BackgroundThe effect of pharmacological treatment on cognition is still uncertain due to an insufficient number of studies examining this issue.
Materials and methodsA total of 114 subjects were included in the study. Of 79 DSM-IV euthymic bipolar patients, 63 were treated with one atypical antipsychotic, quetiapine (n = 12), olanzapine (n = 22), or risperidone (n = 29). Sixteen patients were drug-free. The four groups were compared with a sample of drug-naïve patients and healthy control group (n = 35) on several clinical and neuropsychological variables, especially on the domains of attention, verbal memory and executive functions.
ResultsBipolar patients taking one of the three antipsychotics presented with dose-independent significant deficits in most cognitive tasks compared to healthy controls. After several head-to-head group comparisons, the patients receiving quetiapine showed a better performance in learning task, short-term memory and recognition task assessed with the California Verbal Learning Test and verbal fluency (p < 0.05).
ConclusionsOur results confirm previous studies of cognitive deficits in bipolar disorder. Untreated euthymic patients showed better cognitive performance than patients on atypical antipsychotics. Some iatrogenic-pharmacological effect, therefore, can not be excluded but quetiapine seemed to be less associated with impairment in measures of verbal memory than olanzapine or risperidone. We suggest to use drugs in bipolar disorder with a lower risk of cognitive side-effects. However, randomized controlled trials are urgently needed to give a definite answer to this critical problem.
AcknowledgementsThis study was supported by grants from the Fundacio Marató de TV3 (2510/01), FIS n°PI080180, and the CIBERSAM.
While eye movement desensitization and reprocessing (EMDR) is considered an evidence-based treatment for posttraumatic stress disorder (PTSD) in adults, there are differences as to how various international treatment guidelines judge the strength of this evidence base. Furthermore, in areas other than adult PTSD, major guidelines differ even more as to the strength of the evidence base and when to use EMDR. In 2019, the “Council of Scholars: the Future of EMDR Therapy Project” was initiated. Several working groups were established, with one assigned to the focus area “research.” This article is a product of that working group. Firstly the group concluded that there were five areas where there was some base that EMDR was effective but more data was needed to increase the likelihood that it would be considered in future international treatment guidelines. These areas were PTSD in children and adolescents, early EMDR interventions, combat PTSD, unipolar depression, and chronic pain. In addition, research into costeffectiveness of EMDR therapy was identified as one of the priorities. A hierarchical system was used for classifying and rating evidence in the focus areas. After assessing the 120 outcome studies pertaining to the focus areas we conclude that for two of the areas (i.e., PTSD in children and adolescents and EMDR early interventions research) the strength of the evidence is rated at the highest level, whereas the other areas obtain the second highest level. Some general recommendations for improving the quality of future research on the effectiveness of EMDR therapy are formulated.
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