Cognitive enhancement treatments for bipolar disorder: A systematic review and methodological recommendations

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Although evidence for their efficacy is limited, cognitive enhancement therapies can be considered experimental in this population 72, 239, 240…”

Section: Acute Management Of Bipolar Depressionmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…Miskowiak and colleagues (2016) point out that most of the cited studies with positive results have a significant risk of bias related to details of the randomization process and the lack of test cognition as primary outcomes (for broader information and a systematic review, see Sanches et al, 2015 and Miskowiak et al, 2016). …”

Section: Treatment and Prevention Strategiesmentioning

confidence: 99%

Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies

Solé

Jiménez

Torrent³

et al. 2017

International Journal of Neuropsychopharmacology

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215

138

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Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients’ psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients.

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“…Another issue which has not been fully elucidated in the literature is the influence of characteristics which may act as protective or risk factors for cognitive impairment in BD. These include the use of psychoactive medication (14,15), duration of illness (16,17), age of onset (17,18), history of psychotic symptoms (19,20), current mood state (21,22), and number of mood episodes (21). Though previous studies of these variables have produced interesting findings, clinical characteristics have not been able to fully explain the variations in cognitive profiles observed in BD.…”

Section: Introductionmentioning

confidence: 99%

Executive functions and memory in bipolar disorders I and II: new insights from meta‐analytic results

Cotrena

Branco

Ponsoni

et al. 2019

Acta Psychiatr Scand

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Executive functions and memory in bipolar disorders I and II: new insights from meta-analytic results.Objective: To perform a systematic review and meta-analysis of executive functions (EF) and episodic memory in bipolar disorder (BD). Methods: A literature search was conducted on three electronic databases. Results were combined using random-effects meta-analysis. Results: A total of 126 studies (6424 patients with BDI, 702 with BDII, and 8276 controls) were included. BDI was associated with moderate to large impairments across all cognitive functions and BDII with small-tomedium impairments. Small significant differences were identified between BDI and BDII on all cognitive functions except inhibition. The Trail Making Test (TMT) (g = 0.74, 95% CI: 0.67-0.80), Hayling Test (g = 0.58, 95% CI: 0.34-0.81), Digit Span Total (g = 0.79, 95% CI: 0.57-1.01), and Category Fluency (g = 0.59, 95% CI: 0.45-0.72) tasks were most sensitive to cognitive impairment in BDI. The TMT (g = 0.65, 95% CI: 0.50-0.80) and Category Fluency (g = 0.56, 95% CI: 0.37-0.75) were also sensitive to cognitive alterations in patients with BDII. Conclusion: BD type I was associated with more severe and widespread impairments than BDII, which showed smaller impairments on all functions except inhibition, where impairments were larger. Education and (hypo)manic symptoms should be further investigated in future studies due to their possible influence on the neuropsychological profile of BD. The instruments identified in this review should be considered for inclusion in cognitive assessment batteries in BD. Summations• Patients with BD type I performed worse than control subjects with moderate to large effect sizes, while patients with BD type II showed impairments with small-to-medium effect sizes. Small significant differences were identified between BD types I and II on all cognitive functions except inhibition.• Education, (hypo)mania symptom scores, and lithium use moderated cognitive impairments in BD.• The TMT B, Hayling Test B, Digit Span Total, and Category Fluency were most sensitive to cognitive impairments and to differences between cognitive performance in individuals with BD types I and II. Limitations• Small number of studies involving BD type II. • Large heterogeneity in effect sizes. • Inconsistent reporting of potential moderator variables (mood symptoms, medication use, comorbidities).

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Cognitive enhancement treatments for bipolar disorder: A systematic review and methodological recommendations

Cited by 83 publications

References 56 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies

Executive functions and memory in bipolar disorders I and II: new insights from meta‐analytic results

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