BackgroundA large proportion of patients with bipolar disorder experience persistent cognitive dysfunction, such as memory, attention and planning difficulties, even during periods of full remission. The aim of this trial is to investigate whether cognitive remediation, a new psychological treatment, improves cognitive function and, in turn, psychosocial function in patients with bipolar disorder in partial or full remission.Methods/DesignThe trial has an evaluator-blind, randomized, between-groups design. Forty patients with bipolar disorder in full or partial remission, aged 18 to 50 years, who report moderate to severe cognitive difficulties, are recruited. Patients are randomized to receive weekly group-based cognitive remediation treatment over 12 weeks in addition to standard treatment or standard treatment alone. Both groups undergo neurocognitive testing and functional magnetic resonance imaging (fMRI) at baseline, post-treatment (week 12) and follow-up (week 26). The primary outcome is improved verbal memory, as measured with the Rey Auditory Verbal Learning Test (RAVLT) from baseline to post-treatment. With inclusion of 40 patients we obtain 86% power to detect a clinically relevant difference in verbal memory between groups. Secondary outcomes are improved attention, executive function and psychosocial function, as measured with the Rapid Visual Information Processing test, the Trail Making Test part B and the Functional Assessment Short Test (FAST), respectively. Tertiary outcomes are improved scores for additional neuropsychological tests of memory, attention, executive function and facial expression recognition, as well as in questionnaires measuring subjective cognitive difficulties, stress, coping strategies, personality traits, depressive symptoms and quality of life.DiscussionThis is the first randomized controlled trial to evaluate the effects of cognitive remediation on cognitive function in patients with bipolar disorder who experience persistent cognitive difficulties despite being in full or partial remission.Trial registrationClinicalTrials.gov NCT01457235.

Basic stimulation (BS) is a multimodal approach used in the intensive care unit (ICU) to help patients to perceive, move, communicate and learn. The concept was developed in Germany in the 1970s to help multi-handicapped children. It was adapted to nursing in the 1980s, and to critical care nursing in the 1990s. Little is known about the use of BS outside of Germany although it has been gaining momentum in German-speaking countries as well as Scandinavia. The aim of the present study is to describe the extent and application of BS at Danish ICUs in 2006. The study had a prospective, descriptive, qualitative, multicentre design. Data were generated from key-informant telephone interviews (n = 10). This study has shown that BS is dependent upon the personal interest of individual nurses. At most units the concept is rarely used, or used by only few practitioners, for only few patients, or only few of the elements of the technique are applied. The tenets of BS are similar to those of conventional nursing, and in some cases to health care in general. The concept shows promising potential for critical care nursing. It has, however, been introduced unsystematically at Danish ICUs and needs more management support, systematic implementation and clinical research.