Lack of Differential Cognitive Effects of Lithium and Carbamazepine in Bipolar Affective Disorder

Joffe, Russell T.; Macdonald, C.M.M.; Kutcher, Stan

doi:10.1097/00004714-198812000-00008

Cited by 58 publications

(36 citation statements)

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“…Psychiatry. 1998;55: [41][42][43][44][45][46] T HE NATURE and extent of neurocognitive dysfunction in persons with bipolar disorder remain unclear. Although several studies have assessed neurocognitive functions in persons with bipolar disorder, most have studied patients in either the acutely manic 1 or acutely depressed 1,2 state.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Impairment in Euthymic Bipolar Patients With and Without Prior Alcohol Dependence

Gorp

Altshuler²,

Theberge³

et al. 1998

Arch Gen Psychiatry

397

291

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Section: Discussionmentioning

confidence: 99%

Cognitive Impairment in Euthymic Bipolar Patients With and Without Prior Alcohol Dependence

Gorp

Altshuler²,

Theberge³

et al. 1998

Arch Gen Psychiatry

397

291

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“…Of five studies (67-71) evaluating effects of medication on cognition of euthymic BPD patients, three found that lithium adversely affected cognitive performance (67,68,70), one reported that lithium and carbamazepine had no adverse effects on cognition (69), and another found lithium and valproate to have equivocal effects on cognition (71). More studies are needed to elucidate the extent of adverse psychopharmacologic effects on cognition of euthymic BPD patients as a contribution to assessing risk ⁄ benefit relationships.…”

Section: Psychopharmacologic Effects On Neurocognitionmentioning

confidence: 99%

Neurocognitive impairment in bipolar disorder patients: functional implications

2009

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Growing evidence suggests that bipolar disorder (BPD) patients experience prominent neurocognitive impairment not only during acute mood episodes (1-3) but also during euthymia (1,(4)(5)(6)(7)(8)(9)(10)(11)(12). A recent meta-analytic review of 39 studies comparing neurocognitive functioning in 948 euthymic BPD patients and 1,128 normal controls, matched for age, sex, education, and estimated premorbid IQ, found medium-to-large effect sizes (ES, as group differences ⁄ variance) for impaired attention and processing speed (ES = 0.60-0.79), episodic memory (ES = 0.43-0.81), and executive functioning (ES = 0.47-0.71) in the BPD patients (11). Another meta-analytic review of 20 studies, also comparing neurocognitive performance in euthymic BPD patients to matched normal controls, found deficits of similar magnitude in measures of executive functions, verbal learning, immediate Background: Functional recovery among treated bipolar disorder (BPD) patients is far less likely than syndromal and even symptomatic recovery. We hypothesized that increasingly well-documented aspects of cognitive impairment may contribute to poor functional outcomes in BPD patients, and reviewed the available research on the topic.Methods: Computerized literature searching identified 12 studies with 13 comparisons that simultaneously evaluated cognitive and functional status in euthymic (n = 8) or non-euthymic (n = 5 comparisons) adult BPD patients versus otherwise similar healthy controls.Results: In 6 ⁄ 8 studies of euthymic BPD patients and 5 ⁄ 5 studies of non-euthymic BPD patients, neurocognitive impairment was significantly associated with impaired psychosocial functioning, even after adjusting for residual mood symptoms and relevant demographic and clinical variables. Cognitive status was consistently assessed with standardized, performance-based neuropsychological tests, but functional status usually was based on subjective self-appraisals. Approximately 55% of BPD patients were unemployed.Conclusions: Available studies are limited by subjective assessments of functional status rather than objective, performance-based measures. Nevertheless, they support the hypothesis that enduring aspects of cognitive impairment found even in euthymic BPD patients are associated with inferior functioning. These findings encourage further studies with better assessment methods and greater rehabilitative efforts in BPD patients.

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“…However, in spite of the emerging neuroprotective and neurotrophic actions of lithium, the evidence for corresponding functional benefits on the cognitive-behavioral level is rather equivocal. The putative role of lithium as a cognitive enhancer is challenged by the complaint of mental slowing made by patients receiving it (Joffe et al 1988;Lenzer et al 1989). This discrepancy has stimulated human and animal studies to investigate specific neurocognitive effects of lithium administration.…”

Section: Introductionmentioning

confidence: 99%