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Wei Y, Womer FY, Sun K, Zhu Y, Sun D, Duan J, Zhang R, Wei S, Jiang X, Zhang Y, Tang Y, Zhang X, Wang F. Applying dimensional psychopathology: transdiagnostic prediction of executive cognition using brain connectivity and inflammatory biomarkers. Psychol Med 2023; 53:3557-3567. [PMID: 35536000 DOI: 10.1017/s0033291722000174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The association between executive dysfunction, brain dysconnectivity, and inflammation is a prominent feature across major psychiatric disorders (MPDs), schizophrenia, bipolar disorder, and major depressive disorder. A dimensional approach is warranted to delineate their mechanistic interplay across MPDs. METHODS This single site study included a total of 1543 participants (1058 patients and 485 controls). In total, 1169 participants underwent diffusion tensor and resting-state functional magnetic resonance imaging (745 patients and 379 controls completed the Wisconsin Card Sorting Test). Fractional anisotropy (FA) and regional homogeneity (ReHo) assessed structural and functional connectivity, respectively. Pro-inflammatory cytokine levels [interleukin (IL)-1β, IL-6, and tumor necrosis factor-α] were obtained in 325 participants using blood samples collected with 24 h of scanning. Group differences were determined for main measures, and correlation and mediation analyses and machine learning prediction modeling were performed. RESULTS Executive deficits were associated with decreased FA, increased ReHo, and elevated IL-1β and IL-6 levels across MPDs, compared to controls. FA and ReHo alterations in fronto-limbic-striatal regions contributed to executive deficits. IL-1β mediated the association between FA and cognition, and IL-6 mediated the relationship between ReHo and cognition. Executive cognition was better predicted by both brain connectivity and cytokine measures than either one alone for FA-IL-1β and ReHo-IL-6. CONCLUSIONS Transdiagnostic associations among brain connectivity, inflammation, and executive cognition exist across MPDs, implicating common neurobiological substrates and mechanisms for executive deficits in MPDs. Further, inflammation-related brain dysconnectivity within fronto-limbic-striatal regions may represent a transdiagnostic dimension underlying executive dysfunction that could be leveraged to advance treatment.
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Affiliation(s)
- Yange Wei
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Fay Y Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Kaijin Sun
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yue Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Dandan Sun
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Jia Duan
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Ran Zhang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Shengnan Wei
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Xiaowei Jiang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Yanbo Zhang
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu 210001, China
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
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Lasagna CA, Grove TB, Semple E, Suzuki T, Menkes MW, Pamidighantam P, McInnis M, Deldin PJ, Tso IF. Reductions in regional theta power and fronto-parietal theta-gamma phase-amplitude coupling during gaze processing in bipolar disorder. Psychiatry Res Neuroimaging 2023; 331:111629. [PMID: 36966619 PMCID: PMC10567117 DOI: 10.1016/j.pscychresns.2023.111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/16/2023] [Accepted: 03/11/2023] [Indexed: 04/28/2023]
Abstract
Impaired social cognition is common in bipolar disorder (BD) and predicts poor functional outcomes. A critical determinant of social cognition is the ability to discriminate others' gaze direction, and its alteration may contribute to functional impairment in BD. However, the neural mechanisms underlying gaze processing in BD are unclear. Because neural oscillations are crucial neurobiological mechanisms supporting cognition, we aimed to understand their role in gaze processing in BD. Using electroencephalography (EEG) data recorded during a gaze discrimination task for 38 BD and 34 controls (HC), we examined: theta and gamma power over bilateral posterior and midline anterior locations associated with early face processing and higher-level cognitive processing, and theta-gamma phase-amplitude coupling (PAC) between locations. Compared to HC, BD showed reduced midline-anterior and left-posterior theta power, and diminished bottom-up/top-down theta-gamma PAC between anterior/posterior sites. Reduced theta power and theta-gamma PAC related to slower response times. These findings suggest that altered theta oscillations and anterior-posterior cross-frequency coupling between areas associated with higher-level cognition and early face processing may underlie impaired gaze processing in BD. This is a crucial step towards translational research that may inform novel social cognitive interventions (e.g., neuromodulation to target specific oscillatory dynamics) to improve functioning in BD.
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Affiliation(s)
- Carly A Lasagna
- Department of Psychology, University of Michigan, United States; Department of Psychiatry, University of Michigan, United States.
| | - Tyler B Grove
- Department of Psychiatry, University of Michigan, United States
| | - Erin Semple
- Department of Psychiatry, University of Michigan, United States
| | - Takakuni Suzuki
- Department of Psychology, University of Michigan, United States; Department of Psychiatry, University of Michigan, United States
| | - Margo W Menkes
- Department of Psychology, University of Michigan, United States; Department of Psychiatry, University of Michigan, United States
| | - Preetha Pamidighantam
- Michigan State University College of Human Medicine, Michigan State University, United States
| | - Melvin McInnis
- Department of Psychology, University of Michigan, United States; Department of Psychiatry, University of Michigan, United States
| | - Patricia J Deldin
- Department of Psychology, University of Michigan, United States; Department of Psychiatry, University of Michigan, United States
| | - Ivy F Tso
- Department of Psychiatry & Behavioral Health, The Ohio State University, United States
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Ko H, Park D, Shin J, Yu R, Ryu V, Lee W. Cognitive profiles in bipolar I disorder and associated risk factors: Using Wechsler adult intelligence scale—IV. Front Psychol 2022; 13:951043. [PMID: 36275296 PMCID: PMC9582973 DOI: 10.3389/fpsyg.2022.951043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite the growing evidence of cognitive impairments in bipolar disorder (BD), little work has evaluated cognitive performances utilizing the latest version of the Wechsler Intelligence Scale-IV (WAIS-IV), which is one of the most widely used neurocognitive assessments in clinical settings. Furthermore, clinical characteristics or demographic features that negatively affect the cognitive functioning of BD were not systematically compared or evaluated. Accordingly, the present study aimed to examine the cognitive profile of bipolar I disorder (BD-I) patients and associated risk factors.MethodsParticipants included 45 patients, diagnosed with BD-I, current or most recent episode manic, and matching 46 healthy controls (HC). Cognitive performance was evaluated via WAIS-IV, and clinical characteristics of the BD-I group were examined via multiple self- and clinician-report questionnaires.ResultsMultivariate analysis of covariance (MANCOVA) results indicated that the BD-I group demonstrated significantly poorer performance compared to the HC group in subtests and indexes that reflect working memory and processing speed abilities. Redundancy analysis revealed that overall symptom severity, manic symptom severity, and anxiety were significant predictors of cognitive performance in BD-I, while age of onset, past mood disorder history, depression severity, and impulsiveness showed comparatively smaller predictive values.ConclusionThe current study suggests cognitive deterioration in the cognitive proficiency area while generalized ability, including verbal comprehension and most of the perceptual reasoning skills, remain intact in BD-I. The identified risk factors of cognitive performance provide specific clinical recommendations for intervention and clinical decision-making.
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Affiliation(s)
- Hayoung Ko
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - DongYeon Park
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Jaehyun Shin
- School of Education, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Rina Yu
- Department of Mental Health Research, National Center for Mental Health, Seoul, South Korea
| | - Vin Ryu
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Wonhye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, South Korea
- *Correspondence: Wonhye Lee,
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Lucia M, Romanella SM, Di Lorenzo G, Demchenko I, Bhat V, Rossi S, Santarnecchi E. Neural correlates of N-back task performance and proposal for corresponding neuromodulation targets in psychiatric and neurodevelopmental disorders. Psychiatry Clin Neurosci 2022; 76:512-524. [PMID: 35773784 PMCID: PMC10603255 DOI: 10.1111/pcn.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
AIM Working memory (WM) deficit represents the most common cognitive impairment in psychiatric and neurodevelopmental disorders, making the identification of its neural substrates a crucial step towards the conceptualization of restorative interventions. We present a meta-analysis focusing on neural activations associated with the most commonly used task to measure WM, the N-back task, in patients with schizophrenia, depressive disorder, bipolar disorder, and attention-deficit/hyperactivity disorder. Showing qualitative similarities and differences in WM processing between patients and healthy controls, we propose possible targets for cognitive enhancement approaches. METHODS Selected studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, were analyzed through the activation likelihood estimate statistical framework, with subsequent generation of disorder-specific N-back activation maps. RESULTS Despite similar WM deficits shared across all disorders, results highlighted different brain activation patterns for each disorder compared with healthy controls. In general, results showed brain activity in frontal, parietal, subcortical, and cerebellar regions; however, reduced engagement of specific nodes of the fronto-parietal network emerged in patients compared with healthy controls. In particular, neither bipolar nor depressive disorders showed detectable activations in the dorsolateral prefrontal cortices, while their parietal activation patterns were lateralized to the left and right hemispheres, respectively. On the other hand, patients with attention-deficit/hyperactivity disorder showed a lack of activation in the left parietal lobe, whereas patients with schizophrenia showed lower activity over the left prefrontal cortex. CONCLUSION These results, together with biophysical modeling, were then used to discuss the design of future disorder-specific cognitive enhancement interventions based on noninvasive brain stimulation.
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Affiliation(s)
- Mencarelli Lucia
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
- Precision Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Sara M Romanella
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
- Precision Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giorgio Di Lorenzo
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ilya Demchenko
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Simone Rossi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
- Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
- Precision Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kang Y, Kang W, Han KM, Tae WS, Ham BJ. Associations between cognitive impairment and cortical thickness alterations in patients with euthymic and depressive bipolar disorder. Psychiatry Res Neuroimaging 2022; 322:111462. [PMID: 35231679 DOI: 10.1016/j.pscychresns.2022.111462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Youbin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Wooyoung Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Korea University, Brain Convergence Research Center
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Jiang X, Mio M, Dimick MK, Zou Y, Sultan AA, Goldstein BI. Association of Lithium and Second-Generation Antipsychotics with Neurocognition in Youth with Bipolar Disorder. J Child Adolesc Psychopharmacol 2022; 32:61-69. [PMID: 35085001 PMCID: PMC8884166 DOI: 10.1089/cap.2021.0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Numerous studies have examined the association of antimanic medications with neurocognition in adults with bipolar disorder (BD). However, few studies have examined this topic in youth. Thus, we aimed to examine the association of lithium and second-generation antipsychotics (SGAs), the first-line antimanic medications for youth with BD, with neurocognition in a relatively large sample of youth with BD. Methods: Participants included 91 youth with BD-I, -II, or -Not Otherwise Specified, aged 13-20 years (n = 14 current lithium use, n = 51 current SGA use). We examined four tests from the Cambridge Neuropsychological Test Automated Battery: Intra/Extra Dimensional Set-Shifting Task (IED), Rapid Visual Information Processing Task (RVP), Stockings of Cambridge Test (SOC), and Affective Go/No-Go (AGN). Within-sample Z-scores were computed, and a global neurocognitive composite score and g factor derived from these tests comprised the primary outcomes. Multivariable analyses controlled for age, sex, and IQ. Results: Current lithium use was significantly associated with poorer cognitive flexibility/set-shifting (IED). After further controlling for lifetime comorbid attention-deficit/hyperactivity disorder and current depression symptoms in sensitivity analyses, the lithium finding was no longer significant. Current SGA use was significantly associated with greater affective processing bias (AGN). No significant findings survived correction for multiple comparisons. All other cognitive outcomes were not significantly associated with current lithium use, current SGA use, or total number of current medications. Conclusions: Treatment with lithium or SGAs was associated with minimal neurocognitive impairments, with small effect sizes in primary multivariable analyses. This study adds to the limited body of literature examining medication use in relation to neurocognition in youth with BD. While the current study cannot rule out associations of smaller effect size, present findings suggest that leading mood-stabilizing medications are not associated with frank neurocognitive impairments in youth with BD.
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Affiliation(s)
- Xinyue Jiang
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K. Dimick
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Alysha A. Sultan
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Address correspondence to: Benjamin I. Goldstein, MD, PhD, Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4, Canada
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Tassi E, Boscutti A, Mandolini GM, Moltrasio C, Delvecchio G, Brambilla P. A scoping review of near infrared spectroscopy studies employing a verbal fluency task in bipolar disorder. J Affect Disord 2022; 298:604-617. [PMID: 34780861 DOI: 10.1016/j.jad.2021.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deficits in cognitive functioning, including attention, memory, and executive functions, along with impairments in language production, are present in patients with bipolar disorder (BD) patients during mood phases, but also during euthymia.Verbal fluency tasks (VFTs), being able to evaluate integrity of a wide range of cognitive domains and represent, can be used to screen for these disturbances. Neuroimaging studies, including Near-InfraRed Spectroscopy (NIRS), have repeatedly showed widespread alterations in the prefrontal and temporal cortex during the performance of VFTs in BD patients. This review aims to summarize the results of NIRS studies that evaluated hemodynamic responses associated with the VFTs in prefrontal and temporal regions in BD patients. METHODS We performed a scoping review of studies evaluating VFT-induced activation in prefrontal and temporal regions in BD patients, and the relationship between NIRS data and various clinical variables. RESULTS 15 studies met the inclusion criteria. In BD patients, compared to healthy controls, NIRS studies showed hypoactivation of the dorsolateral prefrontal cortex, ventrolateral prefrontal cortex and anterior temporal regions. Moreover, clinical variables, such as depressive and social adaptation scores, were negatively correlated with hemodynamic responses in prefrontal and temporal regions, while a positive correlation were reported for measures of manic symptoms and impulsivity. LIMITATIONS The heterogeneity of the studies in terms of methodology, study design and clinical characteristics of the samples limited the comparability of the findings. CONCLUSIONS Given its non-invasiveness, good time-resolution and no need of posturalconstraint, NIRS technique could represent a useful tool for the evaluation of prefrontal and temporal haemodynamic correlates of cognitive performances in BD patients.
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Affiliation(s)
- Emma Tassi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy
| | - Andrea Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
| | - Gian Mario Mandolini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy
| | - Chiara Moltrasio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
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Simjanoski M, Jansen K, Mondin TC, Pedrotti Moreira F, Vieira IS, da Silva RA, Souza LDDM, Frey BN, Cardoso TDA, Kapczinski F. Cognitive complaints in individuals recently diagnosed with bipolar disorder: A cross-sectional study. Psychiatry Res 2021; 300:113894. [PMID: 33836469 DOI: 10.1016/j.psychres.2021.113894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/19/2021] [Indexed: 11/25/2022]
Abstract
AIM To assess the differences in subjective cognitive dysfunction between major depressive disorder (MDD) and recently diagnosed Bipolar Disorder (BD) across euthymia and mood episodes. METHODS This is a cross-sectional study corresponding to the second wave of a longitudinal study. The first wave consisted of subjects aged between 18 and 60 diagnosed with MDD. In the follow up after three years (second wave), conversion from MDD to BD diagnosis was assessed by qualified psychologists using the Mini International Neuropsychiatric Interview (MINI-Plus). Subjects were categorized in four diagnostic groups: euthymic MDD, MDD in a current mood episode, euthymic BD, and BD in a current mood episode. All subjects completed the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), an instrument specifically designed for detecting subjective cognitive deficits in BD. RESULTS The total sample (n = 468) included 410 subjects with MDD and 58 individuals recently diagnosed with BD. We subdivided the 2 groups based on their current mood state, and found a significant difference in COBRA total scores between euthymic BD individuals (median 17.00 [IQR: 8.75 - 20.75]) and euthymic MDD subjects (median 8.00 [IRQ: 5.00 - 14.00], p = 0.002), showing higher subjective cognitive dysfunction in individuals recently diagnosed with BD. The differences remained significant after adjusting for the presence of lifetime psychotic symptoms. We found no differences between MDD and BD during an acute mood episode. LIMITATION The small sample size of individuals with BD. CONCLUSION The findings suggest a higher presence of subjective cognitive complaints among individuals recently diagnosed with BD in comparison to individuals with MDD during euthymia.
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Affiliation(s)
- Mario Simjanoski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Karen Jansen
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Thaíse Campos Mondin
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil; Pró-Reitoria de Assuntos Estudantis (PRAE), Universidade Federal de Pelotas, RS, Brazil
| | - Fernanda Pedrotti Moreira
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Igor Soares Vieira
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil; Centro Universitário Estácio de Sergipe, SE, Brazil
| | - Ricardo Azevedo da Silva
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Luciano Dias de Mattos Souza
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Taiane de Azevedo Cardoso
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Flávio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.
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Neuroprogression as an Illness Trajectory in Bipolar Disorder: A Selective Review of the Current Literature. Brain Sci 2021; 11:brainsci11020276. [PMID: 33672401 PMCID: PMC7926350 DOI: 10.3390/brainsci11020276] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 01/29/2023] Open
Abstract
Bipolar disorder (BD) is a chronic and disabling psychiatric condition that is linked to significant disability and psychosocial impairment. Although current neuropsychological, molecular, and neuroimaging evidence support the existence of neuroprogression and its effects on the course and outcome of this condition, whether and to what extent neuroprogressive changes may impact the illness trajectory is still poorly understood. Thus, this selective review was aimed toward comprehensively and critically investigating the link between BD and neurodegeneration based on the currently available evidence. According to the most relevant findings of the present review, most of the existing neuropsychological, neuroimaging, and molecular evidence demonstrates the existence of neuroprogression, at least in a subgroup of BD patients. These studies mainly focused on the most relevant effects of neuroprogression on the course and outcome of BD. The main implications of this assumption are discussed in light of specific shortcomings/limitations, such as the inability to carry out a meta-analysis, the inclusion of studies with small sample sizes, retrospective study designs, and different longitudinal investigations at various time points.
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Huang CC, Chang YH, Wang TY, Lee SY, Chen SL, Chen PS, Lane HY, Yang YK, Lu RB. Effects of mood episodes and comorbid anxiety on neuropsychological impairment in patients with bipolar spectrum disorder. Brain Behav 2020; 10:e01813. [PMID: 32864897 PMCID: PMC7667309 DOI: 10.1002/brb3.1813] [Citation(s) in RCA: 4] [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: 05/02/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Cases of patients with bipolar disorder (BD) having neuropsychological impairment have been reported, although inconsistently. The possibility of comorbidity with anxiety disorder (AD) has been suggested. The association between mood episodes and AD comorbidity on neuropsychological performance is unclear and thus was investigated in the current study. METHODS All participants were informed about and agreed to participate in this study. Patients with BD were recruited from outpatient and inpatient settings, and healthy controls (HCs) were recruited as a comparison group. Six hundred and twenty-eight participants (175 HCs and 453 BD-56 BDI and 397 BDII) were studied based on their current mood episode, namely, depressive (BDd ), manic/hypomanic (BDm), mixed (BDmix), and euthymic (BDeu), compared with/without AD comorbidity (164 with AD). RESULTS Compared to HCs, all BD groups had significantly more impaired neuropsychological profiles, but the BDeu group was found to have less impairment in memory and executive function than the episodic BD groups. The percentage of AD comorbidity in BDd, BDm, BDmix, and BDeu was 33.9%, 40.3%, 33.0%, and 35.6%, respectively (χ2 = 1.61, p > .05). The results show that AD plays a different role in neuropsychological impairment across various mood episodes in BD. CONCLUSION Memory impairment and executive dysfunction may be state-like cognitive phenotypes and are affected by AD comorbidity during mixed and depressive episodes in BD, while sustained attention deficiencies are more like trait markers, regardless of mood episodes, and persist beyond the course of the illness. The AD comorbidity effect on attentional deficit is greater when suffering from a manic episode.
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Affiliation(s)
- Chih-Chun Huang
- Department of Psychiatry, Dou-Liou Branch, National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yun-Hsuan Chang
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung City, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan.,Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan
| | - Tzu-Yun Wang
- Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan.,Department of Psychiatry, Kaohsiung Veteran's General Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shiou-Lan Chen
- Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan.,Graduate Institute of Medicine & M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan.,Department of Medical Research, KMU Hospital, Kaohsiung, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsien-Yuan Lane
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung City, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, Dou-Liou Branch, National Cheng Kung University Hospital, Yunlin, Taiwan.,Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan.,Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan.,Yanjiao Furen Hospital, Hebei, China
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11
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Cho IYK, Goghari VM. The relationship between maintenance and manipulation components of working memory and prefrontal and parietal brain regions in bipolar disorder. J Affect Disord 2020; 264:519-526. [PMID: 31780133 DOI: 10.1016/j.jad.2019.11.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/07/2019] [Accepted: 11/12/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND A domain of cognition that has been found to be impaired in bipolar disorder across mood states is working memory. Working memory can be separated into two components, maintenance and manipulation. Bipolar patients also demonstrate structural brain abnormalities in prefrontal and parietal regions, which are regions associated with working memory processes. Despite the understanding that working memory consists of multiple separable cognitive processes, no study to date has differentiated maintenance and manipulation, and associated them with underlying structural brain regions in bipolar disorder. METHODS Twenty-six bipolar patients and 24 controls completed a visuospatial working memory task and structural neuroimaging. Prefrontal and parietal gray matter volume, surface area, and cortical thickness were obtained using FreeSurfer. The relationship between working memory performance, structural integrity, symptoms, and functioning were investigated. RESULTS Bipolar patients were less accurate on the working memory task compared to controls, without a greater deficit in the manipulation condition. Controls had thicker prefrontal and parietal cortices than bipolar patients. In bipolar patients, thicker prefrontal cortices had a small association with greater accuracy on the maintenance condition, as well as greater depression. LIMITATIONS This study could have benefitted from a larger sample size. CONCLUSIONS Bipolar patients demonstrated both poorer accuracy on the visuospatial working memory task compared to controls and thinner cortices in areas associated with working memory, namely the prefrontal and parietal cortices. This demonstrates an underlying relationship between brain and behavior in bipolar disorder.
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Affiliation(s)
- Ivy Y K Cho
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada; Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.
| | - Vina M Goghari
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada; Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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12
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Jiménez-López E, Sánchez-Morla EM, López-Villarreal A, Aparicio AI, Martínez-Vizcaíno V, Vieta E, Rodriguez-Jimenez R, Santos JL. Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up. Eur Psychiatry 2018; 56:60-68. [DOI: 10.1016/j.eurpsy.2018.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 01/09/2023] Open
Abstract
AbstractBackground:Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up.Methods:Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2).Results:The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration.Conclusions:We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.
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13
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Peedicayil J, Kumar A. Epigenetic Drugs for Mood Disorders. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2018; 157:151-174. [PMID: 29933949 DOI: 10.1016/bs.pmbts.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is increasing evidence that changes in epigenetic mechanisms of gene expression are involved in the pathogenesis of mood disorders. Such evidence stems from studies conducted on postmortem brain tissues and peripheral cells or tissues of patients with mood disorders. This article describes and discusses the epigenetic changes in the mood disorders (major depressive disorder and bipolar disorder) found to date. The article also describes and discusses preclinical drug trials of epigenetic drugs for treating mood disorders. In addition, nonrandomized and randomized controlled trials of nutritional drugs with effects on epigenetic mechanisms of gene expression in patients with major depressive disorder and bipolar disorder are discussed. Trials of epigenetic drugs and nutritional drugs with epigenetic effects are showing promising results for the treatment of mood disorders. Thus, epigenetic drugs and nutritional drugs with epigenetic effects could be useful in the treatment of patients with these disorders.
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14
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Study of memory dysfunction and interleukin-6 in euthymic Egyptian patients with bipolar disorder. MIDDLE EAST CURRENT PSYCHIATRY 2018. [DOI: 10.1097/01.xme.0000530907.80301.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Sanchez-Autet M, Arranz B, Safont G, Sierra P, Garcia-Blanco A, de la Fuente L, Garriga M, García-Portilla MP. Gender differences in C-reactive protein and homocysteine modulation of cognitive performance and real-world functioning in bipolar disorder. J Affect Disord 2018; 229:95-104. [PMID: 29306698 DOI: 10.1016/j.jad.2017.12.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive and psychosocial impairment has been associated with increased levels of C-reactive protein (CRP) and homocysteine in bipolar disorder, but gender differences have seldom been studied. METHODS Two hundred and twenty-four bipolar outpatients were included. Cognitive performance was assessed through the Screen for Cognitive Impairment in Psychiatry (SCIP). Psychosocial functioning was evaluated using the Functioning Assessment Short Test (FAST) and the General Assessment of Functioning (GAF). Homocysteine and CRP levels were determined. Separate analyses were performed by gender. Partial correlations were calculated to test for associations between biomarkers and cognitive and psychosocial functioning. Hierarchical multiple regression was used to assess factors predicting cognitive and psychosocial functioning. Covariates were: age, education, duration of illness, hospital admissions, depressive symptoms, tobacco consumption, and BMI. RESULTS A better performance was noted in women in delayed verbal learning (p = 0.010), along with better occupational functioning (p = 0.027) and greater leisure time impairment (p = 0.034). In men, CRP and homocysteine levels were associated with psychosocial dysfunction (interpersonal relationships and financial functioning, respectively). In women, CRP levels correlated with cognitive performance (SCIP total raw score, immediate and delayed verbal learning, and verbal fluency). CRP was a predictor of cognitive performance in women only. LIMITATIONS The choice of the cognitive scale and covariates and the lack of a control group may be the main limitations. CONCLUSIONS A gender difference was found in biomarker modulation of cognition and psychosocial functioning. A gender-based approach to cognition and real-world functioning should be considered in bipolar disorder to ensure an optimal outcome.
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Affiliation(s)
- M Sanchez-Autet
- Parc Sanitari Sant Joan de Deu, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - B Arranz
- Parc Sanitari Sant Joan de Deu, University of Barcelona, CIBERSAM, Barcelona, Spain.
| | - G Safont
- Hospital Universitari Mutua Terrassa, CIBERSAM, Barcelona, Spain
| | - P Sierra
- Department of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, Department of Medicine, University of Valencia, Spain
| | - A Garcia-Blanco
- Neonatal Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - L de la Fuente
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - M Garriga
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, CIBERSAM, Barcelona, Spain
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16
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Corrêa-Velloso JC, Gonçalves MC, Naaldijk Y, Oliveira-Giacomelli Á, Pillat MM, Ulrich H. Pathophysiology in the comorbidity of Bipolar Disorder and Alzheimer's Disease: pharmacological and stem cell approaches. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:34-53. [PMID: 28476640 DOI: 10.1016/j.pnpbp.2017.04.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/28/2017] [Indexed: 12/22/2022]
Abstract
Neuropsychiatric disorders involve various pathological mechanisms, resulting in neurodegeneration and brain atrophy. Neurodevelopmental processes have shown to be critical for the progression of those disorders, which are based on genetic and epigenetic mechanisms as well as on extrinsic factors. We review here common mechanisms underlying the comorbidity of Bipolar Disorders and Alzheimer's Disease, such as aberrant neurogenesis and neurotoxicity, reporting current therapeutic approaches. The understanding of these mechanisms precedes stem cell-based strategies as a new therapeutic possibility for treatment and prevention of Bipolar and Alzheimer's Disease progression. Taking into account the difficulty of studying the molecular basis of disease progression directly in patients, we also discuss the importance of stem cells for effective drug screening, modeling and treating psychiatric diseases, once in vitro differentiation of patient-induced pluripotent stem cells provides relevant information about embryonic origins, intracellular pathways and molecular mechanisms.
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Affiliation(s)
- Juliana C Corrêa-Velloso
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Av. Prof. Lineu Prestes 748, São Paulo, SP 05508-000, Brazil
| | - Maria Cb Gonçalves
- Departamento de Neurologia e Neurociências, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, São Paulo, SP 04039-032, Brazil
| | - Yahaira Naaldijk
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Av. Prof. Lineu Prestes 748, São Paulo, SP 05508-000, Brazil
| | - Ágatha Oliveira-Giacomelli
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Av. Prof. Lineu Prestes 748, São Paulo, SP 05508-000, Brazil
| | - Micheli M Pillat
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Av. Prof. Lineu Prestes 748, São Paulo, SP 05508-000, Brazil
| | - Henning Ulrich
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Av. Prof. Lineu Prestes 748, São Paulo, SP 05508-000, Brazil.
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Neurocognition in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia. J Affect Disord 2017; 222:169-176. [PMID: 28709024 DOI: 10.1016/j.jad.2017.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND It has been suggested that patients with bipolar disorder with psychotic symptoms (BD-P) have larger neurocognitive impairment than patients with bipolar disorder without a history of psychotic symptoms (BD-NP). The objective of this study was to compare neurocognitive performance of BD-P and BD-NP relative to a group of patients with schizophrenia (SZ), and healthy controls (HC). METHODS Neurocognitive function was examined in 100 subjects with bipolar I disorder (50 BD-P, 50 BD-NP), 50 SZ, and 51 HC. All patients with BD fulfilled criteria for euthymia, while all SZ patients were stabilised for at least the previous 3 months. RESULTS Patients with BD-P and BD-NP performed worse than HC in all neurocognitive measures, except for sustained attention. Differences between BD-P and BD-NP were subtle and circumscribed to the working memory domain (effect size: 0.29). SZ performed worse than BD-NP in the neurocognitive composite index (NCI) and in the working memory domain. There were no differences between SZ and BD-P in any neurocognitive measure. LIMITATIONS The relatively small sample size, the cross-sectional design and, that patients were receiving pharmacological treatment are the main limitations of this study. CONCLUSIONS Our findings show that the three groups of patients have a large neurocognitive impairment. Differences are quantitative and only present in some neurocognitive domains, such as working memory. These results suggest that patients with BD and SZ can benefit from the same strategies of cognitive remediation.
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18
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Belizario GO, Gigante AD, de Almeida Rocca CC, Lafer B. Cognitive impairments and predominant polarity in bipolar disorder: a cross-sectional study. Int J Bipolar Disord 2017; 5:15. [PMID: 28332122 PMCID: PMC5427058 DOI: 10.1186/s40345-017-0085-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background Bipolar disorder (BD) patients exhibit cognitive impairments during euthymic states. Studies suggest that manic episodes may be correlated to cognitive impairments. The present study investigated the relationship between predominant polarity and the cognitive deficits frequently detected in bipolar patients. We hypothesize that mania predominant polarity (MPP) patients should exhibit greater cognitive impairments in comparison to depressive (DPP) and indefinite predominant polarity (IPP) patients and healthy control (HC) individuals. Methods The study evaluated 55 euthymic BD patients, type I and II, and 31 HCs. Patients were divided into 3 groups: MPP (n = 17), DPP (n = 22), and IPP (n = 16), and compared regarding demographic and clinical variables, and performance on a 7-test neuropsychological battery. Results MPP patients demonstrated greater cognitive impairments in alternating attention, verbal fluency, and delayed memory in comparison to DPP, IPP, and HC. Compared to HC, IPP patients exhibit cognitive deficits in verbal fluency and alternating attention and DPP patients solely in verbal fluency. Furthermore, DPP patients did not exhibit, in none of the seven neuropsychological tests, significant poorer performances than MPP or IPP patients, although having significant more episodes than MPP patients. Conclusion MPP patients exhibit increased cognitive impairments in comparison to DPP, IPP, and HC subjects. Manic episodes may play an important role in the development of cognitive deficits and thus, in potential neuroprogression. Predominant polarity may be an important specifier for predicting future cognitive impairments.
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Affiliation(s)
- Gabriel Okawa Belizario
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785-3º Andar/Ala norte/Ceapesq/Sala 4, São Paulo, SP, Zip code: 05403-010, Brazil.
| | - Alexandre Duarte Gigante
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785-3º Andar/Ala norte/Ceapesq/Sala 4, São Paulo, SP, Zip code: 05403-010, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785-3º Andar/Ala norte/Ceapesq/Sala 4, São Paulo, SP, Zip code: 05403-010, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785-3º Andar/Ala norte/Ceapesq/Sala 4, São Paulo, SP, Zip code: 05403-010, Brazil
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19
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Soraggi-Frez C, Santos FH, Albuquerque PB, Malloy-Diniz LF. Disentangling Working Memory Functioning in Mood States of Bipolar Disorder: A Systematic Review. Front Psychol 2017; 8:574. [PMID: 28491042 PMCID: PMC5405335 DOI: 10.3389/fpsyg.2017.00574] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/28/2017] [Indexed: 12/31/2022] Open
Abstract
Working memory (WM) deficits are often reported in patients with Bipolar Disorder (BD). However, it is not clear about the nature of these WM deficits (update or serial order processes) and their association with each BD states (euthymic, mania, and depressive). This review investigated the association between BD patient's states and the functioning of WM components. For this purpose, we carried out a systematic review fulfilling a search in the databases Medline, Scopus, SciELO, and Web of Science using specific terms in the abstracts of the articles that generated 212 outcomes in the restricted period from 2005 to 2016. Twenty-three papers were selected, completely read, and analyzed using PICOS strategy. The mood episodes predicted deficits in different components of WM in BD patients (the phonological loop or visuospatial sketchpad) and were associated with different WM processes (updating and serial recall). Lower cognitive scores persist even in remission of symptoms. This result suggests that WM deficit apparently is stage-independent in BD patients. Furthermore, findings suggest that the neutral point on Hedonic Detector component of WM could be maladjusted by BD.
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Affiliation(s)
- Carolina Soraggi-Frez
- Department of Psychology, Faculty of Philosophy and Human Sciences, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Flávia H Santos
- School of Psychology (CIPsi), University of MinhoBraga, Portugal
| | | | - Leandro F Malloy-Diniz
- Department of Mental Health, National Science and Technology Institutes (INCT-MM), Federal University of Minas GeraisBelo Horizonte, Brazil
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20
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Aparicio A, Santos JL, Jiménez-López E, Bagney A, Rodríguez-Jiménez R, Sánchez-Morla EM. Emotion processing and psychosocial functioning in euthymic bipolar disorder. Acta Psychiatr Scand 2017; 135:339-350. [PMID: 28188631 DOI: 10.1111/acps.12706] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine emotion processing in euthymic bipolar patients (EBP) compared to healthy controls. In addition, to determine whether or not there is an association between emotion processing and psychosocial functioning. MATERIAL AND METHODS A sample of 60 EBP and 60 healthy controls matched for age, gender, education level, and premorbid intelligence were studied. All subjects were assessed using the MATRICS Consensus Cognitive Battery (MCCB) and two additional executive function measures: the Trail Making Test-Part B and the Stroop Test. Emotion processing was examined using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Psychosocial functioning was assessed using the Functional Assessment Short Test (FAST). RESULTS Euthymic bipolar patients obtained lower scores than controls in all MSCEIT measures except for the using emotions branch. Likewise, EBP obtained a worse performance than healthy controls in all neurocognitive domains. Correlation between MSCEIT strategic area measures and FAST total score was found (r = -0.311; P < 0.016). Regression analysis showed that residual depressive symptomatology explains a 9.1% of the variance in functional outcome. MSCEIT strategic area score explained an additional 8.6%. Neurocognition did not increase the percentage of the variance explained by emotion processing. CONCLUSIONS Euthymic bipolar patients exhibit deficits in emotion processing. Emotion processing is associated with social functioning in these patients.
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Affiliation(s)
- A Aparicio
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - J L Santos
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - E Jiménez-López
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - A Bagney
- Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain
| | - R Rodríguez-Jiménez
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain
| | - E M Sánchez-Morla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain.,Department of Medicine, School of Medicine, University of Alcalá, Madrid, Spain.,Department of Psychiatry, University Hospital of Guadalajara, Guadalajara, Spain
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21
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Doruk A, Yazihan NT, Balikci A, Erdem M, Bolu A, Ates MA. Cognitive Functions in Bipolar Manic, Depressed and Remission Episodes. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20130506122642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ali Doruk
- Department of Psycchiatry, Gulhane Military Medical Academy, Ankara - Turkey
| | | | - Adem Balikci
- Department of Psycchiatry, Gulhane Military Medical Academy, Ankara - Turkey
| | - Murat Erdem
- Department of Psycchiatry, Gulhane Military Medical Academy, Ankara - Turkey
| | | | - Mehmet Alpay Ates
- Department of Psychiatry, Haydarpasa Training Hospital, Gulhane Military Medical Academy, Istanbul - Turkey
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Abstract
Bipolar disorder (BD) is associated with important cognitive deficits that persist during the periods of remission. Although these deficits seem to play an important role in the functional impairment experienced by bipolar patients, evidence regarding their clinical management is scant. We revised the databases PubMed, MEDLINE, and clinicaltrials.gov, searching for studies focusing on the pharmacological and nonpharmacological treatment of cognitive deficits among bipolar patients. In addition, a manual search of bibliographical cross-references was performed. Currently, there is no Food and Drug Administration-approved pharmacological agent for the management of cognitive deficits in BD. A number of agents have been tested in the treatment of cognitive deficits in BD, with mixed results. Nonpharmacological interventions, such as cognitive remediation and noninvasive brain stimulation techniques, seem promising, but their role has not yet been properly explored among bipolar patients. Additional studies, aiming at evaluating the efficacy of interventions combining cognitive rehabilitation and biological treatments, are highly desirable.
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23
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Tsai PS, Liu IC, Chiu CH, Huang CJ, Wang MY. Effect of valproic acid on dementia onset in patients with bipolar disorder. J Affect Disord 2016; 201:131-6. [PMID: 27208500 DOI: 10.1016/j.jad.2016.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Valproic acid (VPA) is widely used for treating patients with bipolar disorder; however, it has adverse effects on cognitive function. This study investigated the effect of VPA on the risk of dementia in patients with bipolar disorder. METHODS We analyzed data from Taiwan's Longitudinal Health Insurance Database 2010. Patients with bipolar disorder who were prescribed VPA for 28 days or at least once per month for 3 consecutive months after the index date were classified as the VPA-treated group, whereas those who did not receive VPA were classified as the VPA-untreated group. Both groups were tracked until the end of 2013 or until loss to follow-up to identify new-onset dementia events. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) of subsequent dementia associated with VPA treatment after adjustment for confounding variables. RESULTS The study comprised 5158 patients with bipolar disorder. The multivariable-adjusted HR for newly diagnosed dementia was 1.73 (95% confidence interval [CI], 1.24-2.41, P=0.001) for the VPA-treated group compared with the VPA-untreated group after adjustment for potential confounders. The VPA-treated group had a higher risk than did the VPA-untreated group after propensity score adjustment (HR=1.95, 95% CI=1.42-2.67, P<0.001). LIMITATION Certain variables that may affect the incidence of dementia were unavailable in the claims database and thus could not be considered. CONCLUSION Treating bipolar disorder with VPA increases the risk of dementia by 73-95%.
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Affiliation(s)
- Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - I-Chao Liu
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Huan Chiu
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of General Psychiatry, Taipei City Psychiatric Center, Taipei, Taiwan
| | - Chun-Jen Huang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, 289, Jian Gou Road, Sindian District, New Taipei City 23142, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Mei-Yeh Wang
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, 112, Minzu Road, Sindian District, New Taipei City 23143, Taiwan.
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Romero E, Holtzman JN, Tannenhaus L, Monchablon R, Rago CM, Lolich M, Vázquez GH. Neuropsychological performance and affective temperaments in Euthymic patients with bipolar disorder type II. Psychiatry Res 2016; 238:172-180. [PMID: 27086230 DOI: 10.1016/j.psychres.2016.02.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/27/2015] [Accepted: 02/16/2016] [Indexed: 11/16/2022]
Abstract
Affective temperament has been suggested as a potential mediator of the effect between genetic predisposition and neurocognitive functioning. As such, this report seeks to assess the extent of the correlation between affective temperament and cognitive function in a group of bipolar II subjects. 46 bipolar II outpatients [mean age 41.4 years (SD 18.2); female 58.9%] and 46 healthy controls [mean age 35.1 years (SD 18); female 56.5%] were evaluated with regard to their demographic and clinical characteristics, affective temperament, and neurocognitive performance. Crude bivariate correlation analyses and multiple linear regression models were constructed between five affective temperament subscales and eight neurocognitive domains. Significant correlations were identified in bipolar patients between hyperthymic temperament and verbal memory and premorbid IQ; cyclothymic temperament and attention; and irritable temperament, attention, and verbal fluency. In adjusting for potential confounders of the relationship between temperament and cognitive function, the strongest mediating factors among the euthymic bipolar patients were found to be residual manic and depressive symptoms. It is therefore concluded that affective temperaments may partially influence the neurocognitive performance of both healthy controls and euthymic patients with bipolar disorder type II in several specific domains.
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Affiliation(s)
- Ester Romero
- Department of Neuroscience, Research Center in Neuroscience and Neuropsychology, Palermo University, Buenos Aires, Argentina
| | - Jessica N Holtzman
- Department of Neuroscience, Research Center in Neuroscience and Neuropsychology, Palermo University, Buenos Aires, Argentina,; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Lucila Tannenhaus
- Department of Neuroscience, Research Center in Neuroscience and Neuropsychology, Palermo University, Buenos Aires, Argentina
| | - Romina Monchablon
- Department of Neuroscience, Research Center in Neuroscience and Neuropsychology, Palermo University, Buenos Aires, Argentina
| | - Carlo Mario Rago
- Department of Neuroscience, Research Center in Neuroscience and Neuropsychology, Palermo University, Buenos Aires, Argentina,; Dipartimento di Psicologia Clinica, Universitá La Sapienza, Roma, Italy
| | - Maria Lolich
- Department of Neuroscience, Research Center in Neuroscience and Neuropsychology, Palermo University, Buenos Aires, Argentina,; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Gustavo H Vázquez
- Department of Neuroscience, Research Center in Neuroscience and Neuropsychology, Palermo University, Buenos Aires, Argentina,; International Consortium for Bipolar & Psychotic Disorder Research, McLean Hospital, Belmont, MA, United States.
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Cotrena C, Branco LD, Shansis FM, Fonseca RP. Executive function impairments in depression and bipolar disorder: association with functional impairment and quality of life. J Affect Disord 2016; 190:744-753. [PMID: 26606718 DOI: 10.1016/j.jad.2015.11.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND The neuropsychological correlates of major depressive (MDD) and bipolar disorder (BD), and their association with quality of life (QOL) and functioning, have not been sufficiently studied in the literature. The present study aimed to compare executive functions, attention, processing speed, QOL and disability between patients with BD type I, BD type II, MDD and healthy controls. METHOD 205 participants (n=37 BDI, 81% female; n=35 BDII, 80% female; n=45 MDD, 69% female; n=89C, 46% female) aged between 18 and 67 years were administered an extensive neurocognitive battery consisting of widely used standardized measures such as the Trail Making Test, the Stroop Color-Word Test and a modified version of the Wisconsin Card Sorting Task. Z-scores were compared between groups by ANCOVA. The prevalence of impairments on each measure (Z-score<1.5) was compared between groups using chi-square tests. The associations between cognition, quality of life and functioning were evaluated through correlational analysis. RESULTS Patients with MDD showed poor selective and sustained attention, and exhibited impairments in timed tasks, suggesting low efficiency of executive processing. Patients with BDI displayed more widespread cognitive impairment than the remaining groups, and performed worse than subjects with MDD on measures of sustained attention and inhibitory control. Decision-making ability and attentional control were able to distinguish between patients with BDI and BDII. QOL and disability were most impaired in patients with BDI, and more closely associated with cognitive impairment than in the remaining groups. LIMITATIONS No control of pharmacological variables, clinical or demographic characteristics. CONCLUSIONS Our results provide important information regarding the nature and severity of the cognitive alterations associated with different mood disorders, and may contribute to the diagnosis, rehabilitation and treatment of these conditions.
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Affiliation(s)
- Charles Cotrena
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Avenue Ipiranga, 6681 Prédio 11, Sala 932, Porto Alegre, RS Postal code: 90619-900, Brazil.
| | - Laura Damiani Branco
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Avenue Ipiranga, 6681 Prédio 11, Sala 932, Porto Alegre, RS Postal code: 90619-900, Brazil
| | | | - Rochele Paz Fonseca
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Avenue Ipiranga, 6681 Prédio 11, Sala 932, Porto Alegre, RS Postal code: 90619-900, Brazil
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Tu KY, Wu MK, Chen YW, Lin PY, Wang HY, Wu CK, Tseng PT. Significantly Higher Peripheral Insulin-Like Growth Factor-1 Levels in Patients With Major Depressive Disorder or Bipolar Disorder Than in Healthy Controls: A Meta-Analysis and Review Under Guideline of PRISMA. Medicine (Baltimore) 2016; 95:e2411. [PMID: 26825882 PMCID: PMC5291552 DOI: 10.1097/md.0000000000002411] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An increasing amount of research has focused on insulin-like growth factor-1 (IGF-1) because of multiple neurotrophic effects, including neurogenesis, remyelination, and synaptogenesis. In addition, IGF-1 can mediate an antidepressant effect in patients with major affective disorder, and its levels in the cerebrospinal fluid have been found to vary with antidepressant treatment. Furthermore, it has been proven to crossover the blood-brain barrier, with a reciprocal feedback loop being the central effect. However, recent studies have reported inconclusive findings about the role of IGF-1 in major affective disorder. The aim of the current study was to conduct a thorough meta-analysis of changes in peripheral IGF-1 levels in patients with major depressive disorder (MDD) or bipolar disorder (BD). We conducted a thorough literature search and compared peripheral IGF-1 levels in patients with MDD or BD and in healthy controls, and investigated clinical variables through meta-regression. Electronic research was conducted through platform of PubMed. We used inclusion criteria as clinical trials discussing comparisons of peripheral IGF-1 protein levels in patients with MDD or BD and those in healthy controls. We analyzed the cases from 9 studies with the random-effect model. The main finding was that peripheral IGF-1 levels in the patients were significantly higher than in the healthy controls (P < 0.001), with a significant inverse association with duration of illness (P = 0.03). In meta-analysis comparing peripheral IGF-1 levels in patients with BD or MDD before and after treatment, there was no significant change in peripheral IGF-1 levels after treatment (P = 0.092). The small numbers of studies and lack of correlation data with growth hormone in current studies are the main limitations of this meta-analysis. Our results indicated that peripheral IGF-1 levels may not be an indicator of disease severity, but may be a disease trait marker or an indicator of cognition. However, further investigations on the correlation between cognitive function and peripheral IGF-1 levels are needed to explore the role of IGF-1 in the pathophysiology of MDD and BD.
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Affiliation(s)
- Kun-Yu Tu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan (K-YT, H-YW, C-KW, P-TT); Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan (Y-WC); Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (M-KW, P-YL); and Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (P-YL)
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Vrabie M, Marinescu V, Talaşman A, Tăutu O, Drima E, Micluţia I. Cognitive impairment in manic bipolar patients: important, understated, significant aspects. Ann Gen Psychiatry 2015; 14:41. [PMID: 26609314 PMCID: PMC4659170 DOI: 10.1186/s12991-015-0080-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 11/04/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Bipolar disorder is a chronic mood disorder with episodic progress and high relapse rate. Growing evidence suggests that individuals with bipolar disorder display cognitive impairment which persists even throughout periods of symptom's remission. METHOD 137 bipolar patients met the inclusion criteria (depressive episode: DSM-IV-TR criteria for major depressive episode, HAMD score ≥17; manic/hypomanic episode: DSM-IV-TR criteria for manic/hypomanic episode, YMRS score ≥12, euthymic: 6 months of remission, HAMD score ≤8, YMRS score ≤6; and mixed: DSM-IV-TR criteria for mixed episode, HAMD score >8 and YMRS score >6) and were therefore enrolled in the study. Patients were free of psychotic symptoms (hallucinations/delusions) at the moment of testing. Control group consisted of 62 healthy subjects without history of neurological and/or psychiatric disorder. Cognitive battery has been applied in order to assess verbal memory, working memory, psychomotor speed, verbal fluency, attention and speed of information processing, and executive function. Following data were collected: demographics, psychiatric history, age of illness onset; current and previous treatment (including hospitalizations). Cognitive deficits were assessed in bipolar patients experiencing manic, depressive, mixed episodes or who were euthymic in mood. Results were compared between the subgroups and with healthy individuals. The association of impaired cognition with illness course was analyzed. RESULTS Bipolar patients showed cognitive deficits in all evaluated domains when compared to controls. The lowest scores were obtained for the verbal fluency test. After adjusting for current episode, manic subgroup showed greater cognitive impairment in verbal and working memory, executive function/reasoning and problem solving, compared to depressive, mixed, and euthymic subgroup. Low-neurocognitive performance was directly associated with a predominance of manic episodes and severe course of bipolar illness. An increased number of past manic episodes was the strongest correlated event with the poorest outcomes in verbal memory testing. Other factors correlated with poor verbal memory scores in manic subgroup were age at illness onset (positive correlation), illness length, and hospitalizations (negative correlations). CONCLUSIONS Bipolar patients showed cognitive deficits regardless of the phase of illness. Subjects experiencing a manic episode displayed higher deficits in verbal and working memory, executive function/reasoning, and problem solving. Severe course of illness also showed significant contribution in terms of cognitive impairment.
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Affiliation(s)
- Mădălina Vrabie
- />University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Cluj-Napoca, Romania
- />7th Ward, Clinical Hospital of Psychiatry “Al. Obregia” Bucharest, Bucharest, Romania
| | - Victor Marinescu
- />7th Ward, Clinical Hospital of Psychiatry “Al. Obregia” Bucharest, Bucharest, Romania
- />University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
| | - Anca Talaşman
- />University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
- />9th Ward, Clinical Hospital of Psychiatry “Al. Obregia” Bucharest, Bucharest, Romania
| | - Oana Tăutu
- />University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
- />Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - Eduard Drima
- />Faculty of Medicine and Pharmacy, “Danubius” University, Galati, Romania
- />Clinical Hospital of Psychiatry “Elisabeta Doamna” Galati, Galati, Romania
| | - Ioana Micluţia
- />University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Cluj-Napoca, Romania
- />Second Psychiatric Clinic, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
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Dell'Osso B, Cinnante C, Di Giorgio A, Cremaschi L, Palazzo MC, Cristoffanini M, Fazio L, Dobrea C, Avignone S, Triulzi F, Bertolino A, Altamura AC. Altered prefrontal cortex activity during working memory task in Bipolar Disorder: A functional Magnetic Resonance Imaging study in euthymic bipolar I and II patients. J Affect Disord 2015; 184:116-22. [PMID: 26074021 DOI: 10.1016/j.jad.2015.05.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/17/2015] [Accepted: 05/11/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Working memory (WM) deficits are among the most frequently impaired cognitive domains in patients with Bipolar Disorder (BD), being considered promising cognitive endophenotype of the disorder. However, the related neurobiological correlates still deserve further investigation. The present study was aimed to explore whether dorsolateral prefrontal cortex (DLPFC) activity during WM processing was abnormal in euthymic bipolar patients and may represent a potential trait-related phenotype associated with the disorder. METHODS Using 3 Tesla functional Magnetic Resonance Imaging (3T fMRI), we studied 28 euthymic bipolar patients (15 BDI and 13 BDII), and 27 healthy controls (HCs), matched for a series of socio-demographic variables, while performing the N-back task for WM assessment. RESULTS We found that euthymic bipolar patients showed increased right middle frontal gyrus engagement compared with HCs (FWE-corrected p = 1 × 10(-3)), regardless of WM load, and in spite of similar WM behavioral performance between groups. In particular, BDI patients had greater BOLD signal change compared to HCs (post-hoc Tukey HSD, p = 1 × 10(-3)), while BDII patients expressed an intermediate pattern of activation between BDI patients and HCs. No other significant effects were detected in the corrected whole-brain analysis. LIMITATIONS Sample size, cross-sectional assessment and potential influence of some clinical variables. CONCLUSIONS Results provide direct evidence of a primary physiological abnormality in DLPFC function in BDI and II, even in the absence of behavioral differences with HCs. Such exaggerated fMRI response suggests inefficient WM processing in prefrontal circuitry, and further studies are warranted to investigate whether the dysfunction is related to the genetic risk for the disorder.
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Affiliation(s)
- Bernardo Dell'Osso
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy; Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, United States.
| | - Claudia Cinnante
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Annabella Di Giorgio
- Servizio di Consulenza Psichiatrica, IRCCS "Casa Sollievo della Sofferenza", Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
| | - Laura Cremaschi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - M Carlotta Palazzo
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Marta Cristoffanini
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Leonardo Fazio
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, "Aldo Moro" University, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Cristina Dobrea
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Sabrina Avignone
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Fabio Triulzi
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, "Aldo Moro" University, Piazza Giulio Cesare 11, 70124 Bari, Italy; pRED, NORD DTA, F. Hoffman-La Roche Ltd., Basel, Switzerland
| | - A Carlo Altamura
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
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Daglas R, Yücel M, Cotton S, Allott K, Hetrick S, Berk M. Cognitive impairment in first-episode mania: a systematic review of the evidence in the acute and remission phases of the illness. Int J Bipolar Disord 2015; 3:9. [PMID: 25914866 PMCID: PMC4408302 DOI: 10.1186/s40345-015-0024-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/10/2015] [Indexed: 01/24/2023] Open
Abstract
There is evidence of cognitive impairment that persists in the remission phase of bipolar disorder; however, the extent of the deficits that occur from the first onset of the disorder remains unclear. This is the first systematic review on cognitive functioning in the early stages of bipolar I disorder. The aim of the study was to identify the patterns and degree of cognitive impairment that exists from first-episode mania. Three electronic databases (MEDLINE, PsycINFO and PubMed) were systematically searched for studies published from January 1980 to June 2014. Eligible studies were separated into two groups: acute and remission. The Newcastle-Ottawa quality assessment scale was utilised to measure the quality of the included studies. A total of seven studies (three acute and four remission), including 230 first-episode mania and 345 healthy control participants, were eligible for the review. The studies in the acute phase only examined aspects of executive functioning, with impairments identified in cognitive flexibility, though not in response inhibition and verbal fluency relative to healthy controls. The most consistent finding during the remission phase was a deficit in working memory, whereas in the other domains, the findings were equivocal. Non-verbal memory and verbal fluency were not impacted in remission from first-episode mania. In conclusion, deficits are present in some but not all areas of cognitive functioning during the early stages of bipolar I disorder. Further research is warranted to understand the longitudinal trajectory of change from first-episode mania.
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Affiliation(s)
- Rothanthi Daglas
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Murat Yücel
- Monash Clinical and Imaging Neuroscience (MCIN), School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, VIC 3168 Australia
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Sarah Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia ; IMPACT Strategic Research Centre, School of Medicine, Deakin University, 288-299 Ryrie Street, PO Box 281, Geelong, VIC 3220 Australia ; Barwon Health and the Geelong Clinic, Swanston Centre, 288-299 Ryrie Street, P O Box 281, Geelong, VIC 3220 Australia ; Florey Institute for Neuroscience and Mental Health, Kenneth Myer Building, Royal Parade, Parkville, VIC 3220 Australia
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Poletti S, Locatelli C, Pirovano A, Colombo C, Benedetti F. Glutamate EAAT1 transporter genetic variants influence cognitive deficits in bipolar disorder. Psychiatry Res 2015; 226:407-8. [PMID: 25660734 DOI: 10.1016/j.psychres.2014.12.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 01/14/2023]
Affiliation(s)
- Sara Poletti
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy.
| | - Clara Locatelli
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Adele Pirovano
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Cristina Colombo
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Francesco Benedetti
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
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Reaction time variability and related brain activity in methamphetamine psychosis. Biol Psychiatry 2015; 77:465-74. [PMID: 25444164 PMCID: PMC4315764 DOI: 10.1016/j.biopsych.2014.07.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 06/19/2014] [Accepted: 07/15/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study investigated the dynamics of cognitive control instability in methamphetamine (MA) abuse, as well its relationship to substance-induced psychiatric symptoms and drug use patterns. METHODS We used an ex-Gaussian reaction time (RT) distribution to examine intraindividual variability (IIV) and excessively long RTs (tau) in an individual's RT on a Stroop task in 30 currently drug-abstinent (3 months to 2 years) MA abusers compared with 27 nonsubstance-abusing control subjects. All subjects underwent functional magnetic resonance imaging while performing the Stroop task, which allowed us to measure the relationship between IIV and tau to functional brain activity. RESULTS Elevated IIV in the MA compared with the control group did not reach significance; however, when the MA group was divided into those subjects who had experienced MA-induced psychosis (MAP+) (n = 19) and those who had not (n = 11), the MAP+ group had higher average IIV compared with the other groups (p < .03). In addition, although control subjects displayed a relationship between IIV and conflict-related brain activity in bilateral prefrontal cortex such that increased IIV was associated with increased activity, the MAP+ group displayed this relationship in right prefrontal cortex only, perhaps reflecting elevated vigilance in the MAP+ group. Greater IIV did not correlate with severity of use or months MA abstinent. No group differences emerged in tau values. CONCLUSIONS These results suggest increased cognitive instability in those MA-dependent subjects who had experienced MA-induced psychosis.
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Yang Z, Lin Y, Guan L, Li X, Deng W, Jiang Z, Lao G, Wang Q, Hao X, Liu X, Wang Y, Zhao L, Ma X, Cao L, Li T. Association analysis of genes in serotonin pathway with attention and executive function in patients with bipolar affective disorder. Compr Psychiatry 2014; 55:1785-90. [PMID: 25200194 DOI: 10.1016/j.comppsych.2014.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The reason why it is difficult to identify susceptibility genes attributed to bipolar disorder (BPD) is the phenotypic heterogeneity. The use of endophenotypes has been advocated as one possible strategy to discovery cause variants of BPD. METHODS A total of 164 patients with BPD and 164 matched controls were employed in the present research. Fifty-two single nucleotide polymorphisms (SNPs) within the genes in serotonin pathway were selected for genotyping using the GoldenGate genotyping assay. All participants completed three neurocognitive tests including the tower of Hanoi (TOH), the Wisconsin card sorting test (WCST) and Trail making tests (TMTA and TMTB-M). RESULTS Patients with BPD demonstrated a wide range of deficits in mental activities of attention and speed of information processing, and executive function. Significant interactions between rs2760347 in 5HTR2A gene and diagnosis were found for the executive time of TOH, with β=11.82 and P=0.002 (adjusted P=0.03 after Bonferroni correction). CONCLUSIONS Cognitive impairments existing in BPD may be particularly notable in certain domains of attention and executive function, and 5HTR2A gene may be involved in modulating executive function of BP-I patients.
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Affiliation(s)
- Zhenxing Yang
- The State Key Laboratory of Biotherapy, Laboratory of Psychiatry Research, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yin Lin
- The State Key Laboratory of Biotherapy, Laboratory of Psychiatry Research, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; The Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Guangzhou Brain Hospital, Guangzhou, PR China
| | - Lijie Guan
- Guangzhou Brain Hospital, Guangzhou, PR China
| | - Xuan Li
- Guangzhou Brain Hospital, Guangzhou, PR China
| | - Wei Deng
- The State Key Laboratory of Biotherapy, Laboratory of Psychiatry Research, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; The Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Zeyu Jiang
- Guangzhou Brain Hospital, Guangzhou, PR China
| | - Guohui Lao
- Guangzhou Brain Hospital, Guangzhou, PR China
| | - Qiang Wang
- The State Key Laboratory of Biotherapy, Laboratory of Psychiatry Research, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; The Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaoyu Hao
- Guangzhou Brain Hospital, Guangzhou, PR China
| | - Xiang Liu
- The Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yingcheng Wang
- The Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lianshen Zhao
- The State Key Laboratory of Biotherapy, Laboratory of Psychiatry Research, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaohong Ma
- The State Key Laboratory of Biotherapy, Laboratory of Psychiatry Research, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; The Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liping Cao
- Guangzhou Brain Hospital, Guangzhou, PR China.
| | - Tao Li
- The State Key Laboratory of Biotherapy, Laboratory of Psychiatry Research, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; The Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Santos JL, Aparicio A, Bagney A, Sánchez-Morla EM, Rodríguez-Jiménez R, Mateo J, Jiménez-Arriero MÁ. A five-year follow-up study of neurocognitive functioning in bipolar disorder. Bipolar Disord 2014; 16:722-31. [PMID: 24909395 DOI: 10.1111/bdi.12215] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 08/27/2013] [Accepted: 10/16/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Cognitive dysfunction in bipolar disorder has been well-established in cross-sectional studies; however, there are few data regarding the longitudinal course of cognitive performance in bipolar disorder. The aim of this study was to examine the course of cognitive function in a sample of euthymic patients with bipolar disorder during a five-year follow-up period. METHODS Eighty euthymic outpatients with a DSM-IV diagnosis of bipolar disorder and 40 healthy control comparison subjects were neuropsychologically assessed at baseline (T1) and then at follow-up of five years (T2). A neurocognitive battery including the main cognitive domains of speed of processing, working memory, attention, verbal memory, visual memory, and executive function was used to evaluate cognitive performance. RESULTS Repeated-measures multivariate analyses showed that progression of cognitive dysfunction in patients was not different to that of control subjects in any of the six cognitive domains examined. Only a measure from the verbal memory domain, delayed free recall, worsened more in patients with bipolar disorder. Additionally, it was found that clinical course during the follow-up period did not influence the course of cognitive dysfunction. CONCLUSIONS Cognitive dysfunction that is characteristic of bipolar disorder is persistent and stable over time. Only dysfunction in verbal recall was found to show a progressive course that cannot be explained by clinical or treatment variables.
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Affiliation(s)
- José Luis Santos
- Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
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Buoli M, Caldiroli A, Caletti E, Zugno E, Altamura AC. The impact of mood episodes and duration of illness on cognition in bipolar disorder. Compr Psychiatry 2014; 55:1561-6. [PMID: 25011691 DOI: 10.1016/j.comppsych.2014.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE A number of studies showed cognitive impairment in bipolar patients but few researches have studied the impact of mood episodes or duration of illness on neuropsychological functioning. METHODS Cognitive functioning was examined in 110 bipolar 1 outpatients with different mood state (mania, major depression, mixed episode and euthymia). The neuropsychological battery included The Visual Search Test, Trail Making Test, Corsi Test, Frontal Assessment Battery (FAB), Cognitive Estimation Task (CET) and Tower of London and it assessed attention, memory and executive/planning functions. Failures in the different cognitive tests were compared between groups using χ(2) tests with Bonferroni's corrections. Finally a binary logistic regression was performed in order to find an eventual association between age and duration of illness and CET bizarreness. RESULTS All the symptomatic patients (manic, depressed, mixed) failed more frequently The Visual Search Test in comparison with euthymics (χ(2)=9.882, df=3, p=0.017, phi=0.30; rate of failures: manic patients 32.2%, depressed patients 30.6%, euthymics 0%, mixed patients 18.2%). CET was performed worse by manic and euthymic patients (χ(2)=10.086, df=3, p=0.015, phi=0.31; rate of failures: manic patients 46.4%, depressed patients 22.9%, euthymics 52.1%, mixed patients 18.2%). Finally, a longer duration of illness was found to be predictive of more bizarreness at CET (OR=1.06, p=0.01). CONCLUSIONS Bipolar patients present impairment in different cognitive domains even in euthymic phases. Frontal dysfunction might be associated with a long duration of illness as shown by number of bizarreness at CET in chronic bipolar patients.
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Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Caletti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Zugno
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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Latalova K, Prasko J, Kamaradova D, Jelenova D, Ociskova M, Sedlackova Z. Internet psychoeducation for bipolar affective disorder: basis for preparation and first experiences. Psychiatr Q 2014; 85:241-55. [PMID: 24307178 DOI: 10.1007/s11126-013-9286-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is growing evidence that patients with bipolar affective disorder (BAD), who use medication, respond well to further psychotherapeutic interventions. Internet-based psychoeducation is typically centered on the interaction between a client and therapist via the Internet. Multiple methods were required to investigate existing psychoeducational and psychotherapeutic strategies used on patients suffering from BAD. Systematic reviews and original reports of all trials of psychoeducation in BAD patients were retrieved. Patients with BAD, who were hospitalized in a psychiatric department or attended a day hospital program, were exposed to the first version of the program during the treatment, and then questioned about understandability, comprehensibility, and usefulness of each lecture. Twelve modules of the Internet E-Program for BAD were developed and the intervention was a pilot tested with twelve patients. Internet psychoeducation program for BAD is an intervention designed for universal implementation that addresses heightened learning needs of patients suffering from BAD. It is designed to promote confidence and reduce the number of episodes of the disorder by providing skills in monitoring warning signs, planning daily activities and practicing communication skills.
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Affiliation(s)
- Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic,
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Caldirola D, Grassi M, Riva A, Daccò S, De Berardis D, Dal Santo B, Perna G. Self-reported quality of life and clinician-rated functioning in mood and anxiety disorders: relationships and neuropsychological correlates. Compr Psychiatry 2014; 55:979-88. [PMID: 24445117 DOI: 10.1016/j.comppsych.2013.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 12/09/2013] [Accepted: 12/13/2013] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate 1) the relationship between subjective perception of quality of life (QoL) and clinician-rated levels of psychosocial functioning and 2) the relationship of these indicators with neuropsychological performances, in a sample of 117 subjects with mood and anxiety disorders hospitalized for a 4-week psychiatric rehabilitation program. At the beginning of the hospitalization, QoL and clinician-rated functioning were respectively measured by the World Health Organization Quality of Life Assessment-Brief Form (WHOQOL-BREF) and the Global Assessment of Functioning (GAF) scale, and subjects were administered a neuropsychological battery evaluating verbal and visual memory, working memory, attention, visual-constructive ability, language fluency and comprehension. We did not find any association between WHOQOL-BREF and GAF scores and between cognitive impairment and lower QoL or clinician-rated functioning. Our results suggest that 1) the individuals' condition encompasses different dimensions that are not fully captured by using only clinician-rated or self-administered evaluations; 2) the GAF scale seems unable to indicate the cognitive impairments of our subjects and the WHOQOL-BREF does not appear to be influenced by these deficits. Overall, our findings suggest the need of simultaneously use of multiple assessment tools, including objective evaluations of functioning and different measures of QoL, in order to obtain a more complete clinical picture of the patients. This may allow to identify more specific targets of therapeutic interventions and more reliable measures of outcome.
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Affiliation(s)
- Daniela Caldirola
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy.
| | - Massimiliano Grassi
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | - Alice Riva
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | - Silvia Daccò
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, "G. Mazzini" Hospital, p.zza Italia 1, 64100 Teramo, Italy
| | - Barbara Dal Santo
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands; Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA
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Levy B, Celen-Demirtas S, Surguladze T, Eranio S, Ellison J. Neuropsychological screening as a standard of care during discharge from psychiatric hospitalization: the preliminary psychometrics of the CNS Screen. Psychiatry Res 2014; 215:790-6. [PMID: 24503284 DOI: 10.1016/j.psychres.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
Cost-prohibitive factors currently prevent a warranted integration of neuropsychological screenings into routine psychiatric evaluations, as a standard of care. To overcome this challenge, the current study examined the psychometric properties of a new computerized measure-the CNS Screen. One hundred and twenty six psychiatric inpatients completed the CNS Screen, the Montreal Cognitive Assessment (MoCA), and the Quick Inventory of Depressive Symptomatology-Self Rated (QIDS-SR₁₆) on the day of hospital discharge. Statistical analysis established convergent validity with a moderate correlation between the self-administered CNS Screen and the clinician-administered MoCA (r=0.64). Discriminant validity was implicated by a non-significant correlation with the QIDS-SR₁₆. Concurrent validity was supported by a moderate, negative correlation with patients' age (r=-0.62). In addition, consistent with previous findings, patients with psychotic disorders exhibited significantly poorer performance on the CNS Screen than patients with a mood disorder. Similarly, patients with a formal disability status scored significantly lower than other patients. The CNS Screen was well tolerated by all patients. With further development, this type of measure may provide a cost-effective approach to expanding neuropsychological screenings on inpatient psychiatric units.
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Affiliation(s)
- Boaz Levy
- Department of Counseling and School Psychology, University of Massachusetts, Boston, MA, United States.
| | - Selda Celen-Demirtas
- Department of Counseling and School Psychology, University of Massachusetts, Boston, MA, United States
| | - Tinatin Surguladze
- Department of Counseling and School Psychology, University of Massachusetts, Boston, MA, United States
| | - Sara Eranio
- Department of Counseling and School Psychology, University of Massachusetts, Boston, MA, United States
| | - James Ellison
- McLean Hospital/Harvard Medical School, Belmont, MA, United States
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Abstract
Schizophrenia without any comorbidity confers a modest, but statistically significant elevation of the risk for violence. That risk is considerably increased by comorbid antisocial personality disorder or psychopathy as well as by comorbid substance use disorders. These comorbidities are frequent. Conduct disorder and conduct disorder symptoms elevate the risk for aggressive behavior in patients with schizophrenia. Violence among adults with schizophrenia may follow at least two distinct pathways-one associated with premorbid conditions, including antisocial conduct, and another associated with the acute psychopathology of schizophrenia. Aggressive behavior in bipolar disorder occurs mainly during manic episodes, but it remains elevated in euthymic patients in comparison with controls. The risk of violent behavior is increased by comorbidity with borderline personality disorder, antisocial personality disorder, and substance use disorders. These comorbidities are frequent. Borderline personality disorder and bipolar disorder are related in their phenomenology and response to medication. These two disorders share a tendency to impulsiveness, and impulsive behavior, including impulsive aggression, is particularly expressed when they co-occur.
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Affiliation(s)
- Jan Volavka
- Emeritus of Psychiatry, New York University School of Medicine, PO Box 160663, Big Sky, MT, 59716, USA,
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Poletti S, Sferrazza Papa G, Locatelli C, Colombo C, Benedetti F. Neuropsychological deficits in bipolar depression persist after successful antidepressant treatment. J Affect Disord 2014; 156:144-9. [PMID: 24393447 DOI: 10.1016/j.jad.2013.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bipolar disorder is a common disabling illness with a lifetime morbid risk of approximately 4%. Neuropsychological deficits constitute enduring trait-like features in bipolar disorder, are associated with each phase of the illness and persist also in euthymia. Total sleep deprivation (TSD) has been shown to cause rapid and sustained antidepressant effects in bipolar depression and to revert the biased self description and speed of information processing present in these patients. The aim of the study was to assess neuropsychological performances first in a sample of bipolar patients during a depressive episode compared to healthy controls and secondly to investigate if TSD treatment would change cognitive performances. METHODS One-hundred bipolar patients and 100 healthy controls were evaluated through the Brief Assessment of Cognition in Schizophrenia, 42 patients were assessed before and after TSD treatment. RESULTS Bipolar patients obtained significantly lower domain scores across the entire battery compared to healthy subjects. Cognitive deficits persisted in each function despite a clinical improvement of depressive symptomatology. LIMITATIONS Limitations of the study include issues such as generalizability, possible undetected past comorbidities, population stratification and ongoing medication. CONCLUSIONS This is the first study of the effect of TSD treatment on cognitive performance. TSD treatment improved clinical symptoms but not cognitive deficits however bipolar patients did not experience the well known worsening of performance observed in healthy controls after sleep loss.
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Affiliation(s)
- Sara Poletti
- Scientific Institute and University Vita-Salute San Raffaele Turro, Department of Clinical Neurosciences, Stamira d'Ancona 20, Milano, Italy.
| | - Giovanna Sferrazza Papa
- Scientific Institute and University Vita-Salute San Raffaele Turro, Department of Clinical Neurosciences, Stamira d'Ancona 20, Milano, Italy
| | - Clara Locatelli
- Scientific Institute and University Vita-Salute San Raffaele Turro, Department of Clinical Neurosciences, Stamira d'Ancona 20, Milano, Italy
| | - Cristina Colombo
- Scientific Institute and University Vita-Salute San Raffaele Turro, Department of Clinical Neurosciences, Stamira d'Ancona 20, Milano, Italy
| | - Francesco Benedetti
- Scientific Institute and University Vita-Salute San Raffaele Turro, Department of Clinical Neurosciences, Stamira d'Ancona 20, Milano, Italy
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Abstract
Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.
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Abstract
Individuals with bipolar disorder (BD) may exhibit attentional deficits, however, the extent of impairment and long-term fluctuations in performance in attention are relatively unknown. We investigated the relationship between sustained attention and affective symptoms over time among BD patients. We also examined whether global differences in attentional capacity differed among BD versus normal comparison (NC) subjects. Participants included 106 outpatients with BD and 66 NC subjects who were administered symptom rating scales and a measure of sustained attention (Continuous Performance Test- Identical Pairs). Measures were repeated 6, 12, and 26 weeks post-baseline. Compared to NC subjects, participants with BD showed impairment in sustained attention across time. Within patient increases in manic symptoms were associated with increased false alarms; both manic and depressive symptoms were associated with worse discrimination. Neither manic nor depressive symptoms were related to hit rates. Our results indicate that the ability to inhibit a response to near miss stimuli (i.e., those that are close to but not identical to the target) is globally impaired among BD patients relative to NC subjects, as well as state-dependent, covarying with affective symptoms. Psychosocial interventions requiring high levels of attentional capacity may need to be adapted according to patients' current symptomatology.
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Sex dependence of cognitive functions in bipolar disorder. ScientificWorldJournal 2014; 2014:418432. [PMID: 24616627 PMCID: PMC3926268 DOI: 10.1155/2014/418432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/11/2013] [Indexed: 01/05/2023] Open
Abstract
The objective of the present study was to assess the performance of lithium treated euthymic bipolar patients in tests measuring spatial working memory (SWM), planning, and verbal fluency and to delineate the influence of gender on cognitive functioning. Fifty-nine euthymic bipolar patients, treated with lithium carbonate for at least 5 yr, were studied. Patients and controls underwent a neuropsychological assessment. Bipolar patients had significantly worse results than the healthy controls in the spatial memory and planning as well as verbal fluency tests. We detected a gender-related imbalance in the SWM results. Deficits in SWM were observed in male-only comparisons but not in female-only comparisons. The SWM scores were significantly poorer in male patients than in male controls. In female-only comparisons, female patients did not have significantly poorer SWM results in any category than their controls. Bipolar women scored worse in some other tests. The present study points to the different patterns of neuropsychological disturbances in female and male patients and suggests that sex-dependent differences should be taken into account in order to tailor the therapeutic intervention aimed at the improvement of cognitive functions.
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Kim YK, Na KS, Hwang JA, Yoon HK, Lee HJ, Hahn SW, Lee BH, Jung HY. High insulin-like growth factor-1 in patients with bipolar I disorder: a trait marker? J Affect Disord 2013; 151:738-743. [PMID: 24012102 DOI: 10.1016/j.jad.2013.07.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/28/2013] [Accepted: 07/30/2013] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Neurotrophic factors exert substantial effects on the central nervous system. The present study investigates the roles of insulin-like growth factor-1 (IGF-1), β-nerve growth factor (β-NGF), and brain-derived neurotrophic factor (BDNF) in bipolar disorder. METHODS Baseline levels of culture-stimulated IGF-1, β-NGF, and BDNF were compared in 116 patients with bipolar I disorder and 123 healthy controls. Neurotrophic factors were also compared in patients before and after 6 weeks of pharmacotherapy. A multivariate logistic regression analysis was used to investigate the influence of the neurotrophic factors analyzed in quartile form, in relation to confounding variables, such as age, sex, and body mass index. RESULTS IGF-1 was significantly higher in patients (mean=514.57, SD=259.78) than in healthy controls (mean=316.82, SD=270.00, p<0.0001) at baseline. Furthermore, higher levels of IGF-1 substantially increased the risk for bipolar I disorder. IGF-1 level was not significantly changed at 6-weeks (mean=506.41, SD=313.66). No changes in BDNF or β-NGF-1 levels were found following the 6-week treatment period. IGF-1 and β-NGF were negatively correlated in healthy controls, but not in patients. Severity of manic symptoms was not associated with any of the neurotrophic factors. LIMITATIONS We did not measure cortisol, growth hormone, or IGF-1 receptors. This study is cross-sectional in design. CONCLUSIONS Elevated IGF-1 levels may be a trait marker for bipolar disorder. Further studies are needed to thoroughly investigate the role of IGF-1 in relation to other neuroendocrine factors and biological markers for bipolar disorder.
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-Gu, Incheon, Republic of Korea.
| | - Jung-A Hwang
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sang-Woo Hahn
- Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
| | - Bun-Hee Lee
- Department of Psychiatry, Gangnam Eulji Hospital, Eulji University, Seoul, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
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Cognitive impairment in Egyptian euthymic patients with bipolar I disorder compared with controls. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000433325.69290.c9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Celikyurt IK, Ulak G, Mutlu O, Akar FY, Erden F, Komsuoglu SS. Lamotrigine, a mood stabilizer, may have beneficial effects on memory acquisition and retrieval in mice. Life Sci 2012; 91:1270-4. [DOI: 10.1016/j.lfs.2012.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 09/07/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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Dean OM, Bush AI, Copolov DL, Kohlmann K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Berk M. Effects of N-acetyl cysteine on cognitive function in bipolar disorder. Psychiatry Clin Neurosci 2012; 66:514-7. [PMID: 23066769 DOI: 10.1111/j.1440-1819.2012.02392.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Bipolar disorder is characterized by progressive changes in cognition with declines in executive functioning, memory and sustained attention. Current pharmacotherapies for bipolar disorder target mood symptoms but have not addressed these cognitive changes resulting in euthymic individuals who still experience cognitive deficits. N-acetyl cysteine (NAC) has been shown to have effects on antioxidant status, glutamate transmission, inflammation and neurogenesis. Adjunctive treatment with NAC improves the symptoms experienced by those with bipolar disorder, particularly depression, and it was hypothesized that cognition may also be improved following NAC treatment. METHODS As part of a larger randomized, double-blind, placebo-controlled trial, participants in the current report were tested at baseline and 6 months to assess changes in cognitive function following either 2000 mg of NAC daily or placebo. RESULTS This study failed to find changes in cognitive function following treatment with NAC compared to placebo. CONCLUSIONS While an important pilot study, this study had a small sample size and included a limited battery of cognitive tests. Further investigations on the effects of NAC on cognitive performance in bipolar disorder are required.
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Affiliation(s)
- Olivia M Dean
- School of Medicine, Deakin University, Melbourne, Australia
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