Persistent Neuropsychological Deficit in Euthymic Bipolar Patients

Mur, M.; Portella, María J.; Martínez‐Arán, Anabel; Pifarré, Josep; Vieta, Eduard

doi:10.4088/jcp.v68n0715

Cited by 148 publications

(125 citation statements)

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“…Non-parametric Wilcoxon tests to compare patients' performances on memory, attentional/executive measures showed that patients performed worse on planning abilities than interference control and ability to detect rule in sequences of stimuli (P < 0.05). These results confirm that all the aspects of executive function, consistent with failures in goal selection, evaluation and execution, are significantly affected in patients with BD (14). More interestingly, a Spearman's Rank correlation showed a negative association between FAB subtest Go-No-Go and PIT (rho = -0.583, P < 0.01).…”

supporting

confidence: 75%

Cognitive Psychopathology of Bipolar Disorder: Future Directions for Treatment

Cammisuli

Pruneti

2018

Iran J Psychiatry Behav Sci

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In the last decade, cognitive psychopathology has shed light on how abnormal changes in cognitive functions, which are closely related to emotional and relational processes, may explain development, maintenance, and recurrence of psychiatric disorders and how dysfunction of certain brain areas determine specific cognitive phenotypes characterizing psychiatric disorders (1). The authors of the current study first described episodic memory impairment accounting for severe damage of a sense of self and lack of autonoetic consciousness in schizophrenia (2). Neuropsychological investigations have also demonstrated that patients with Bipolar Disorder (BD) present persistent cognitive impairment even during the euthymic phase (3). Given high rates of neurocognitive impairment in BD and their relevance for functional outcome, these deficits should be considered as primary targets for treatment. In light of this assumption, the aim of cognitive psychopathology is to suggest a relationship between cognitive dysfunction and clinical symptoms and to indicate treatment directions. In the current study, 20 patients (M:F = 12:8, mean age 39, mean education of 11 years) were diagnosed with BD type I, according to DSM-V criteria (4) in a current euthymic phase. They were assessed by brief neurocognitive exam (BNE) (5) (overall cognitive screening), digit span (short-term verbal memory) (splithalf reliability = 0.90) (6), Corsi Span (short-term visuospatial memory) (test-retest reliability = 0.38), Pairs Associates Leaning (long-term verbal memory) (test-retest reliability = 0.59), Memory of Prose (long-term verbal memory) (testretest reliability = 0.69), Corsi Learning Suvra-span (longterm visuospatial memory) (test-retest reliability = 0.80), Visual Search Test (selective attention) (test-retest reliability = 0.53) (7), frontal assessment battery (FAB) Go-NoGo subtest (inhibitory control) (inter-rater reliability =.96; test-retest reliability = 0.85) (8), Tower of London Drexel version (ToLDX) (planning abilities) (test-retest reliability = 0.80) (9), Stroop Test (interference control) (test-retest reliability =0.85) (10), Brixton test (detecting rules in sequence of stimuli) (inter-rater reliability =0.96) (11), and picture interpretation test (PIT) (logical inference) (Cohen's kappa statistic PIT and Verbal Fluency = 0.76, P < 0.001) (12). Written informed consent was obtained by the patients. On BNE, BD patients presented difficulties in divided attention, cognitive flexibility, and visual-perceptual abilities. According to the literature, BD patients poorly sustain cognitive tasks overload that is associated to altered impulsive control (13). Non-parametric Wilcoxon tests to compare patients' performances on memory, attentional/executive measures showed that patients performed worse on planning abilities than interference control and ability to detect rule in sequences of stimuli (P < 0.05). These results confirm that all the aspects of executive function, consistent with failures in goal selection, evaluation and execution...

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confidence: 75%

Cognitive Psychopathology of Bipolar Disorder: Future Directions for Treatment

Cammisuli

Pruneti

2018

Iran J Psychiatry Behav Sci

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“…To provide a more general pattern of cognitive performance, this battery included neuropsychological tests that tapped into broad cognitive categories as documented in previous literature (Mur et al 2007 Meyers & Meyers, 1995).…”

Section: Neuropsychological Assessmentmentioning

confidence: 99%

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

et al. 2012

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BackgroundPrevious cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome.MethodA total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.ResultsRepeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).ConclusionsExecutive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

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“…Thus, it is possible that patients with depressive symptoms who are using psychotropic drugs and who may present psychomotor slowness achieve a poorer performance compared to the healthy subjects, but since the patients participating in our study used different medications, sometimes even more than one, it was impossible to isolate any interference by this confounding factor. In a recent study 40 comparing a sample of lithium-treated euthymic bipolar outpatients and controls, it was found that the patients presented cognitive impairment in the executive domain and in the processing speed even after the subclinical symptoms were controlled. According to these authors, the results suggest that neuropsychological impairment may be an expression of the disease phenotype and not necessarily be related to other characteristics such as more severe illness or polypharmacy.…”

Section: Discussionmentioning

confidence: 99%