1
|
Liu F, Gao M, Wu Q, Yan M, Wu R, Shao P, Huang J. Diagnostic Stability in Psychiatric Patients From Hospital Admission to Discharge: A 10-Year Retrospective Study. Psychiatry Investig 2023; 20:461-470. [PMID: 37253472 PMCID: PMC10232057 DOI: 10.30773/pi.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the consistency or stability of mental disorders diagnosed in the psychiatry ward setting, investigate factors associated with consistency, and observe the disease distribution over the decade. METHODS A total of 20,359 psychiatric inpatients were included in this retrospective study from June 2011 to December 2020. Diagnoses from the first admission to discharge were evaluated to determine the diagnostic consistency during hospitalization. Readmissions were selected as the subgroup, whose first and last discharge diagnoses were compared to analyze the relatively long-term diagnostic stability. Demographic and clinical characteristics were collected to identify predictors of diagnostic discrepancy. RESULTS From 2011-2020, the hospitalization rate decreased from 42.7% to 20.7% for schizophrenia and grew from 13.3% to 23.8% for depression. Diagnoses were retained by 92.6% of patients at their first discharge diagnosis, ranging from 100% for disorders of psychological development to 16.3% for unspecified mental disorders. About 33.9% of diagnostic conversions were to bipolar disorder in patients having inconsistent diagnoses. However, among rehospitalizations, the diagnostic stability notably dropped to 71.3%. For rehospitalizations, mood disorders and schizophrenia spectrum disorders were relatively stable diagnoses categories, with 72.6% to 76.7% of patients receiving the same diagnosis, although results of specified diagnoses within these categories ranged from 5.9% to 91.0%. Except for mood disorders and schizophrenia spectrum disorders, the diagnoses of all other categories were below 70%. Long lengths of hospitalization and old age were associated with short-term diagnosis alterations. CONCLUSION Longitudinal follow-up and integration of multiple aspects of information are essential for accurate diagnosis.
Collapse
Affiliation(s)
- Furu Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | | | - Qiongqiong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Meiqi Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Ping Shao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| |
Collapse
|
2
|
Bora E. A comparative meta-analysis of neurocognition in first-degree relatives of patients with schizophrenia and bipolar disorder. Eur Psychiatry 2020; 45:121-128. [DOI: 10.1016/j.eurpsy.2017.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 12/29/2022] Open
Abstract
AbstractObjective:Cognitive impairment is a familial and heritable aspect of major psychoses and might be a shared vulnerability marker for schizophrenia and BP. However, it is not clear whether some aspects of cognitive deficits are uniquely associated with risk for specific diagnoses.Methods:A novel meta-analysis of cognitive functions in first-degree relatives of probands with bipolar disorder (BP-Rel) and schizophrenia (Sch-Rel) was conducted. Current meta-analysis included 20 studies and compared cognitive functions of 1341 Sch-Rel, 939 BP-Rel and 1427 healthy controls.Results:Sch-Rel was associated with cognitive deficits in all domains (d = 0.20–0.58) and BP-Rel underperformed healthy controls in processing speed, verbal fluency and speed based executive function tests (d = 0.33–0.41). Sch-Rel underperformed BP-Rel in general intellectual ability, working memory, verbal memory, planning, processing speed and fluency (d = 0.24–0.42).Conclusions:Inefficiency in processing information and impaired processing speed might be common vulnerability factors for major psychoses. On the other hand, low performance in accuracy based tasks and deficits in general intellectual ability, verbal learning, planning and working memory might be more specifically associated with risk for schizophrenia.
Collapse
|
3
|
Neurodevelopmental pathways in bipolar disorder. Neurosci Biobehav Rev 2020; 112:213-226. [PMID: 32035092 DOI: 10.1016/j.neubiorev.2020.02.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/03/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022]
Abstract
Aberrations in neurodevelopmental trajectories have been implicated in the neurobiology of several mental disorders and evidence indicates a pathophysiological and genetic overlap of schizophrenia and bipolar disorder (BD). In this narrative review, we summarize findings related to developmental and perinatal factors as well as epidemiological, clinical, neuropsychological, brain imaging, postmortem brain and genomic studies that provide evidence for a putative neurodevelopmental pathogenesis and etiology of BD. Overall, aberrations in neurodevelopmental pathways have been more consistently implicated in the pathophysiology of schizophrenia compared to BD. Nevertheless, an accumulating body of evidence indicates that dysfunctional neurodevelopmental pathways may be implicated in the underlying pathophysiology of at least a subset of individuals with BD particularly those with an early age of illness onset and those exhibiting psychotic symptoms. A heuristic neurodevelopmental model for the pathophysiology of BD based on the findings of this review is proposed. Furthermore, we critically discuss clinical and research implications of this model. Finally, further research directions for this emerging field are provided.
Collapse
|
4
|
Basal ganglia volumetric changes in psychotic spectrum disorders. J Affect Disord 2019; 255:150-157. [PMID: 31153051 DOI: 10.1016/j.jad.2019.05.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/30/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Basal ganglia are particularly important for understanding the pathobiology of psychosis given their key roles in dopaminergic neurotransmission which are associated with psychotic symptoms and one of the target sites of antipsychotic drugs. Psychotic symptoms are prevalent in both schizophrenia (SZ) and bipolar disorder (BD). Although the components of basal ganglia are implicated in psychosis, comparative structural changes of components of the basal ganglia between SZ and BD are less clear after disentanglement of clinical effects of antipsychotic dose, duration and severity of illness. METHODS In this study, we examined the morphology of the basal ganglia in 326 subjects comprising of 45 patients of BD type I with psychotic symptoms, 97 first-episode SZ (FE-SZ) patients, 86 non-first-episode chronic SZ (NFE-SZ) patients, in comparison with 98 healthy controls (HC). RESULTS Results showed increased volumes in subregions of caudate, putamen, and pallidum in chronic SZ patients compared with HC after controlling for age, gender, and total intracranial volume. No change was found between FE-SZ patients, psychotic BD patients, and HC. Furthermore, hierarchical regressions showed that the dosage of antipsychotics had a significant contribution to basal ganglia volumetric enlargement in NFE-SZ after controlling for the effects of age, gender, total intracranial volume, age at illness onset, as well as illness duration and severity. LIMITATIONS Lack of information about the cumulative history of exposure to medication for all the three groups of patients is a major limitation in our study. CONCLUSIONS There are distinct basal ganglia structural changes in SZ and psychotic BD. Basal ganglia are enlarged in chronic SZ but not in FE-SZ and BD and this enlargement is significantly associated with antipsychotic dosage over and beyond the effects of illness duration and severity.
Collapse
|
5
|
From the microscope to the magnet: Disconnection in schizophrenia and bipolar disorder. Neurosci Biobehav Rev 2019; 98:47-57. [PMID: 30629976 DOI: 10.1016/j.neubiorev.2019.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/22/2018] [Accepted: 01/06/2019] [Indexed: 12/15/2022]
Abstract
White matter (WM) abnormalities have implicated schizophrenia (SZ) and bipolar disorder (BD) as disconnection syndromes, yet the extent to which these abnormalities are shared versus distinct remains unclear. Diffusion tensor imaging (DTI) studies yield a putative measure of WM integrity while neuropathological studies provide more specific microstructural information. We therefore systematically reviewed all neuropathological (n = 12) and DTI (n = 11) studies directly comparing patients with SZ and BD. Most studies (18/23) reported no difference between patient groups. Changes in oligodendrocyte density, myelin staining and gene, protein and mRNA expression were found in SZ and/or BD patients as compared to healthy individuals, while DTI studies showed common alterations in thalamic radiations, uncinate fasciculus, corpus callosum, longitudinal fasciculus and corona radiata. Altogether, findings suggest shared disconnectivity in SZ and BD, which are likely related to their considerable overlap. Above all, neuroimaging findings corroborated neuropathological findings in the prefrontal cortex, demonstrating the utility of integrating multiple methodologies. Focusing on clinical dimensions over disease entities will advance our understanding of disconnectivity and help inform preventive medicine.
Collapse
|
6
|
Yasmin N, Pandey R. Prospective memory, working memory, planning, and attention in schizophrenia and bipolar disorder: A comparative study. APPLIED COGNITIVE PSYCHOLOGY 2018. [DOI: 10.1002/acp.3423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Natasha Yasmin
- School of Psychology; University of Birmingham; Birmingham UK
| | - Rashmi Pandey
- Department of Clinical Psychology, Amity Institute of Behavioural Health & Allied Sciences; AMITY University; Noida India
| |
Collapse
|
7
|
Abstract
Clinical trials in psychiatry inherit methods for design and statistical analysis from evidence-based medicine. However, trials in other clinical disciplines benefit from a more specific relationship between instruments that measure disease state (e.g. biomarkers, clinical signs), the underlying pathology and diagnosis such that primary outcomes can be readily defined. Trials in psychiatry use diagnosis (i.e. a categorical label for a syndrome) as a proxy for the underlying disorder, and outcomes are defined, for example, as a percentage change in a univariate total score on some clinical instrument. We label this approach to defining outcomes weak aggregation of disease state. Univariate measures are necessary, because statistical methodology is both tractable and well-developed for scalar outcomes, but we show that weak aggregate approaches do not capture disease state sufficiently, potentially leading to loss of information about response to intervention. We demonstrate how multivariate disease state can be captured using geometric concepts of spaces defined over routine clinical instruments, and show how clinically meaningful disease states (e.g. representing different profiles of symptoms, recovery or remission) can be defined as prototypes (geometric locations) in these spaces. Then, we show how to derive univariate (scalar) measures, which capture patient's relationships to these prototypes and argue these represent strong aggregates of disease state that may be a better basis for outcome measures. We demonstrate our proposal using a large publically available dataset. We conclude by discussing the impact of strong aggregates for analyses in traditional and novel trial designs.
Collapse
Affiliation(s)
- D W Joyce
- Cognition Schizophrenia and Imaging Laboratory,Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,De Crespigny Park,London SE5 8AF,PO63,UK
| | - D K Tracy
- Cognition Schizophrenia and Imaging Laboratory,Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,De Crespigny Park,London SE5 8AF,PO63,UK
| | - S S Shergill
- Cognition Schizophrenia and Imaging Laboratory,Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,De Crespigny Park,London SE5 8AF,PO63,UK
| |
Collapse
|
8
|
Au RWC, Xiang YT, Ungvari GS, Lee E, Shum DHK, Man D, Tang WK. Prospective Memory Performance in Persons With Schizophrenia and Bipolar Disorder and Healthy Persons. Perspect Psychiatr Care 2017; 53:266-274. [PMID: 27373547 DOI: 10.1111/ppc.12172] [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: 01/21/2016] [Revised: 04/25/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE There is a paucity of studies comparing prospective memory (PM) impairment between persons with schizophrenia and bipolar disorder. The aim of this study was to directly compare PM performances of these two groups and healthy controls. DESIGN AND METHODS A total of 44 persons with schizophrenia and 76 with bipolar disorder, and 44 healthy controls formed the study sample. FINDINGS Patients were found to be impaired in PM relative to controls and the two patient groups showed similar level of PM performance after controlling confounding sociodemographic and clinical variables. PRACTICE IMPLICATIONS The findings add to the evidence concerning the neurocognitive similarity between cohorts of schizophrenia and bipolar disorder with respect to PM. Rehabilitative effort in PM remedies for both patient groups is warranted.
Collapse
Affiliation(s)
- Raymond W C Au
- Senior Occupational Therapist, Occupational Therapy Department, United Christian Hospital, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Associate Professor, Faculty of Health Sciences, University of Macau, Macau SAR, China
| | - Gabor S Ungvari
- Professor, Marian Centre, University of Notre Dame Australia, Perth, Australia
| | - Edwin Lee
- Assistant Professor, Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - David H K Shum
- Professor, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - David Man
- Professor, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Wai-Kwong Tang
- Professor, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
9
|
Realising stratified psychiatry using multidimensional signatures and trajectories. J Transl Med 2017; 15:15. [PMID: 28100276 PMCID: PMC5241978 DOI: 10.1186/s12967-016-1116-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/27/2016] [Indexed: 12/21/2022] Open
Abstract
Background
Stratified or personalised medicine targets treatments for groups of individuals with a disorder based on individual heterogeneity and shared factors that influence the likelihood of response. Psychiatry has traditionally defined diagnoses by constellations of co-occurring signs and symptoms that are assigned a categorical label (e.g. schizophrenia). Trial methodology in psychiatry has evaluated interventions targeted at these categorical entities, with diagnoses being equated to disorders. Recent insights into both the nosology and neurobiology of psychiatric disorder reveal that traditional categorical diagnoses cannot be equated with disorders. We argue that current quantitative methodology (1) inherits these categorical assumptions, (2) allows only for the discovery of average treatment response, (3) relies on composite outcome measures and (4) sacrifices valuable predictive information for stratified and personalised treatment in psychiatry. Methods and findings To achieve a truly ‘stratified psychiatry’ we propose and then operationalise two necessary steps: first, a formal multi-dimensional representation of disorder definition and clinical state, and second, the similar redefinition of outcomes as multidimensional constructs that can expose within- and between-patient differences in response. We use the categorical diagnosis of schizophrenia—conceptualised as a label for heterogeneous disorders—as a means of introducing operational definitions of stratified psychiatry using principles from multivariate analysis. We demonstrate this framework by application to the Clinical Antipsychotic Trials of Intervention Effectiveness dataset, showing heterogeneity in both patient clinical states and their trajectories after treatment that are lost in the traditional categorical approach with composite outcomes. We then systematically review a decade of registered clinical trials for cognitive deficits in schizophrenia highlighting existing assumptions of categorical diagnoses and aggregate outcomes while identifying a small number of trials that could be reanalysed using our proposal. Conclusion We describe quantitative methods for the development of a multi-dimensional model of clinical state, disorders and trajectories which practically realises stratified psychiatry. We highlight the potential for recovering existing trial data, the implications for stratified psychiatry in trial design and clinical treatment and finally, describe different kinds of probabilistic reasoning tools necessary to implement stratification.
Collapse
|
10
|
Buoli M, Caldiroli A, Cumerlato Melter C, Serati M, de Nijs J, Altamura AC. Biological aspects and candidate biomarkers for psychotic bipolar disorder: A systematic review. Psychiatry Clin Neurosci 2016; 70:227-44. [PMID: 26969211 DOI: 10.1111/pcn.12386] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/24/2016] [Accepted: 03/06/2016] [Indexed: 12/23/2022]
Abstract
AIM We carried out a systematic review of the available literature about potential biomarkers of psychotic bipolar disorder (BD-P), a specific subset presenting worse outcome and greater risk of relapse than non-psychotic bipolar disorder (BD-NP). METHODS We searched the main psychiatric databases (PubMed, ISI Web of Knowledge, PsychInfo). Only original articles with the main topic of BD-P compared to schizophrenia/BD-NP/healthy controls (HC) written in English from 1994 to 2015 were included. RESULTS BD-P patients presented higher kynurenic acid levels in the cerebrospinal fluid, elevated anti- S accharomyces cerevisiae antibodies levels, and lower serum levels of dehydroepiandrosterone sulfate and progesterone than BD-NP/HC. Event-related potentials abnormalities have been identified in BD-P with respect to BD-NP. BD-P patients also presented bigger ventricles but similar hippocampal volumes compared to BD-NP/HC. Although the results are contrasting, some cognitive deficits seemed to be related to the psychotic dimension of bipolar affective disorder, such as impairment in verbal/logical memory, working memory, verbal and semantic fluency and executive functioning. Finally, polymorphisms of genes, such as NRG1, 5HTTLPR (s), COMT, DAOA and some chromosome regions (16p12 and 13q), were positively associated with BD-P. CONCLUSION Data about the identification of specific biomarkers for BD-P are promising, but most of them have not yet been replicated. They could lead the clinicians to an early diagnosis and proper treatment, thus ameliorating outcome of BD-P and reducing the biological changes associated with a long duration of illness. Further studies with bigger samples are needed to detect more specific biological markers of the psychotic dimension of bipolar affective disorder.
Collapse
Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Psychiatry, University Medical Center Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cumerlato Melter
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Jessica de Nijs
- Department of Psychiatry, University Medical Center Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
11
|
Lozano V, Soriano MF, Aznarte JI, Gómez-Ariza CJ, Bajo MT. Interference control commonalities in patients with schizophrenia, bipolar disorder, and borderline personality disorder. J Clin Exp Neuropsychol 2015; 38:238-50. [DOI: 10.1080/13803395.2015.1102870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
12
|
Gallagher P, Nilsson J, Finkelmeyer A, Goshawk M, Macritchie KA, Lloyd AJ, Thompson JM, Porter RJ, Young AH, Ferrier IN, McAllister-Williams RH, Watson S. Neurocognitive intra-individual variability in mood disorders: effects on attentional response time distributions. Psychol Med 2015; 45:2985-2997. [PMID: 26073667 DOI: 10.1017/s0033291715000926] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Attentional impairment is a core cognitive feature of major depressive disorder (MDD) and bipolar disorder (BD). However, little is known of the characteristics of response time (RT) distributions from attentional tasks. This is crucial to furthering our understanding of the profile and extent of cognitive intra-individual variability (IIV) in mood disorders. METHOD A computerized sustained attention task was administered to 138 healthy controls and 158 patients with a mood disorder: 86 euthymic BD, 33 depressed BD and 39 medication-free MDD patients. Measures of IIV, including individual standard deviation (iSD) and coefficient of variation (CoV), were derived for each participant. Ex-Gaussian (and Vincentile) analyses were used to characterize the RT distributions into three components: mu and sigma (mean and standard deviation of the Gaussian portion of the distribution) and tau (the 'slow tail' of the distribution). RESULTS Compared with healthy controls, iSD was increased significantly in all patient samples. Due to minimal changes in average RT, CoV was only increased significantly in BD depressed patients. Ex-Gaussian modelling indicated a significant increase in tau in euthymic BD [Cohen's d = 0.39, 95% confidence interval (CI) 0.09-0.69, p = 0.011], and both sigma (d = 0.57, 95% CI 0.07-1.05, p = 0.025) and tau (d = 1.14, 95% CI 0.60-1.64, p < 0.0001) in depressed BD. The mu parameter did not differ from controls. CONCLUSIONS Increased cognitive variability may be a core feature of mood disorders. This is the first demonstration of differences in attentional RT distribution parameters between MDD and BD, and BD depression and euthymia. These data highlight the utility of applying measures of IIV to characterize neurocognitive variability and the great potential for future application.
Collapse
Affiliation(s)
- P Gallagher
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - J Nilsson
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - A Finkelmeyer
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - M Goshawk
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - K A Macritchie
- South London and Maudsley NHS Foundation Trust,London,UK
| | - A J Lloyd
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - J M Thompson
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - R J Porter
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - A H Young
- King's College London,Institute of Psychiatry,Psychology and Neurosciences,London,UK
| | - I N Ferrier
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | | | - S Watson
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| |
Collapse
|
13
|
Tsitsipa E, Fountoulakis KN. The neurocognitive functioning in bipolar disorder: a systematic review of data. Ann Gen Psychiatry 2015; 14:42. [PMID: 26628905 PMCID: PMC4666163 DOI: 10.1186/s12991-015-0081-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND During the last decades, there have been many different opinions concerning the neurocognitive function in Bipolar disorder (BD). The aim of the current study was to perform a systematic review of the literature and to synthesize the data in a comprehensive picture of the neurocognitive dysfunction in BD. METHODS Papers were located with searches in PubMed/MEDLINE, through June 1st 2015. The review followed a modified version of the recommendations of the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses statement. RESULTS The initial search returned 110,403 papers. After the deletion of duplicates, 11,771 papers remained for further evaluation. Eventually, 250 were included in the analysis. CONCLUSION The current review supports the presence of a neurocognitive deficit in BD, in almost all neurocognitive domains. This deficit is qualitative similar to that observed in schizophrenia but it is less severe. There are no differences between BD subtypes. Its origin is unclear. It seems it is an enduring component and represents a core primary characteristic of the illness, rather than being secondary to the mood state or medication. This core deficit is confounded (either increased or attenuated) by the disease phase, specific personal characteristics of the patients (age, gender, education, etc.), current symptomatology and its treatment (especially psychotic features) and long-term course and long-term exposure to medication, psychiatric and somatic comorbidity and alcohol and/or substance abuse.
Collapse
Affiliation(s)
| | - Konstantinos N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos street (1st Parodos, Ampelonon str.) 55536 Pournari Pylaia, Thessaloniki, Greece
| |
Collapse
|
14
|
Interleukin 1 receptor antagonist and soluble tumor necrosis factor receptor 1 are associated with general severity and psychotic symptoms in schizophrenia and bipolar disorder. Schizophr Res 2013; 145:36-42. [PMID: 23403415 DOI: 10.1016/j.schres.2012.12.023] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 11/13/2012] [Accepted: 12/17/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies suggest elevated inflammation in schizophrenia and bipolar disorder, with increased activity of the Interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor (TNF)-alpha, von Willebrand factor (vWf) and osteoprotegerin (OPG). It is unclear how immune activation is involved in the psychopathology. We investigated if elevated inflammation was associated with disease severity (trait) or current symptom level (state), comparing psychotic with general characteristics. METHODS Plasma levels of sTNF receptor 1 (sTNF-R1), IL-1 receptor antagonist (IL-1Ra), IL-6, vWf and OPG were measured with ELISA techniques in 322 patients with schizophrenia spectrum and bipolar disorder. Current symptom level (state) was measured with Global Assessment of Functioning (GAF) and Positive and Negative Syndrome Scale (PANSS). Disease severity (trait) was measured with premorbid adjustment scale (PAS), age at onset, number of psychotic episodes and number and length of hospitalizations. RESULTS After controlling for confounders, IL-1Ra and TNF-R1 were independently associated with GAF, and significantly correlated with PANSS negative and positive, respectively. In addition, Il-1Ra was associated with PAS, and sTNF-R1 with number of hospitalizations and psychotic episodes. VWf was significantly correlated with psychotic episodes, OPG with hospitalizations and IL-6 with history of psychosis. Linear regression analysis showed that GAF remained associated with sTNF-R1 and IL-1Ra with PANSS, after controlling for the other clinical measures. CONCLUSIONS This supports that inflammatory markers, particularly IL-1Ra and sTNF-R1 are associated with both general disease severity and psychotic features. This supports a role of immune activation in the core pathological mechanisms of severe mental disorders.
Collapse
|
15
|
Arts B, Simons CJP, Drukker M, van Os J. Antipsychotic medications and cognitive functioning in bipolar disorder: moderating effects of COMT Val108/158 Met genotype. BMC Psychiatry 2013; 13:63. [PMID: 23421957 PMCID: PMC3583705 DOI: 10.1186/1471-244x-13-63] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 02/08/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is a negative association between the use of antipsychotics and cognitive functioning in bipolar patients, which may be mediated by altered dopamine signaling in selected brain areas, and moderation thereof by genetic sequence variation such as COMT Val108/158Met. The interaction between antipsychotic drug use and the COMT Val108/158Met genotype on two-year cognitive functioning in bipolar patients was examined. METHODS Interaction between the COMT Val108/158Met and antipsychotics on a composite cognitive measure was examined in 51 bipolar patients who were assessed 12 times at two-monthly intervals over a period of two years (379 observations). RESULTS There was a significant negative effect of the interaction between antipsychotic medications and Val allele load on the composite cognitive measure in bipolar patients (p < 0.001). CONCLUSIONS The negative effects of antipsychotics on cognitive functioning in bipolar disorder may be moderated by the COMT Val 108/158 Met genotype, with a negative effect of Val allele load. If replicated, the results may be indicative of pharmacogenetic interactions in bipolar disorder.
Collapse
Affiliation(s)
- Baer Arts
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience (EURON), South Limburg Mental Health Research and Teaching Network (SEARCH), Maastricht University Medical Centre, P,O, Box 616 (DRT 12), Maastricht, MD, 6200, The Netherlands.
| | - Claudia JP Simons
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience (EURON), South Limburg Mental Health Research and Teaching Network (SEARCH), Maastricht University Medical Centre, P.O. Box 616 (DRT 12), Maastricht, MD, 6200, The Netherlands,GGZE, Institute for Mental Health Care Eindhoven en de Kempen, P.O. Box 909, Eindhoven, AX, 5600, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience (EURON), South Limburg Mental Health Research and Teaching Network (SEARCH), Maastricht University Medical Centre, P.O. Box 616 (DRT 12), Maastricht, MD, 6200, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience (EURON), South Limburg Mental Health Research and Teaching Network (SEARCH), Maastricht University Medical Centre, P.O. Box 616 (DRT 12), Maastricht, MD, 6200, The Netherlands,King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| |
Collapse
|
16
|
Evidence for the impact of the CACNA1C risk allele rs1006737 on 2-year cognitive functioning in bipolar disorder. Psychiatr Genet 2013; 23:41-2. [DOI: 10.1097/ypg.0b013e328358641c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Vöhringer PA, Barroilhet SA, Amerio A, Reale ML, Alvear K, Vergne D, Ghaemi SN. Cognitive impairment in bipolar disorder and schizophrenia: a systematic review. Front Psychiatry 2013; 4:87. [PMID: 23964248 PMCID: PMC3737461 DOI: 10.3389/fpsyt.2013.00087] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/29/2013] [Indexed: 01/10/2023] Open
Abstract
AIMS Previous comparisons of cognitive decline among patients with bipolar disorder (BD) and schizophrenia (SZ) have found somehow quite similar profiles of deficits, but results have varied between studies. Therefore an extensive and thoughtful systematic review of the matter is warranted. METHODS Studies were found through systematic search (PubMed) following PRISMA guidelines. To be included, studies must have assessed the following cognitive functions: executive functions, memory, IQ, attention-concentration, and perceptuomotor function. In order to make comparison between the two entities, studies should include BD patients with operationally defined euthymia, schizophrenic patients in remission, and third group of healthy control patients. Comparisons were made after controlling for years of schooling and residual affective symptoms. RESULTS We found that overall both SZ and BD patients present deficits on all neurocognitive measures compared to healthy controls. In particular, SZ patients show more severe and pervasive cognitive deficits while BD patients present a milder and more confined impairment. In addition, evidence from the literature suggests that SZ and BD patients share a similar cognitive impairment profile with different degrees of deficits. Therefore, the difference between the two groups seems to be more quantitative (degree of deficit) rather than qualitative (profile), supporting a dimensional approach to the two clinical entities. Limitations of the present review includes the impossibility to control for effects of medication, varying time required for assessment across studies, illness diagnosis reliability, and course severity. CONCLUSION Patients with BD might exhibit a cognitive impairment that could be similar to SZ in terms of their profile, although patients with SZ may have more severe and widespread impairments.
Collapse
Affiliation(s)
- Paul A Vöhringer
- Unidad de Trastornos del Ánimo, Clínica Psiquiátrica, Departamento de Psiquiatria, Facultad Medicina, Hospital Clínico Universidad de Chile , Santiago , Chile ; Mood Disorders Program, Tufts Medical Center , Boston, MA , USA ; Harvard School of Public Health , Boston, MA , USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Cognitive processes and attitudes in bipolar disorder: a study into personality, dysfunctional attitudes and attention bias in patients with bipolar disorder and their relatives. J Affect Disord 2012; 143:265-8. [PMID: 22840633 DOI: 10.1016/j.jad.2012.04.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/06/2012] [Accepted: 04/06/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Research in cognitive processes and attitudes in bipolar disorder is scarce and has provided mixed findings, possibly due to differences in current mood state. It is unclear whether alterations in cognitive processes and attitudes are only related to the depressive mood states of bipolar patients or also represent a vulnerability marker for the development of future (depressive) episodes. This was investigated in the current study. METHODS Both implicit (attentional bias for emotional words) and explicit (dysfunctional attitudes and personality characteristics) measures of cognitive processes and attitudes were assessed in 77 bipolar patients with varying levels of depressive symptoms (depressed=17, euthymic n=60), their healthy first-degree relatives (n=39) and a healthy control group (n=61). Analyses of variance were used to investigate differences between groups. RESULTS Mildly depressed patients with bipolar disorder demonstrated an attentional bias away from positive emotional words and showed increased dysfunctional attitudes and higher levels of neuroticism. Euthymic patients were largely comparable to healthy controls and only differed from controls in higher levels of neuroticism. Relatives were similar to controls on all measures, although they significantly differed from bipolar patients in displaying less neuroticism and more extraversion. LIMITATIONS No firm conclusions regarding causality can be drawn from the associations that were found between cognitive processes and attitudes and the evolution of mood symptoms in bipolar disorder. CONCLUSION Alterations in cognitive processes and attitudes in bipolar patients appear to be mostly related to the expression of mood symptomatology rather than to the vulnerability for bipolar disorder.
Collapse
|
19
|
Sepede G, De Berardis D, Campanella D, Perrucci MG, Ferretti A, Serroni N, Moschetta FS, Del Gratta C, Salerno RM, Ferro FM, Di Giannantonio M, Onofrj M, Romani GL, Gambi F. Impaired sustained attention in euthymic bipolar disorder patients and non-affected relatives: an fMRI study. Bipolar Disord 2012; 14:764-79. [PMID: 23036083 DOI: 10.1111/bdi.12007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Behavioral deficits in sustained attention have been reported during both acute and euthymic phases of type I bipolar disorder (BD-I) and also in non-affected relatives of bipolar disorder (BD) patients. In particular, selective failure in target recognition was proposed as a potential trait marker for BD, but there are few studies exploring the neural correlates. The aim of the present study was to analyze the behavioral and functional magnetic resonance imaging (fMRI) response of euthymic BD-I patients and non-affected relatives during a sustained attention task. METHODS Twenty-four euthymic BD-I patients, 22 non-affected first-degree relatives of BD-I subjects, and 24 matched controls underwent a continuous performance test (CPT) with two levels of difficulty during event-related fMRI scanning. RESULTS Both patients and relatives showed a lower accuracy in target detection when compared to controls. The fMRI data analysis revealed between-group differences in several brain regions involved in sustained attention. During error in target recognition, both patients and relatives showed a larger activation in the bilateral insula and the posterior part of the middle cingulate cortex. By contrast, during correct target response, only patients failed to activate the right insula, whereas relatives showed an increased activation of the left insula and bilateral inferior parietal lobule - limited to the higher attention load - and an augmented deactivation of the posterior cingulate/retrosplenial cortex. CONCLUSIONS A selective impairment in target recognition during a CPT was behaviorally and functionally detectable in both euthymic BD-I patients and non-affected first-degree relatives, suggesting that specific sustained attention deficits may be a potential trait marker for BD-I.
Collapse
Affiliation(s)
- Gianna Sepede
- Department of Neuroscience and Imaging, University of Chieti, Chieti, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Walshe M, Schulze KK, Stahl D, Hall MH, Chaddock C, Morris R, Marshall N, McDonald C, Murray RM, Bramon E, Kravariti E. Sustained attention in bipolar I disorder patients with familial psychosis and their first-degree relatives. Psychiatry Res 2012; 199:70-3. [PMID: 22513042 DOI: 10.1016/j.psychres.2012.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/28/2012] [Accepted: 03/18/2012] [Indexed: 01/03/2023]
Abstract
Sustained attention (SA) was examined in patients with familial, psychotic Bipolar Disorder (BD) (n=43), their non-bipolar, non-psychotic relatives (n=44) and controls (n=47). Patients were impaired compared to relatives, but the latter did not differ from controls. Having a relative with familial, psychotic BD does not confer risk for SA deficits.
Collapse
Affiliation(s)
- Muriel Walshe
- Department of Psychosis Studies, PO Box 63, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Differences in resting-state functional magnetic resonance imaging functional network connectivity between schizophrenia and psychotic bipolar probands and their unaffected first-degree relatives. Biol Psychiatry 2012; 71:881-9. [PMID: 22401986 PMCID: PMC3968680 DOI: 10.1016/j.biopsych.2012.01.025] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Schizophrenia and bipolar disorder share overlapping symptoms and genetic etiology. Functional brain dysconnectivity is seen in both disorders. METHODS We compared 70 schizophrenia and 64 psychotic bipolar probands, their respective unaffected first-degree relatives (n = 70, and n = 52), and 118 healthy subjects, all group age-, gender-, and ethnicity-matched. We used functional network connectivity analysis to measure differential connectivity among 16 functional magnetic resonance imaging resting state networks. First, we examined connectivity differences between probands and control subjects. Next, we probed these dysfunctional connections in relatives for potential endophenotypes. Network connectivity was then correlated with Positive and Negative Syndrome Scale (PANSS) scores to reveal clinical relationships. RESULTS Three different network pairs were differentially connected in probands (false-discovery rate corrected q < .05) involving five individual resting-state networks: (A) fronto/occipital, (B) anterior default mode/prefrontal, (C) meso/paralimbic, (D) fronto-temporal/paralimbic, and (E) sensory-motor. One abnormal pair was unique to schizophrenia, (C-E), one unique to bipolar, (C-D), and one (A-B) was shared. Two of these three combinations (A-B, C-E) were also abnormal in bipolar relatives but none was normal in schizophrenia relatives (nonsignificant trend for C-E). The paralimbic circuit (C-D), which uniquely distinguished bipolar probands, contained multiple mood-relevant regions. Network relationship C-D correlated significantly with PANSS negative scores in bipolar probands, and A-B with PANSS positive and general scores in schizophrenia. CONCLUSIONS Schizophrenia and psychotic bipolar probands share several abnormal resting state network connections, but there are also unique neural network underpinnings between disorders. We identified specific connections that might also be candidate psychosis endophenotypes.
Collapse
|
22
|
Ivleva EI, Morris DW, Osuji J, Moates AF, Carmody TJ, Thaker GK, Cullum M, Tamminga CA. Cognitive endophenotypes of psychosis within dimension and diagnosis. Psychiatry Res 2012; 196:38-44. [PMID: 22342122 PMCID: PMC3351583 DOI: 10.1016/j.psychres.2011.08.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 08/21/2011] [Accepted: 08/28/2011] [Indexed: 01/27/2023]
Abstract
This study sought to characterize the psychosis phenotype, contrasting cognitive features within traditional diagnosis and psychosis dimension in a family sample containing both schizophrenia and psychotic bipolar I disorder. Seventy-six probands with psychosis [44 probands with schizophrenia, 32 probands with psychotic bipolar I disorder] and 55 first-degree relatives [30 relatives of schizophrenia probands, 25 relatives of bipolar probands] were recruited. Standardized clinical and neuropsychological measures were administered. No differences in cognitive performance emerged between probands with schizophrenia and probands with psychotic bipolar disorder, or between relatives of probands with schizophrenia and relatives of probands with bipolar disorder in the domains of working and declarative memory, executive function and attention. Relatives overall showed higher cognitive performance compared to probands, as expected. However, when we segmented the probands and relatives along a psychosis dimension, independent of diagnostic groups, results revealed lower cognitive performance in probands compared to relatives without psychosis spectrum disorders, whereas relatives with psychosis spectrum disorders showed an intermediate level of performance across all cognitive domains. In this study, cognitive performance did not distinguish either probands or their first-degree relatives within traditional diagnostic groups (schizophrenia and psychotic bipolar disorder), but distinguished probands and relatives with and without lifetime psychosis manifestations independent of diagnostic categories. These data support the notion that schizophrenia and psychotic bipolar disorder present a clinical continuum with overlapping cognitive features defining the psychosis phenotype.
Collapse
Affiliation(s)
- Elena I. Ivleva
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA,Corresponding author: Elena I. Ivleva, M.D., Ph.D., Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Road, BL6.633, Dallas, TX 75390, USA, Phone 214 648 0843, Fax 214 648 5321,
| | - David W. Morris
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Julian Osuji
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Amanda F. Moates
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Thomas J. Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Gunvant K. Thaker
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA,Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Carol A. Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| |
Collapse
|
23
|
Nieto RG, Castellanos FX. A meta-analysis of neuropsychological functioning in patients with early onset schizophrenia and pediatric bipolar disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2011; 40:266-80. [PMID: 21391023 DOI: 10.1080/15374416.2011.546049] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the nosological distinction between bipolar disorder and schizophrenia, there is increasing evidence that these conditions share phenomenological characteristics. To examine the similarities in their patterns of cognitive impairment, we conducted a meta-analysis from 12 studies of Early Onset Schizophrenia (EOS) and 12 studies of Pediatric Bipolar Disorder (PBD). We found that individuals with PBD suffer from cognitive deficits (e.g., verbal learning and memory, processing speed, or executive control) that are milder but similar in nature to those of patients with EOS. Qualitative similarities between the neuropsychological profiles produced by these groups of patients might represent a "continuum of psychosis" or reflect some degree of genetic biological overlap.
Collapse
Affiliation(s)
- Rebeca Garcia Nieto
- Child Study Center, New York University Langone Medical Center, New York, NY, USA.
| | | |
Collapse
|
24
|
Martino DJ, Strejilevich SA, Torralva T, Manes F. Decision making in euthymic bipolar I and bipolar II disorders. Psychol Med 2011; 41:1319-1327. [PMID: 20860871 DOI: 10.1017/s0033291710001832] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The main aim of this study was to compare a large population of patients with bipolar disorder (BD) types I and II strictly defined as euthymic with healthy controls on measures of decision making. An additional aim was to compare performance on a decision-making task between patients with and without a history of suicide attempt. METHOD Eighty-five euthymic patients with BD-I or BD-II and 34 healthy controls were included. All subjects completed tests to assess verbal memory, attention and executive functions, and a decision-making paradigm (the Iowa Gambling Task, IGT). RESULTS Both groups of patients had worse performance than healthy controls on measures of verbal memory, attention and executive function. No significant differences were found between BD-I, BD-II and healthy controls on measures of decision making. By contrast, patients with a history of suicide attempt had lower performance in the IGT than patients without a history of suicide attempt. CONCLUSIONS Patients with euthymic BD-I and BD-II had intact decision-making abilities, suggesting that this does not represent a reliable trait marker of the disorder. In addition, our results provide further evidence of an association between impairments in decision making and vulnerability to suicidal behavior.
Collapse
Affiliation(s)
- D J Martino
- Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | | | | | | |
Collapse
|
25
|
Arts B, Jabben N, Krabbendam L, van Os J. A 2-year naturalistic study on cognitive functioning in bipolar disorder. Acta Psychiatr Scand 2011; 123:190-205. [PMID: 20846251 DOI: 10.1111/j.1600-0447.2010.01601.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Cognitive alterations in bipolar disorder may reflect genetic influence. However, to what degree mood, medication, thyroid function and other factors impact on longitudinal cognitive functioning remains unclear. METHOD A group of patients with bipolar (spectrum) disorder (n = 76) underwent two monthly cognitive assessments over a 2-year period in a prospective, repeated measures design. Regression models were used to investigate associations with predictors, corrected for multiple testing. RESULTS Patients with bipolar disorder performed worse than healthy controls (n = 61) on all cognitive domains tested. Effect sizes were small, with a maximum of -0.36 for sustained attention. However, cognitive performance varied substantially over the 2-year follow-up, co-varying with subjective cognitive complaints and impacting on functioning. Alterations in sustained attention and motor speed were the only impairments that were invariant over time. Predictors had very limited explanatory power on temporal variation in cognition. Use of second-generation antipsychotics was associated with the largest negative effects on cognition, which were evident in the areas of motor speed and basic information processing (-0.35 < β < -0.5). CONCLUSION Cognitive function in bipolar disorder varies significantly over time, largely independent of clinical factors. The temporal stability of sustained attention is the exception, suggesting it may represent a possible candidate intermediary phenotype.
Collapse
Affiliation(s)
- B Arts
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands.
| | | | | | | |
Collapse
|
26
|
Stanghellini G, Ballerini M. What is it like to be a person with schizophrenia in the social world? A first-person perspective study on Schizophrenic dissociality--part 1: state of the art. Psychopathology 2011; 44:172-82. [PMID: 21412031 DOI: 10.1159/000322637] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 11/09/2010] [Indexed: 11/19/2022]
Abstract
This is a critical review of research on the subjective experience of social dysfunction in persons with schizophrenia. Studies from the phenomenological and cognitive paradigms are examined, and significant outcomes and shortcomings are pointed out. Clinical phenomenologists have mainly interpreted schizophrenic dissociality as an anomaly of prereflexive attunement. The main shortcoming of phenomenological research is that it lacks adequate methodology to collect reliable data since most studies are based on the analysis of a few typical cases. Cognitivism has reliably documented disorders of social functioning in large-scale experimental studies. The main shortcoming of most cognitive paradigms is that they do not properly investigate the personal level of experience in real-world functioning. We conclude that there is a need to reliably collect data through quantitative as well as qualitative methodology as established and accepted by the scientific community in the area of schizophrenic dissociality, reflecting the subjective experiences of people with schizophrenia in the real world.
Collapse
|
27
|
Abstract
OBJECTIVES Studies into social cognition in psychiatric disorders have recently been expanded to address the question of whether or not theory of mind (ToM), i.e., the ability to represent ones own and others mental states, is impaired in bipolar affective disorder (BPD). Results have been mixed so far, mainly due to possible confounding effects of neurocognition, as well as clinical factors such as acuity and current mood. Here, we explored ToM and its associations with neurocognitive functioning in BPD. METHODS A total of 33 patients with bipolar I disorder (of whom 12 were currently depressed, 10 manic, and 11 remitted) and 29 healthy controls were assessed using a test battery that was identical to the one that was used in previous studies in schizophrenia, comprising diverse neurocognitive tasks, including measures of intelligence, executive functioning, and ToM tasks. RESULTS The bipolar disorder patient group as a whole and all three clinical subgroups were impaired on all measures of ToM relative to controls, but did not differ from each other in most ToM scores. Patients poorer performance on executive tasks did not fully explain ToM differences between patients and controls, suggesting a partially selective ToM deficit in BPD. CONCLUSIONS Patients with BPD are impaired in ToM, partially independent of other cognitive dysfunctions and current mood.
Collapse
Affiliation(s)
- Frederike Wolf
- Research Department of Cognitive Neuropsychiatryand Psychiatric Preventive Medicine, University of Bochum, LWL-University Hospital, Germany
| | | | | |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW Research on the neurocognitive functions of bipolar patients has yielded inconsistent results over recent years. There is a growing need for clarification regarding the magnitude, clinical relevance and confounding variables of cognitive impairment in bipolar patients. RECENT FINDINGS Current findings of studies investigating executive functions, psychomotor speed and memory functions suggest heterogeneous cognitive functioning in patients. A significant amount of variance can be attributed to treatment factors or interactions of those factors with the course of illness and individual characteristics. Furthermore, cognitive domains are presumably inter-related. The impact of bipolar illness on cognition can be influenced by age of onset, pharmaceutical treatment approaches, individual response, familial risk factors, and clinical features. Although brain activation patterns appear to be altered, these alternations do not necessarily correlate with impairment in cognitive performance. Without carefully controlling for confounding variables, the actual effect of bipolar disorder on cognitive performance scores cannot be evaluated. SUMMARY Cognitive deficits of clinical relevance are documented for a substantial proportion, but not the majority, of bipolar patients. Yet, available data are inconclusive with respect to the origin of these deficits. Future studies on cognitive deficits in bipolar patients need to deliver detailed descriptions of drug treatment and clinical features.
Collapse
|
29
|
Besnier N, Richard F, Zendjidjian X, Kaladjian A, Mazzola-Pomietto P, Adida M, Azorin JM. Stroop and emotional Stroop interference in unaffected relatives of patients with schizophrenic and bipolar disorders: distinct markers of vulnerability? World J Biol Psychiatry 2010; 10:809-18. [PMID: 19707957 DOI: 10.1080/15622970903131589] [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: 01/14/2023]
Abstract
Reduced inhibition has been demonstrated in both schizophrenic and bipolar patients through the findings of increased interference on the Stroop Colour-Word Task (SCWT) and increased emotional interference on specific versions of the Emotional Stroop Task (EST). Despite previous findings of enhanced interference in unaffected relatives of schizophrenic and bipolar patients, it remains unclear whether interference might be a candidate endophenotype to both disorders. Moreover, data regarding emotional interference in unaffected relatives are critically lacking. In the present study, we aimed to compare unaffected relatives of patients with schizophrenia (SZ-rel, N = 30) and bipolar disorder (BD-rel, N= 30) with normal controls (N = 60) when performing the SCWT and an EST designed with neutral, depressive, paranoid and manic words. SZ-rel exhibited greater interference effect on both the SCWT and the EST as compared to either BD-rel or normal controls. BD-rel, and by contrast to SZ-rel and controls, showed increased emotional interference effect on the EST that was specifically associated to the disease-related words. The findings support the hypothesis of different markers of vulnerability to schizophrenic and bipolar disorders; impairment in cognitive inhibition could characterize high-risk individuals for schizophrenia whereas an emotional bias towards mood-related information could be a trait marker of bipolar disease.
Collapse
Affiliation(s)
- Nathalie Besnier
- Pôle de Psychiatrie, Hôpital Sainte Marguerite, Marseille, France.
| | | | | | | | | | | | | |
Collapse
|
30
|
Barch DM. Neuropsychological abnormalities in schizophrenia and major mood disorders: similarities and differences. Curr Psychiatry Rep 2009; 11:313-9. [PMID: 19635240 PMCID: PMC3836606 DOI: 10.1007/s11920-009-0045-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The past 20 years have been witness to a growing knowledge base of research highlighting the critical importance of cognition in understanding functional status and outcome in schizophrenia. This work has led to an increased emphasis on identifying and evaluating treatments that enhance cognition in schizophrenia, with the hope that this would translate into a better quality of life and improved outcome for patients. At the same time, this research has raised new questions about the specificity of cognitive impairments to schizophrenia and the degree to which similar cognitive impairments may be present in other disorders that can involve psychotic symptoms (eg, schizoaffective disorder, bipolar disorder, and psychotic major depression). This article provides a brief overview of work comparing cognitive function across the nonaffective and affective psychoses and highlights areas of similarity and dissimilarity in the role cognition plays in these disorders.
Collapse
|