Neurocognitive impairment and evidence-based treatment options in Bipolar disorder

Abstract

Background The current paper briefly summarizes the literature on the neurocognitive deficit and its treatment in BD patients. Methods The material was chosen on the basis of previous systematic reviews the author has taken part in. Results The data so far suggest that the deficit is qualitatively similar but quantitatively milder in comparison to schizophrenia, it is present already since the first episode, is weakly related to mood symptoms and somewhat stronger to psychotic symptoms, it probably determines much of the disability and treatment is problematic. This deficit is also present during periods of euthymia. The possible adverse effect of psychotropic medication is rather small if any at all and is confounded by the specific clinical symptoms, for which medication is used for their treatment. This is especially true concerning antipsychotics and psychotic symptoms. The origin and the etiopathogenesis of the core neurocognitive impairment remain elusive. The presence of a neurodegenerative and of a neurodevelopmental component has both data in favor and against and they are both the focus of debate. Conclusions Treatment of the neurocognitive deficit and restoration of functioning is problematic. The data are limited and treatment options are few and with a weak overall effect. Pharmacological treatments, ECT and rTMS present some hard data, while the literature is inconclusive concerning psychotherapeutic interventions.

Association of cannabis use with neurocognition in adolescents with bipolar disorder

“…The finding of worse sustained attention in the BD CB− group versus HC converges with prior studies of adolescents and adults with BD (Fountoulakis, 2020; Kolur et al, 2006). While not statistically significant, Figure 2 depicts a visual trend toward better sustained attention in the BD CB+ group versus BD CB− ( p = 0.32) and HCs ( p = 0.26).…”

Calcium imaging reveals depressive- and manic-phase-specific brain neural activity patterns in a murine model of bipolar disorder: a pilot study

“…Clinical and macro-imaging studies have shown that cognitive impairment is a pivotal symptom in patients with BPD; similar findings have been obtained with animal models of depression or mania [ 90 – 94 ]. Our finding that cognitive impairment was more severe in the manic phase provides a new clue for investigation of this difficult-to-improve symptom in patients with BPD, although it may have been influenced by confounding factors.…”

Electroconvulsive therapy combined with lithium developed reversible pure anomic aphasia: a case report

“…In some cases, electroconvulsive therapy (ECT) is recommended as a highly and rapidly effective treatment for the management of serious acute manic episodes [1]. Although some studies have reported that Li and ECT (Li-ECT) combined treatment is safe and more effective than either Li or ECT alone for both depression [2] and mania [3], opposing views have implied that Li-ECT may increase the risk of cognitive impairment and delirium [4,5]. Here, we report a case of BD where the patient developed delirium and reversible pure anomic aphasia after Li-ECT treatment.…”