Validity and reliability of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Japanese patients with bipolar disorder

Associations Between Cognitive Impairment, Depressive Symptoms, and Work Productivity Loss in Patients With Bipolar Disorder: A Cross-Sectional Analysis

AIM

To evaluate the relationship between cognitive impairment and work productivity loss in patients with bipolar disorder.

METHODS

We enrolled outpatients with bipolar disorder aged 18-59 years undergoing treatment and actively employed or on sick leave. Baseline demographic, medical resource use, and employment data were collected. We evaluated work productivity, cognitive impairment, quality of life (QOL), depressive symptoms (defined as a Patient Health Questionnaire-9 [PHQ-9] score of ≥ 10), and sleep disturbance. This interim analysis examined correlations among baseline symptom scores and correlations of each symptom score with work productivity loss and QOL.

RESULTS

Among 211 participants, cognitive impairment was moderately correlated with depressive symptoms (r = 0.595) and insomnia (r = 0.481), and depressive symptoms and insomnia were highly correlated (r = 0.719) (all p < 0.001). Work productivity loss (presenteeism) was moderately correlated with cognitive impairment (r = 0.474), depression (r = 0.577), and insomnia (r = 0.547) (all p < 0.001). Depression had the strongest influence on presenteeism (multiple regression analysis, regression coefficient: 22.98; p < 0.001). Among participants without severe depressive symptoms (PHQ-9 ≤ 19), cognitive impairment (13.91, p = 0.007) and insomnia (13.80, p = 0.016) strongly affected presenteeism. Among participants without moderately severe or severe depressive symptoms (PHQ-9 ≤ 14), insomnia affected presenteeism (23.14, p = 0.011). QOL was moderately negatively associated with cognitive impairment (r = -0.653), depression (r = -0.699), and insomnia (r = -0.559) (all p < 0.001). In multiple regression analysis, cognitive impairment (-0.12, p < 0.001), depression (-0.12, p = 0.010), and insomnia (-0.16, p < 0.001) were significantly associated with QOL.

CONCLUSIONS

Treatment should focus on improving the core symptoms of bipolar disorder, insomnia, and cognitive impairment.

TRIAL REGISTRATION

UMIN Clinical Trials Registry (UMIN000051519).

Relationship between subjective cognitive functioning and fluid and crystallized cognitive abilities in bipolar disorder

OBJECTIVE

People with bipolar disorder (BD) often show inaccurate subjective ratings of their objective cognitive function. However, it is unclear what information individuals use to formulate their subjective ratings. This study evaluated whether people with BD are likely using information about their crystallized cognitive abilities (which involve an accumulated store of verbal knowledge and skills and are typically preserved in BD) or their fluid cognitive abilities (which involve the capacity for new learning and information processing in novel situations and are typically impaired in BD) to formulate their subjective cognitive ratings.

METHOD

Eighty participants diagnosed with BD and 55 control volunteers were administered cognitive tests assessing crystallized and fluid cognitive abilities. Subjective cognitive functioning was assessed with the Cognitive Failures Questionnaire (CFQ), daily functioning was rated using the Multidimensional Scale of Independent Functioning (MSIF) and the Global Assessment of Functioning Scale (GAF), and quality of life was assessed with the Quality of Life in Bipolar Disorder scale (QoL.BD).

RESULTS

The BD group exhibited considerably elevated subjective cognitive complaints relative to controls. Among participants with BD, CFQ scores were associated with fluid cognitive abilities including measures of memory and executive function, but not to crystallized abilities. After controlling for objective cognition and depression, higher cognitive complaints predicted poorer psychosocial outcomes.

CONCLUSIONS

Cognitive self-reports in BD may represent a metacognitive difficulty whereby cognitive self-appraisals are distorted by a person's focus on their cognitive weaknesses rather than strengths. Moreover, negative cognitive self-assessments are associated with poorer daily functioning and diminished quality of life.

Cognition in Bipolar Disorder: An Update for Clinicians

Bipolar disorder is associated with cognitive deficits, which persist across mood states and affect functional outcomes. This article provides an overview of recent progress in measuring cognition in bipolar disorder and its implications for both research and clinical practice. The authors summarize work conducted over the past decade that has helped guide researchers and clinicians in the appropriate measurement of cognitive functioning in bipolar disorder, the design of research studies targeting this domain for treatment, and the implementation of screening and psychoeducational tools in the clinic. Much of this work was conducted by the International Society for Bipolar Disorders Targeting Cognition Task Force. Here, the authors also highlight the need for clinicians to be informed about this aspect of illness and to be equipped with the necessary information to assess, track, and intervene on cognitive problems when appropriate. Finally, the article identifies gaps in the literature and suggests potential future directions for research in this area.

The mediating role of depressive symptoms and subjective cognitive dysfunction in the relationship between stressful life events and functional disability in adult community volunteers

BACKGROUND

Stressful life events (SLE) impact psychosocial functioning. However, the psychological mechanism underlying the association between SLE and functional disability (FD) has not been fully elucidated. This study focused on whether depressive symptoms (DS) and subjective cognitive dysfunction (SCD) mediated the influence of SLE, comprising negative SLE (NSLE) and positive SLE (PSLE), on FD.

METHODS

A total of 514 adults from Tokyo, Japan, completed the self-administered questionnaires to evaluate DS, SCD, SLE, and FD. We investigated the relationships among the variables using path analysis.

RESULTS

Path analyses showed that NSLE positively affected FD directly (β = 0.253, p < .001), and indirectly via DS and SCD (β = 0.192, p < .001). PSLE negatively affected FD indirectly via DS and SCD (β = -0.068, p = .010), although PSLE did not affect FD directly (β = -0.049, p = .163).

LIMITATIONS

Causal relationships could not be determined owing to the cross-sectional design. All participants were recruited in Japan, which limits the generalization of findings to other countries.

CONCLUSIONS

DS and SCD, in this order, may partially mediate the positive effect of NSLE on FD. DS and SCD may fully mediate the negative effect of PSLE on FD. When considering the impact of SLE on FD, evaluating the mediating role of DS and SCD could be useful. Our findings may elucidate how perceived life stress affects daily functioning via depressive and cognitive symptoms. In the future, it is desirable to conduct a longitudinal study based on our results.

Validation of the THINC-It Tool for Assessment of Cognitive Impairment in Patients with Bipolar Depression

BACKGROUND

Cognitive impairment is one of the core features of bipolar depression. A unified, reliable, and valid assessment tool is key to screening and assessing cognitive impairment. The THINC-Integrated Tool (THINC-it) is a simple and quick battery for screening cognitive impairment in patients with major depressive disorder. However, the use of the tool has not been validated in patients with bipolar depression.

METHODS

The cognitive functions of 120 patients with bipolar depression and 100 healthy controls were evaluated using the THINC-it tool including Spotter, Symbol Check, Codebreaker, Trials, and the only one subjective test (PDQ-5-D) and five corresponding standard tests. A psychometric analysis of the THINC-it tool was performed.

RESULTS

The overall Cronbach's alpha coefficient of the THINC-it tool was 0.815. The intra-group correlation coefficient (ICC) of retest reliability ranged from 0.571 to 0.854 (P<0.001), while the correlation r of parallel validity ranged from 0.291 to 0.921 (P<0.001). There were significant differences in the two groups Z-scores of THINC-it total score, Spotter, Codebreaker, Trails, and PDQ-5-D (P<0.05). Construct validity was analyzed using exploratory factor analysis (EFA). The Kaiser-Meyer-Olkin (KMO) value was 0.749. Using Bartlett's Sphericity test, the χ ² (10) value was 198.257 (P<0.001). The factor loading coefficients of Spotter, Symbol Check, Codebreaker, and Trails on the common factor 1 were -0.724, 0.748, 0.824, and -0.717, respectively, and the factor loading coefficient of PDQ-5-D on the common factor 2 was 0.957. Results revealed that the correlation coefficient of the two common factors was 0.125.

CONCLUSION

The THINC-it tool has good reliability and validity in assessing patients with bipolar depression.

Cognitive complaints mediate childhood parental bonding influence on presenteeism

Background

Childhood parental bonding and cognitive complaints (CCs) affect a worker’s mental health (MH), and CCs affect presenteeism. However, the impact of childhood parental bonding on presenteeism and the mediating effect of CCs with respect to the association among childhood parental bonding and presenteeism remain poorly understood.

Aim

We aimed to investigate the mediating role of CCs on the relationship between childhood parental bonding and presenteeism to better understand the influence of childhood parental bonding on adulthood presenteeism.

Setting

A total of 440 Japanese adult workers recruited using convenience sampling were evaluated.

Methods

The Parental Bonding Instrument, Cognitive Complaints in Bipolar Disorder Rating Assessment and Work Limitations Questionnaire 8 were used to assess childhood parental bonding, CCs, and presenteeism, respectively. We performed Spearman’s correlation analysis and path analysis to investigate the relationship among the variables.

Results

Path analysis revealed that childhood parental bonding and CCs significantly affected presenteeism. More specifically, CCs fully and partially mediated the effect of paternal and maternal care on presenteeism, respectively. Moreover, CCs partially mediated the effects of both paternal and maternal overprotection on presenteeism.

Conclusion

The mediating role of CCs on the relationship between childhood parental bonding and presenteeism was shown in this study. In occupational MH, evaluating the mediating effect of CCs may be useful for addressing adulthood presenteeism associated with childhood parental bonding.

Cognitive complaints mediate the influence of sleep disturbance and state anxiety on subjective well-being and ill-being in adult community volunteers: a cross sectional study

Background

Sleep disturbance, state anxiety, and cognitive complaints (CCs) have been recognized as important issues in public health. Although the mediating role of CCs has been proposed, their role in the relationships between sleep disturbance, state anxiety, and subjective well-being (SWB) and subjective ill-being (SIB) are not yet fully understood. This study used path analyses to investigate whether CCs mediate these relationships.

Methods

The study recruited 523 Japanese adult volunteers using convenience sampling. Participants completed the Pittsburgh Sleep Quality Index, State–Trait Anxiety Inventory (Form Y), Cognitive Complaints in Bipolar Disorder Rating Assessment, and Subjective Well-Being Inventory to evaluate sleep disturbance, state anxiety, CCs, and SWB and SIB, respectively. Path analyses were conducted to assess the mediating effects of CCs.

Results

The path analyses showed significant indirect associations of sleep disturbance and state anxiety with SWB (p = 0.024 and p = 0.012) and SIB (p < 0.001 and p < 0.001), respectively, mediated by CCs. Furthermore, there were significant indirect associations of sleep disturbance with CCs (p < 0.001), SWB (p < 0.001), and SIB (p < 0.001), via state anxiety, respectively.

Conclusions

This study suggests that CCs mediate the associations of sleep disturbance and state anxiety with SWB and SIB, respectively, in adult community volunteers. To address SWB and SIB associated with sleep disturbance and state anxiety, evaluating CCs may be useful in public mental health. Our findings will encourage health care workers to assess CCs more systematically. Future studies may need to target CCs to develop interventions for SWB and SIB.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12936-0.

Subjective cognitive impairment and presenteeism mediate the associations of rumination with subjective well-being and ill-being in Japanese adult workers from the community

Background

In recent years, the roles of rumination, subjective cognitive impairment (SCI), and presenteeism have been emphasized in occupational mental health. However, associations between rumination, SCI, presenteeism, and psychological well-being are not fully understood. We hypothesized that SCI and presenteeism mediate the associations between rumination and subjective well-being (SWB) and subjective ill-being (SIB). Hence, we investigated the mediating roles of SCI and presenteeism in this study.

Methods

A total of 458 adult workers (mean age, 40.8±11.9 years; 44.1% male), who were recruited in Tokyo using convenience sampling, were analyzed in this study. The Ruminative Responses Scale, Cognitive Complaints in Bipolar Disorder Rating Assessment, Work Limitations Questionnaire 8, and Subjective Well-being Inventory were used to evaluate rumination, SCI, presenteeism, and psychological well-being (SWB and SIB), respectively. Path analyses were performed to evaluate the relations between these parameters.

Results

The path analysis indicated that rumination, SCI, and presenteeism were directly and negatively associated with SWB and SIB. Regarding indirect effects, rumination was negatively associated with SWB and SIB via SCI, presenteeism, and both SCI and presenteeism. Furthermore, SCI was negatively associated with SWB and SIB via presenteeism.

Conclusions

The results suggest that SCI and presenteeism mediate the associations of rumination with SWB and SIB in Japanese adult workers. To address the psychological well-being associated with rumination, evaluating SCI and presenteeism simultaneously may be useful in occupational mental health. This study provides key insights into the development of comprehensive intervention strategy based on the biopsychosocial perspective for worker’s psychological well-being.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13030-021-00218-x.

Associations of Cognitive Complaints and Depressive Symptoms with Health-Related Quality of Life and Perceived Overall Health in Japanese Adult Volunteers

Cognitive complaints, defined as perceived cognitive dysfunction in daily living, are associated with depressive symptoms. The associations of cognitive complaints and depressive symptoms with health-related quality of life (HRQoL) and perceived overall health in Japanese adults remains unknown. To investigate these relationships, we evaluated a convenience sample of 525 Japanese adult volunteers (Mage: 41.3 ± 11.7; 238 male and 287 female). We used the Cognitive Complaints in Bipolar Disorder Rating Assessment (evaluating cognitive complaints), Patient Health Questionnaire-9 (evaluating depressive symptoms), EuroQol-5 Dimension-5 Level (EQ-5D-5L; evaluating HRQoL), and EuroQol-Visual Analogue Scale (EQ-VAS; evaluating perceived overall health). Our path analyses suggested that both cognitive complaints and depressive symptoms had significant total effects on HRQoL and perceived overall health. Furthermore, cognitive complaints were not significantly associated directly with HRQoL and perceived overall health, whereas cognitive complaints were significantly associated with HRQoL and perceived overall health indirectly via depressive symptoms. Depressive symptoms were significantly associated directly with HRQoL and perceived overall health. This study suggests that depressive symptoms may mediate the associations of cognitive complaints with HRQoL and perceived overall health. Thus, to address the HRQoL and perceived overall health associated with cognitive complaints, evaluation and intervention for depressive symptoms may be useful in public health.

Mediating Roles of Cognitive Complaints on Relationships between Insomnia, State Anxiety, and Presenteeism in Japanese Adult Workers

Complaints of cognitive functions (CCFs), defined as subjective cognitive dysfunction, affect social function; additionally, for workers, this condition is an important factor in presenteeism and mediates the effect of depressive symptoms on presenteeism. This study aimed to investigate whether CCFs mediate the relationships among insomnia, state anxiety (SA), and presenteeism. Participants were 471 Japanese adult workers evaluated using the Athens Insomnia Scale, State-Trait Anxiety Inventory (Form Y), Cognitive Complaints in Bipolar Disorder Rating Assessment, and Work Limitations Questionnaire 8 to assess insomnia, SA, CCFs, and presenteeism, respectively. Path analysis was used to evaluate the correlations between variables. CCFs significantly mediated the associations among insomnia, SA, and presenteeism. To address the presenteeism associated with insomnia and SA, it may be useful to assess the mediating roles of CCFs.

Associations between cognitive impairment and illness awareness in fully remitted bipolar outpatients

The euthymic state of bipolar disorder is often characterized by impaired cognitive function. In this investigation, we hypothesized that subjective cognitive function is impaired and illness awareness is inadequate and we further explored the associations among cognitive complaints, objective cognitive functions, and current illness awareness in Japanese patients. Twenty-seven patients in remission and 27 healthy subjects were recruited in this study. The Japanese version of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and Scale to Assess Unawareness in Mental Disorders (Japanese, SUMD-J) were used to assess each patient. All patients underwent neuropsychological tests for the assessment of objective cognitive functions. Only SUMD2.C (current awareness of the effects of medication) was significantly correlated with COBRA, and the objective cognitive assessments, Word Fluency Test and Stroop Test Reaction Time, represented significant correlations with SUMD1.C (current awareness of mental illness). In remitted bipolar outpatients, both the objective and subjective cognitive functions were found to be associated with illness awareness. However, subjective and objective cognitive functions differed in the related illness awareness subscales in fully remitted bipolar outpatients.

The Role of Cognitive Complaints in the Relationship Between Trait Anxiety, Depressive Symptoms, and Subjective Well-Being and Ill-Being in Adult Community Volunteers

PURPOSE

Trait anxiety, depressive symptoms, and cognitive complaints affect mental health. The mediating role of cognitive complaints has been reported recently. However, the mediating effects of cognitive complaints in the relationships between trait anxiety, depressive symptoms, and subjective well-being (SWB) and ill-being (SIB) remain unknown. Therefore, we used path analyses to investigate these mediating effects.

MATERIALS AND METHODS

A total of 554 adult community volunteers in Japan were studied using the State-Trait Anxiety Inventory (Form Y), Patient Health Questionnaire-9, Cognitive Complaints in Bipolar Disorder Rating Assessment, and Subjective Well-Being Inventory. These assessment tools evaluated trait anxiety, depressive symptoms, cognitive complaints, SWB, and SIB. Path analyses were performed in this study.

RESULTS

Path analyses revealed that there were significant indirect effects, via cognitive complaints, of trait anxiety and depressive symptoms on SIB. However, there were no significant indirect effects of trait anxiety and depressive symptoms on SWB. There were significant indirect effects, via depressive symptoms, of trait anxiety on cognitive complaints, SWB, and SIB.

CONCLUSION

The role of cognitive complaints may be different between SWB and SIB associated with trait anxiety and depressive symptoms. Evaluating the mediating effect of cognitive complaints may be more useful on SIB than SWB associated with trait anxiety and depressive symptoms. These findings may be useful when considering intervention targets in mental health.

Associations among childhood parenting, affective temperaments, depressive symptoms, and cognitive complaints in adult community volunteers

BACKGROUND

Correlations between depressive symptoms and affective temperaments or quality of childhood parenting have been investigated previously; however, how childhood parenting and affective temperaments affect cognitive complaints remains unknown. Thus, we evaluated correlations among childhood parenting, affective temperaments, depressive symptoms, and cognitive complaints in adults.

METHODS

Participants (N = 490) completed the Parental Bonding Instrument (PBI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire version (TEMPS-A), the Patient Health Questionnaire-9 (PHQ-9), and the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA). Multiple regression analyses and structural equation modeling were performed to evaluate scale correlations.

RESULTS

As per structural equation modeling, the direct effect of PHQ-9 and four subscales (cyclothymic, depressive, irritable, and anxious temperament) of TEMPS-A on COBRA were significant; the indirect effect of the four subscales of TEMPS-A on COBRA via PHQ-9 was significant; the direct effect of the three subscales (paternal care, maternal care, and maternal overprotection) of PBI on PHQ-9 and four subscales of TEMPS-A were significant; the indirect effect of the three subscales of PBI on PHQ-9 via the four subscales of TEMPS-A was significant.

LIMITATIONS

Cross-sectional designs cannot identify causal relationships between parameters. As participants were adult volunteers from the community, results may not be generalizable to individuals with psychiatric disorders.

CONCLUSIONS

Childhood parenting affects cognitive complaints indirectly via affective temperaments and depressive symptoms in adult community volunteers. An important role of affective temperaments and depressive symptoms in the effects of childhood parenting on cognitive complaints is suggested.

Structural equation modeling approach to explore the influence of childhood maltreatment in adults

Background

Childhood maltreatment affects social functioning in the general adult population. However, how child abuse affects functional disability in adulthood remains unknown. Thus, we investigated the correlation between child abuse, depressive symptoms, cognitive complaints, and functional disability in adult community volunteers.

Methods

Participants (N = 556) completed the Child Abuse and Trauma Scale, Patient Health Questionnaire-9, Cognitive Complaints in Bipolar Disorder Rating Assessment, and Sheehan Disability Scale. Multiple regression analyses and structural equation modeling were performed to evaluate scale correlations.

Results

Structural equation modeling showed that the direct effect of childhood maltreatment on depressive symptoms, the indirect effect of childhood maltreatment on cognitive function via depressive symptoms, and the indirect effects of childhood maltreatment on functional disability via depressive symptoms and via cognitive function were all significant. The direct effects of childhood maltreatment on cognitive function and functional disability were not significant. There was no significant association between variables.

Limitations

Cross-sectional designs cannot identify causal relationships between parameters. Participants were adult volunteers from the community; therefore, results may not be generalizable to individuals with psychiatric disorders. Sociodemographic variability was a limitation because we used self-reported childhood maltreatment.

Conclusions

Childhood maltreatment indirectly affects functional disability via depressive symptoms and via cognitive function through depressive symptoms. We suggest that depressive symptoms and cognitive function play crucial roles in the influence of childhood maltreatment on functional disability in adult community volunteers.

Associations between cognitive impairment and P300 mean amplitudes in individuals with bipolar disorder in remission

Cognitive functions are often affected during the euthymic state of bipolar disorder (BD). In this study, we investigated the associations among cognitive complaints, objective cognitive functions, and the mean amplitudes of the P300 event-related potential (ERP) wave in individuals with BD. The study population comprised 33 individuals with BD who were in remission and was conducted at Hokkaido University Hospital, Sapporo, Japan. Cognitive complaints were assessed using the Japanese version of the tool named "cognitive complaints in bipolar disorder rating assessment (COBRA)", whereas objective cognitive functions were measured by neuropsychological tests. P300 mean amplitudes were investigated during two- and three-stimulus oddball tasks and showed significant correlations with neuropsychological test scores at all electrode locations, confirming that ERPs and objective cognitive tests that assessed attention and memory function tend to coincide; however, neither P300 amplitudes nor neuropsychological test scores were correlated with COBRA scores. ERPs most likely represent the neurophysiological basis for objective rather than subjective cognitive function in euthymic individuals. Thus, our results suggest that objective cognitive function is related more to P300 mean amplitude scores than subjective cognitive function in individuals with BD.

Associations between the depressive symptoms, subjective cognitive function, and presenteeism of Japanese adult workers: a cross-sectional survey study

Background

Presenteeism has attracted much attention in the research into mental health. However, how cognitive complaints and depressive symptoms affect presenteeism remains unknown. Therefore, this study examined the correlation between subjective cognitive impairment, depressive symptoms, and work limitations.

Methods

We collected data from 477 adult workers in Japan. We evaluated subjective cognitive function using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9), and work limitations with the Work Limitations Questionnaire 8 (WLQ-8). The relations between depressive symptoms, cognitive complaints, and work limitations were examined using Spearman’s rank correlations and multiple regression analysis. It was hypothesized that cognitive complaints would mediate the effects of depressive symptoms on work productivity loss, which was tested using path analysis.

Results

The results indicated that cognitive complaints were significantly correlated with work limitations and depressive symptoms. Multiple regression analysis, using the WLQ-8 productivity loss score as the dependent variable, revealed that COBRA and PHQ-9 scores were significant predictors of work productivity loss. We performed path analysis using PHQ-9, COBRA, and WLQ-8 productivity loss scores and created a path diagram, which revealed that the direct effects of both depressive symptoms and cognitive dysfunction on work productivity loss were statistically significant. Moreover, depressive symptoms indirectly affected work productivity loss through subjective cognitive impairment. There was no significant interaction effect between depressive symptoms and cognitive complaints.

Conclusions

Our results suggest that work limitations may be predicted by not only depressive symptoms but also cognitive complaints. Moreover, subjective cognitive impairment may mediate the effect of depressive symptoms on presenteeism among adult workers.

Subjective cognitive dysfunction in patients with bipolar disorder: The prevalence, related factors and effects on predicting psychosocial functioning and suicidal ideation

Persistent cognitive deficits are prevalent during all stages of bipolar disorder (BD). However, few studies have examined subjective cognitive complaints in patients with BD. This study aimed to investigate the prevalence and relevant factors of subjective cognitive functioning and its potential effects on predicting psychosocial functioning and suicidal ideation in BD. Ninety-two patients with BD type I (including 42 depressed patients and 50 euthymic patients) and 60 healthy individuals were recruited for this study. All participants were assessed with a battery of neuropsychological tests examining attention and processing speed, visual memory, working memory and executive functions, as well as the Cognitive Complaints in Bipolar Disorder Rating Assessment, the Global Assessment of Functioning scale and the Beck Scale for Suicide Ideation. Bipolar patients exhibited worse subjective cognitive dysfunction compared with healthy individuals, and depressed patients expressed more cognitive complaints than euthymic bipolar patients. In bipolar group, psychosocial functioning, suicidal ideation and occupational status were the main relevant factors of subjective cognitive functioning. Subjective cognitive functioning could also predict psychosocial functioning and suicidal ideation. Depressive symptoms moderated the associations between objective cognitive functioning and suicidal ideation, but could not moderate the correlations between cognitive functioning and psychosocial functioning. These findings suggest that subjective cognitive assessment should be further emphasized in clinical practice.

Does Subjective Cognitive Function Mediate the Effect of Affective Temperaments on Functional Disability in Japanese Adults?

PURPOSE

Functional disability is affected by subjective cognitive function, depressive symptoms, and affective temperaments in adults. However, the role of subjective cognitive function as a mediator of affective temperaments in functional disability remains unknown. Therefore, we aimed to determine how subjective cognitive function mediates the effect of affective temperaments on functional disability in adults.

MATERIALS AND METHODS

A total of 544 participants completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire version (TEMPS-A), the Patient Health Questionnaire-9 (PHQ-9), the cognitive complaints in bipolar disorder rating assessment (COBRA), and the Sheehan Disability Scale (SDS). The association among these instruments was evaluated by multiple regression and covariance structure analyses.

RESULTS

The structural equation model showed that the COBRA scores could be predicted directly by the four affective temperaments of the TEMPS-A (cyclothymic, depressive, irritable, and anxious) and indirectly by the PHQ-9. Moreover, the SDS score was predicted directly by these four affective temperaments and indirectly by the COBRA and PHQ-9.

CONCLUSION

Subjective cognitive function mediates the effect of affective temperaments on functional disability in Japanese adults. However, the cross-sectional design may limit the identification of causal associations between the parameters. In the present study, the participants were from a specific community population; therefore, the results may not be generalizable to other communities.

Controlling the laxative abuse of anorexia nervosa patients with the Serigaya Methamphetamine Relapse Prevention Program workbook: a case report

Background

There is no consensus on effective treatment for laxative abuse in patients with eating disorders. Here, we report the case of a patient with laxative abuse who showed some improvement through an intervention based on the Matrix model.

Case presentation

A woman diagnosed with anorexia nervosa-binge eating/purging type (AN-BP) steadfastly denied laxative abuse and would not admit to suffering from an eating disorder. This led to low motivation for undergoing conventional psychotherapy, psychoeducation, and cognitive behavioral therapy. These were ineffective and followed by repeated cycles of hospitalization and discharge. The patient’s general condition, as depicted by her laboratory and clinical parameters, deteriorated due to the medical complications resulting from laxative abuse.

Focusing on laxative abuse, we considered an intervention for drug addiction. Because the patient could maintain a diet diary and acknowledged laxative abuse as a drug addiction, we introduced the Serigaya Methamphetamine Relapse Prevention Program (SMARPP) workbook as a self-administered treatment. The patient meticulously completed the treatment and experienced a gradual improvement in laxative abuse. She has not been re-hospitalized in 4 years, currently performs household chores, and demonstrates improved social function.

Conclusions

In patients with AN-BP, the SMARPP workbook may be effective in treating laxative abuse.

The associations between subjective and objective cognitive functioning across manic or hypomanic, depressed, and euthymic states in Chinese bipolar patients

BACKGROUND

Patients may present cognitive deficits during all stages of bipolar disorder (BD). Few studies have examined self-reported cognitive difficulties and its relation to neurocognitive dysfunction during symptomatic periods of BD. This study aimed to compare subjective cognitive functioning and explore associations between subjective and objective cognitive functioning across different BD clinical states, and investigate the predicting and moderating roles of mood symptoms.

METHODS

Subjective cognitive functioning (measured by Cognitive Complaints in Bipolar Disorder Rating Assessment, COBRA) and several domains of cognitive functioning (assessed by a neuropsychological battery), including executive functions, attention and processing speed, and visual memory, were examined in 48 hypomanic or manic patients, 42 depressed bipolar patients, 50 euthymic bipolar patients and 60 healthy comparisons.

RESULTS

All patients exhibited subjective and objective cognitive deficits in relation to healthy comparisons. There was a significant association between subjective and objective cognitive functioning in euthymic group, but the association was not significant in acute symptomatic groups, which could be moderated by depressive or manic symptoms in depressive or manic group, respectively. Subjective cognitive functioning was significantly correlated with mood symptoms, and the best predictor of subjective cognitive functioning was depressive symptoms.

LIMITATIONS

This was a cross-sectional study with a mixed sample of inpatients and outpatients. The medication effect was not adjusted.

CONCLUSIONS

The associations between subjective and objective cognitive dysfunction varied in clinical states, and mood symptoms moderated the associations. A neuropsychological test battery is required to substantiate actual cognitive dysfunction in clinical settings, irrespective of subjective cognitive deficits.

Associations between cognitive impairment and quality of life in euthymic bipolar patients

During the euthymic state in bipolar disorder, cognitive functions often remain affected. Specifically, subjective and objective cognitive impairment might distinctly affect patients' quality of life (QoL); however, this question had not been examined previously in Japanese patients. Therefore, the current study investigated the associations between cognitive complaints, QoL, and objective cognitive functions. Forty patients in remission were recruited from the Hokkaido University Hospital, Sapporo, Japan and assessed with the translated version of the cognitive complaints in bipolar disorder rating assessment (COBRA), medical outcomes study 36-item short-form health survey version 2 (SF-36v2), and Sheehan disability scale (SDS). The Japanese adult reading scale, Wisconsin card sorting test, word fluency, continuous performance test, trail making test (TMT), auditory verbal learning, and Stroop test evaluated objective cognitive functions. Significant correlations were observed between the COBRA, SF-36v2, and SDS results, as well as the TMT scores. Overall, euthymic patients were aware of their cognitive dysfunction, which could be understood in relation to the decrease in satisfaction in their daily life. Therefore, even mild cognitive impairments can have ramifications for patients in the euthymic state of bipolar disorder.

Evaluation Of Subjective Cognitive Function Using The Cognitive Complaints In Bipolar Disorder Rating Assessment (COBRA) In Japanese Adults

PURPOSE

To examine the relationship between depressive symptoms, subjective cognitive function, and quality of life in Japanese adults using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA).

PATIENTS AND METHODS

We evaluated 585 adult community volunteers using the Patient Health Questionnaire-9 (PHQ-9) for evaluation of depressive symptoms and the COBRA for evaluation of subjective cognitive function. We additionally used the 8-item Short-Form Health Survey and the Sheehan Disability Scale to evaluate the quality of life (QoL).

RESULTS

Measures of subjective cognitive function were significantly correlated with depressive symptoms and QoL. Structural equation modeling demonstrated that depressive symptoms directly and indirectly decreased QoL via their effects on subjective cognitive dysfunction. Measures of depressive symptoms were more closely related to QoL than were measures of subjective cognitive function.

LIMITATIONS

Study participants were general adult population community volunteers and included healthy people; thus, these results may not be generalizable to patients with depression or bipolar disorder. In addition, the cross-sectional design of this study prevented the identification of causal relationships among the parameters.

CONCLUSION

Changes in subjective cognitive function may affect QoL via depressive symptoms. Evaluations of subjective cognitive function may help identify factors that reduce QoL.

Psychometric properties and cross-cultural comparison of the cognitive complaints in bipolar disorder rating assessment (COBRA) in Mexican patients with bipolar disorder

Bipolar Disorder (BD) is a serious and frequent mental health condition that is sometimes fatal. Several longitudinal studies have found an important correlation between cognition and functionality in BD. Despite the known importance of cognitive symptoms in BD, evaluation of cognitive deficits is not routinely done in clinical settings, as assessment is time-consuming and requires neuropsychological testing. The aim was to evaluate the psychometric properties of the subjective cognitive deficits in bipolar disorder (COBRA) rating scale in a Mexican sample of patients with BD and perform a cross-cultural comparison with the results obtained in other cultures. Ninety-two Healthy Subjects and 80 euthymic patients with BD were asked to complete the COBRA rating scale. The psychometric properties found in Mexican population show a good internal consistency and good discriminant validity with control subjects. Adequate congruence coefficients were obtained between the COBRA analyses in Mexican population and Spanish population and acceptable when compared to Japanese population. The COBRA scale is a brief and valid measure of cognitive complaints in BD for use in Mexican population.

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

OBJECTIVES

Cognition is a new treatment target to aid functional recovery and enhance quality of life for patients with bipolar disorder. The International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force aimed to develop consensus-based clinical recommendations on whether, when and how to assess and address cognitive impairment.

METHODS

The task force, consisting of 19 international experts from nine countries, discussed the challenges and recommendations in a face-to-face meeting, telephone conference call and email exchanges. Consensus-based recommendations were achieved through these exchanges with no need for formal consensus methods.

RESULTS

The identified questions were: (I) Should cognitive screening assessments be routinely conducted in clinical settings? (II) What are the most feasible screening tools? (III) What are the implications if cognitive impairment is detected? (IV) What are the treatment perspectives? Key recommendations are that clinicians: (I) formally screen cognition in partially or fully remitted patients whenever possible, (II) use brief, easy-to-administer tools such as the Screen for Cognitive Impairment in Psychiatry and Cognitive Complaints in Bipolar Disorder Rating Assessment, and (III) evaluate the impact of medication and comorbidity, refer patients for comprehensive neuropsychological evaluation when clinically indicated, and encourage patients to build cognitive reserve. Regarding question (IV), there is limited evidence for current evidence-based treatments but intense research efforts are underway to identify new pharmacological and/or psychological cognition treatments.

CONCLUSIONS

This task force paper provides the first consensus-based recommendations for clinicians on whether, when, and how to assess and address cognition, which may aid patients' functional recovery and improve their quality of life.

Validity and reliability of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Brazilian bipolar patients

Abstract Introduction: In Brazil, there is no valid instrument to measure subjective cognitive dysfunction in bipolar disorder. The present study analyzed the psychometric properties of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Brazilian bipolar patients. We further investigated the relationship between the COBRA, objective cognitive measures, and illness course variables. Methods: The total sample (N=150) included 85 bipolar disorder patients and 65 healthy controls. The psychometric properties of the COBRA (e.g., internal consistency, concurrent validity, discriminative validity, factor analyses, ROC curve, and feasibility) were analyzed. Results: The COBRA showed a one-factor structure with very high internal consistency (Cronbach's alpha=0.890). Concurrent validity was indicated by a strong correlation with the cognitive domain of the FAST (r=0.811, p<0.001). Bipolar patients experienced greater cognitive complaints (mean=14.69; standard deviation [SD]=10.03) than healthy controls (mean=6.78; SD=5.49; p<0.001), suggesting discriminative validity of the instrument. No significant correlations were found between the COBRA and objective cognitive measures. Furthermore, higher COBRA scores were associated with residual depressive (r=0.448; p<0.001) and manic (r=0.376; p<0.001) symptoms, number of depressive episodes (r=0.306; p=0.011), number of total episodes (r=0.256; p=0.038), and suicide attempts (r=0.356; p=0.003). Conclusion: The COBRA is a valid instrument to assess cognitive complaints, and the combined use of subjective-objective cognitive measures enables the correct identification of cognitive dysfunctions in bipolar disorder.