haack S, Becker T, Frasch K. Schizoaffective disorder--an ongoing challenge for psychiatric nosology. Eur Psychiatry 2010; 26:159-65. [PMID: 20646917 DOI: 10.1016/j.eurpsy.2010.03.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 02/12/2010] [Accepted: 03/04/2010] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Schizoaffective disorder is a common diagnosis in mental health services. The present article aims to provide an overview of diagnostic reliability, symptomatology, outcome, neurobiology and treatment of schizoaffective disorder. METHOD Literature was identified by searches in "Medline" and "Cochrane Library". RESULTS The diagnosis of schizoaffective disorder has a low reliability. There are marked differences between the current diagnostic systems. With respect to psychopathological symptoms, no clear boundaries were found between schizophrenia, schizoaffective disorder and affective disorders. Common neurobiological factors were found across the traditional diagnostic categories. Schizoaffective disorder according to ICD-10 criteria, but not to DSM-IV criteria, shows a more favorable outcome than schizophrenia. With regard to treatment, only a small and heterogeneous database exists. CONCLUSION Due to the low reliability and questionable validity there is a substantial need for revision and unification of the current diagnostic concepts of schizoaffective disorder. If future diagnostic systems return to Kraepelin's dichotomous classification of non-organic psychosis or adopt a dimensional diagnostic approach, schizoaffective disorder will disappear from the psychiatric nomenclature. A nosological model with multiple diagnostic entities, however, would be compatible with retaining the diagnostic category of schizoaffective disorder.
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Affiliation(s)
- M Jäger
- Department of Psychiatry II, Ulm University, BKH Günzburg, Ludwig-Heilmeyer-Strasse 2, Günzburg, Germany.
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Wobrock T, Ecker UKH, Scherk H, Schneider-Axmann T, Falkai P, Gruber O. Cognitive impairment of executive function as a core symptom of schizophrenia. World J Biol Psychiatry 2010; 10:442-51. [PMID: 18609418 DOI: 10.1080/15622970701849986] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cognitive dysfunction is a common finding in schizophrenia. Nevertheless the specific pattern of neuropsychological impairment in schizophrenia compared to other severe mental illnesses has not been intensively studied. Twenty-four patients with schizophrenia belonging to different stages of the disease (11 first-episode patients, 13 patients with multiple episodes), 18 patients with bipolar disorder and 23 healthy control subjects underwent standardized neuropsychological assessment. Statistical analysis of covariance (ANCOVA) demonstrated that, compared to control subjects, patients with schizophrenia performed significantly worse in the trail-making test (P = 0.012), verbal fluency (category letter, P = 0.004), verbal learning/memory (P = 0.005), and the Wisconsin Card Sorting Test (WCST) (P = 0.004 for administered trials; P = 0.025 for perseverative responses, T value) indicating significant deficits in attention and psychomotor performance, and in particular in verbal working memory and cognitive flexibility for schizophrenic patients. A significant difference between schizophrenic and bipolar patients was found only in the WCST. Schizophrenic patients made significantly more perseverative responses (P = 0.002, ANCOVA), indicating a more pronounced and specific deficit in cognitive flexibility and frontally based executive function. In conclusion, these results may suggest a cognitive endophenotype in schizophrenia and underline the role of the prefrontal cortex in schizophrenic pathophysiology.
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Affiliation(s)
- Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University, Göttingen, Germany.
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31
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Bhardwaj R, Chakrabarti S, Mittal BR, Sharan P. A single photon emission computerized tomography (SPECT) study of regional cerebral blood flow in bipolar disorder. World J Biol Psychiatry 2010; 11:334-43. [PMID: 20218796 DOI: 10.3109/15622970802575977] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Data on functional imaging of bipolar disorder (BD) utilizing single photon emission computerized tomography (SPECT) is limited. This study assessed regional cerebral blood flow (rCBF), using (99m)Tc-ECD SPECT, among patients with BD, with mania (N=10) or depression (N=10), compared with 10 patients with unipolar depression and 10 normal controls. Regions of interest were analysed using a semi-automatic brain quantification programme. Compared to controls, patients with mania had significantly reduced perfusion mainly in the left frontal area, also in the left anterior cingulate and parietal cortices; those with bipolar depression had significantly lowered rCBF principally in the anterior temporal regions bilaterally, as well as the left parietal area. Patients with unipolar depression had significantly lowered perfusion than controls in most of the regions examined, chiefly in the anterior temporal and frontal cortices bilaterally; they also had lowered perfusion in the right anterior temporal and frontal areas, as well as the right middle temporal area and the right thalamus, compared to patients with mania. Increased severity of psychotic symptoms was associated with reduced rCBF in patients. These results indicate that altered blood flow in the frontal-subcortical systems characterises patients with BD, as well as those with unipolar depression.
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Affiliation(s)
- Rahul Bhardwaj
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Juselius S, Kieseppa T, Kaprio J, Lonnqvist J, Tuulio-Henriksson A. Executive Functioning in Twins with Bipolar I Disorder and Healthy Co-Twins. Arch Clin Neuropsychol 2009; 24:599-606. [DOI: 10.1093/arclin/acp047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yen CF, Cheng CP, Huang CF, Ko CH, Yen JY, Chang YP, Chen CS. Relationship between psychosocial adjustment and executive function in patients with bipolar disorder and schizophrenia in remission: the mediating and moderating effects of insight. Bipolar Disord 2009; 11:190-7. [PMID: 19267701 DOI: 10.1111/j.1399-5618.2008.00650.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this study were to examine the relationships between executive function and psychosocial adjustment, and the mediating and moderating effects of insight on the association between executive function and psychosocial adjustment in patients with bipolar disorder and schizophrenia in clinical remission. METHODS The level of psychosocial adjustment was assessed in 96 subjects with bipolar disorder and 96 subjects with schizophrenia who were in remitted state. The association between executive function and psychosocial adjustment and the mediating and moderating effects of insight were examined by multiple regression analysis models and the Goodman test. RESULTS The results indicated that executive function had direct effect on psychosocial adjustment in both subjects with bipolar disorder and schizophrenia. However, the mediating effect of insight on the association between executive function and psychosocial adjustment was only found in subjects with schizophrenia, but not in subjects with bipolar disorder. No moderating effect of insight on the association between executive function and psychosocial adjustment was found in subjects with schizophrenia or bipolar disorder. CONCLUSIONS The results of this study indicated that executive function has an important role in psychosocial adjustment in both patients with bipolar disorder and schizophrenia. Meanwhile, insight has a different role in the association between executive function and psychosocial adjustment between patients with bipolar disorder and schizophrenia.
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Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, Taiwan
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Soreca I, Frank E, Kupfer DJ. The phenomenology of bipolar disorder: what drives the high rate of medical burden and determines long-term prognosis? Depress Anxiety 2009; 26:73-82. [PMID: 18828143 PMCID: PMC3308337 DOI: 10.1002/da.20521] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Bipolar disorder (BD) has been classically described as one of episodic mood disturbances. New evidence suggests that a chronic course and multisystem involvement is the rule, rather than the exception, and that together with disturbances of circadian rhythms, mood instability, cognitive impairment, a high rate of medical burden is often observed. The current diagnostic approach for BD neither describes the multisystem involvement that the recent literature has highlighted nor points toward potential predictors of long- term outcome. In light of the new evidence that the long-term course of BD is associated with a high prevalence of psychiatric comorbidity and an increased mortality from medical disease, we propose a multidimensional approach that includes several symptom domains, namely affective instability, circadian rhythm dysregulation, and cognitive and executive dysfunction, presenting in various combinations that give shape to each individual presentation, and offers potential indicators of overall long-term prognosis.
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Affiliation(s)
- Isabella Soreca
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Andersson S, Barder HE, Hellvin T, Løvdahl H, Malt UF. Neuropsychological and electrophysiological indices of neurocognitive dysfunction in bipolar II disorder. Bipolar Disord 2008; 10:888-99. [PMID: 19594504 DOI: 10.1111/j.1399-5618.2008.00638.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There are conflicting findings regarding the nature and degree of neurocognitive dysfunction in bipolar II disorder (BD II). The aim of this study was to describe different levels of neurocognitive functioning in BD II by combining behavior-based methods (neuropsychological testing) and event-related potentials (ERP). METHODS Twenty-five consecutively referred outpatients fulfilling DSM-IV criteria for BD II and 28 matched controls performed a neuropsychological test battery targeting working memory/attention, executive functions, verbal and visual memory, and psychomotor speed. In addition, ERPs for measuring early and controlled stages of information processing were recorded using a duration mismatch negativity (MMN) paradigm and a three-tone auditory oddball paradigm. RESULTS Compared to controls, BD II patients' performance was significantly impaired on all neuropsychological measures, except for phonemic verbal fluency, with moderate to strong effect sizes ranging from 0.62 to 1.34. The ERP results indicate dysfunctions in early stages of information processing, showing a significant MMN latency increase and attenuated frontal amplitudes in BD II patients. Female patients showed increased P3a latency compared to female controls, but no group differences were found for P3b latency or amplitude, the ERP component expressing controlled information processing. CONCLUSIONS The functional significance of neuropsychological impairment is discussed. Differences regarding some aspects of executive function may be related to psychomotor speed, and not primarily to dysexecutive functioning. ERP results must be interpreted with caution, but the differences found in MMN latency and amplitudes may be related to fronto-temporal circuitry underlying pre-attentive stimulus change detection as measured by MMN, and are discussed in relation to previous research on MMN in other neuropsychiatric conditions.
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Affiliation(s)
- Stein Andersson
- Department of Neuropsychiatry and Psychosomatic Medicine, Division of Clinical Neurosciences, Rikshospitalet University Hospital, Oslo N-0027, Norway.
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36
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A roadmap to disentangle the molecular etiology of schizophrenia. Eur Psychiatry 2008; 23:224-32. [PMID: 18583106 DOI: 10.1016/j.eurpsy.2008.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 12/08/2007] [Accepted: 02/26/2008] [Indexed: 12/17/2022] Open
Abstract
Schizophrenia is a severe mental disorder striking mainly young adults and leading to life-long disability in a substantial portion of the sufferers. On the other hand, substantial knowledge about its etiology and pathogenesis is still lacking. Therefore the European Science Foundation (ESF) sponsored a meeting of a panel of European experts on schizophrenia research to discuss the state of art and future perspectives of key topics in this area. The fields covered genetics, epidemiology, animal models, molecular neuropathology and imaging. This was a first step to establish a network of European groups dedicated to Schizophrenia research. The coming calls of the frame work program will be used to strengthen this network in order to achieve substantial progress in understanding and treating this devastating illness.
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de Almeida Rocca CC, de Macedo-Soares MB, Gorenstein C, Tamada RS, Isller CK, Dias RS, de Almeida KM, Schwartzmann AM, Amaral JA, Lafer B. Verbal fluency dysfunction in euthymic bipolar patients: a controlled study. J Affect Disord 2008; 107:187-92. [PMID: 17716747 DOI: 10.1016/j.jad.2007.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 06/25/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study the executive functioning in euthymic bipolar patients in comparison to healthy controls and to examine the relationship between neuropsychological deficits and clinical variables. METHODS Twenty-five euthymic bipolar patients and 31 controls underwent a battery of executive tasks including mental flexibility, inhibitory control and verbal fluency tests. RESULTS There were no significant differences between bipolar patients and controls in relation to mental flexibility and inhibitory control. However, patients performed worse than controls on verbal fluency tests. Poor performances on the Stroop Test and the Hayling and Brixton Tests--part A were associated to lifetime occurrence of psychotic symptoms, prior number of episodes, and previous hospitalizations. CONCLUSIONS In our study, only verbal fluency tests differentiated bipolar euthymic patients from healthy controls. Patients who showed deficits in information processing speed and inhibitory control had more episodes and hospitalizations and lifetime occurrence of psychotic symptoms.
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Malhi GS, Green M, Fagiolini A, Peselow ED, Kumari V. Schizoaffective disorder: diagnostic issues and future recommendations. Bipolar Disord 2008; 10:215-30. [PMID: 18199238 DOI: 10.1111/j.1399-5618.2007.00564.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Difficulties surrounding the classification of mixed psychotic and affective syndromes continue to plague psychiatric nosology. This paper addresses the controversy regarding the diagnostic validity of schizoaffective disorder (SAD), a diagnosis that is used in both DSM-IV and ICD-10 and one that encroaches on both schizophrenia (SCZ) and bipolar disorder (BD). METHODS A systematic synthesis of clinical and empirical literature, including evidence from cognitive, neurobiological, genetic, and epidemiological research, was undertaken with the aim of evaluating the utility of the SAD classification. RESULTS Distinctions between the diagnostic categories of SCZ, SAD and BD are not clearly demarcated by findings from neuropsychological, neuroimaging, molecular neurobiology, or genetic epidemiology studies. On the contrary, convergent evidence purports overlap across current diagnostic boundaries in the heritability and pathophysiology of psychotic and affective disorders. However, there are some disorder-specific findings. CONCLUSIONS Schizoaffective disorder is a prototypic boundary condition that epitomizes the pitfalls of the current categorical classification system. Future revisions to the DSM should consider the implementation of one of two alternative models to account for individuals presenting with mixed psychotic and affective symptoms. These include the views that (i) SAD is a comorbid set of symptoms that occur as a by-product of two separate disorders (SCZ and BD) or, that (ii) SAD exists as the mid-point on a continuum between SCZ and BD, such that the incorporation of these two disorders onto one dimension may be a suitable alternative. Hence the category SAD should be omitted in future revisions of DSM, allowing the development of meaningful nomenclature that rests upon further rigorous investigation of differences and similarities between disorders.
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Affiliation(s)
- Gin S Malhi
- Northern Clinical School, University of Sydney, Sydney, Australia.
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Varga M, Magnusson A, Flekkøy K, David AS, Opjordsmoen S. Clinical and neuropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter? Compr Psychiatry 2007; 48:583-91. [PMID: 17954145 DOI: 10.1016/j.comppsych.2007.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 06/20/2007] [Accepted: 06/22/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Lack of insight is a well-recognized feature of schizophrenia and is associated with symptom severity and cognitive impairments. However, the diagnostic specificity of insight variables and their correlates is not known. To assess this specificity, we compared awareness of illness and neuropsychological function between patients with chronic schizophrenia and bipolar I disorder. METHOD We assessed insight, level of psychopathology, and cognitive performance on a neuropsychological test battery in 37 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition bipolar I disorder, 32 patients with schizophrenia, and 31 healthy subjects for comparison. RESULTS There was no significant difference between the 2 diagnostic groups on general illness awareness. However, patients with bipolar disorder had better awareness of their symptoms and their pathologic nature compared to patients with schizophrenia. Similar patterns of association emerged between insight and clinical variables. General unawareness was associated with clinical severity, especially of the affective type, and working memory deficits (Wechsler Adult Intelligence Scale digit span) in both diagnostic groups. The contribution of other cognitive deficits to insight differed across the groups. Misattribution differed from the other aspects of insight in its relative independence of clinical and neurocognitive correlates. Both patient groups were neurocognitively impaired, with the schizophrenia group performing significantly worse on conceptual ability, verbal learning, visuospatial processing, and motor speed. CONCLUSIONS The results suggest that differences in general insight in major mental disorders may be explained by symptom severity and working memory function rather than the specific diagnosis. Subcomponents of insight are influenced by different factors emphasizing the need to consider insight as multidimensional.
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Affiliation(s)
- Monica Varga
- Department of Acute Psychiatric Emergency Ward, Aker University Hospital, N-0514 Oslo, Norway.
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40
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Abstract
This article reviews neuropsychological research in adults with bipolar disorder and compares the findings with emergent data on neuropsychological function in juvenile bipolar disorder. Despite a recent surge of interest in childhood onset bipolar disorder, there remains a scarcity of neuropsychological literature investigating this population. From the study of adult bipolar disorder a substantial body of literature points to the existence of trait deficits in verbal and executive function that are detectable even during euthymia. In the nascent literature on neuropsychology in early onset bipolar, there is growing evidence to suggest that some of the deficits apparent in adults are also discernible in adolescents. Precise knowledge about when, how, and why these deficits appear requires future research of prodromal changes in neurocognition in childhood and adolescent bipolar disorder.
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Senturk V, Goker C, Bilgic A, Olmez S, Tugcu H, Oncu B, Atbasoglu EC. Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate. Bipolar Disord 2007; 9 Suppl 1:136-44. [PMID: 17543032 DOI: 10.1111/j.1399-5618.2007.00481.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Patients with bipolar disorder have been reported to have neurocognitive deficits; however, it is not known whether the cognitive dysfunctions are state-dependent or a stable trait. Lithium and valproate, 2 of the most widely used mood stabilizers in the treatment of bipolar disorder, have also been associated with cognitive impairment. However, the degree and pattern of neurocognitive impairment in euthymic bipolar patients on either monotherapy with lithium or valproate have not been compared before in depth. METHODS We compared 17 euthymic outpatients with bipolar disorder (BD) on lithium monotherapy to 11 euthymic outpatients with BD on valproate monotherapy and 29 comparison subjects using tests measuring immediate verbal memory and executive functions in addition to 3 subtests of the Wechsler Adult Intelligence Scale Revised. The groups were similar in terms of level of education, duration and severity of illness, and gender distribution. Patients on lithium monotherapy were older than patients on valproate and healthy controls. Mood symptoms as assessed by standardized scales were mild to non-existent in both patient groups. RESULTS Immediate verbal memory was impaired in both patient groups compared to controls, where the main effect of age was not significant. No significant differences could be found on the other cognitive measures. CONCLUSIONS Both lithium and valproate may be associated with immediate verbal memory impairment, sparing other cognitive functions. Presence of a similar verbal memory deficit in the lithium and valproate groups suggests that this deficit might be intrinsic to BD or that the 2 medications influence immediate verbal memory similarly. Larger samples of remitted bipolar patients on monotherapy should be studied for more precise conclusions.
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Affiliation(s)
- Vesile Senturk
- Department of Psychiatry, Ankara University School of Medicine, Ankara, Turkey.
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Correll CU, Penzner JB, Lencz T, Auther A, Smith CW, Malhotra AK, Kane JM, Cornblatt BA. Early identification and high-risk strategies for bipolar disorder. Bipolar Disord 2007; 9:324-38. [PMID: 17547579 DOI: 10.1111/j.1399-5618.2007.00487.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe and compare the relative merits of different identification strategies for individuals at risk for bipolar disorder (BPD). METHODS Selective review of data that support early identification in BPD, with a particular focus on emerging clinical high-risk strategies. RESULTS Early detection of individuals at risk for BPD can utilize genetic, endophenotypic and clinical methods. Most published work focuses on genetic familial endophenotypic risk markers for BPD. However, despite encouraging results, problems with specificity and sensitivity limit the application of these data to early prevention programs. In addition, offspring studies of BPD patients systematically exclude the majority of subjects without a first-degree bipolar relative. On the other hand, emerging work in the clinical-high-risk arena has already produced encouraging results. Although still preliminary, the identification of individuals in subsyndromal or attenuated symptom 'prodromal' stages of BPD seems to be an under-researched area that holds considerable promise deserving increased attention. Required next steps include the development of rating tools for attenuated and subsyndromal manic and depressive symptoms and of prodromal criteria that will allow prodromal symptomatology to be systematically studied in patients with recent-onset bipolar, as well as in prospective population-based phenomenology trials and attenuated symptom-based high-risk studies. CONCLUSIONS Given the current limitations of each early identification method, combining clinical, endophenotypic and genetic strategies will increase prediction accuracy. Since reliable biological markers for BPD have not been established and since most patients with BPD lack a first-degree relative with this disorder, clinical high-risk approaches have great potential to inform early identification and intervention programs.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
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Bearden CE, Glahn DC, Caetano S, Olvera RL, Fonseca M, Najt P, Hunter K, Pliszka SR, Soares JC. Evidence for disruption in prefrontal cortical functions in juvenile bipolar disorder. Bipolar Disord 2007; 9 Suppl 1:145-59. [PMID: 17543033 DOI: 10.1111/j.1399-5618.2007.00453.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Systematic parsing of executive function processes is critical for the development of more specific models of neurobiological processes mediating disturbed cognition in youth with bipolar disorder (BPD). METHODS A sample of 33 children and adolescents with bipolar I disorder (BPD I) (mean age 12.1 +/- 3.0 years, 39% female) and 44 demographically matched healthy participants (mean age 12.9 +/- 2.8 years, 50% female) completed a neurocognitive battery including measures aimed at detection of disruption in prefrontal cortical circuitry (i.e., working memory, set shifting, and rule attainment). RESULTS Compared to healthy controls, BPD I children exhibited significant deficits in spatial working memory, visual sequencing and scanning, verbal fluency and abstract problem solving, particularly when a memory component was involved. In our spatial delayed response task, memory set size was parametrically varied; the performance pattern in BPD I children suggested deficits in short-term memory encoding and/or storage, rather than capacity limitations in spatial working memory. Earlier age at onset of illness and antipsychotic medication usage were associated with poorer performance on speeded information-processing tasks; however, severity of mood symptomatology and comorbidity with disruptive behavior disorders were not associated with task performance. CONCLUSIONS These results suggest impairment in measures of prefrontal cortical function in juvenile BPD I that are similar to those seen in the adult form of the illness, and implicate both the ventral and dorsolateral prefrontal cortex as loci of pathology in juvenile BPD. As these deficits were not associated with clinical state or comorbidity with other disorders, they may reflect trait-related impairments, a hypothesis that will be pursued further in longitudinal studies.
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Affiliation(s)
- Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA 90095, USA.
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