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Cañada Y, Torres SC, Andreu-Martinez J, Cristancho DB, Chicchi Giglioli IA, Garcia-Blanco A, Adriasola A, Navalón P, Sierra P, Alcañiz M. Characterization and assessment of executive functions through a virtual cooking task in euthymic patients with bipolar disorder. J Psychiatr Res 2024; 178:349-358. [PMID: 39191204 DOI: 10.1016/j.jpsychires.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 07/16/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024]
Abstract
Bipolar disorder (BD)1 implies impairments in executive functions during euthymia that interfere in psychosocial functioning. Virtual reality assessments may confer advantages respect to traditional assessments in terms of efficiency and ecological validity. The aim of this study was to validate a novel Virtual Cooking Task (VCT) for executive functions assessment in euthymic patients with BD. This is a cross-sectional study in which a group of BD patients (n = 42) and healthy controls (n = 42) were assessed with the VCT and a battery of computerized standard tasks (CST). Additionally, the influence on psychosocial functioning of both forms of assessment, measured with the FAST, was investigated to check ecological validity. In BD group significant impairments in interference, working memory and sustained attention were found in CST and VCT respect to controls. However, deficits in planning and problem-solving were also revealed with the VCT. With respect to psychosocial functioning, only VCT variables were able to predict FAST scores at the assessment time. The VCT showed a greater sensitivity than CST to assess executive functions and real-life functioning in BD. This provides evidence about the opportunity to design novel cognitive assessments for diagnostic and therapeutic purposes in BD.
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Affiliation(s)
- Yolanda Cañada
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - Sergio C Torres
- Human-centred Technology Institute (Human-tech), Polytechnic University of Valencia, Valencia, Spain
| | - Julia Andreu-Martinez
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - Diana Beltrán Cristancho
- Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain; Mental Health Unit of Badalona, Barcelona, Spain
| | | | - Ana Garcia-Blanco
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain; Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Asier Adriasola
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - Pablo Navalón
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain.
| | - Pilar Sierra
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Mariano Alcañiz
- Human-centred Technology Institute (Human-tech), Polytechnic University of Valencia, Valencia, Spain
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Chakrabarty T, Frangou S, Torres IJ, Ge R, Yatham LN. Brain age and cognitive functioning in first-episode bipolar disorder. Psychol Med 2023; 53:5127-5135. [PMID: 35875930 PMCID: PMC10476063 DOI: 10.1017/s0033291722002136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is significant heterogeneity in cognitive function in patients with bipolar I disorder (BDI); however, there is a dearth of research into biological mechanisms that might underlie cognitive heterogeneity, especially at disease onset. To this end, this study investigated the association between accelerated or delayed age-related brain structural changes and cognition in early-stage BDI. METHODS First episode patients with BDI (n = 80) underwent cognitive assessment to yield demographically normed composite global and domain-specific scores in verbal memory, non-verbal memory, working memory, processing speed, attention, and executive functioning. Structural magnetic resonance imaging data were also collected from all participants and subjected to machine learning to compute the brain-predicted age difference (brainPAD), calculated by subtracting chronological age from age predicted by neuroimaging data (positive brainPAD values indicating age-related acceleration in brain structural changes and negative values indicating delay). Patients were divided into tertiles based on brainPAD values, and cognitive performance compared amongst tertiles with ANCOVA. RESULTS Patients in the lowest (delayed) tertile of brainPAD values (brainPAD range -17.9 to -6.5 years) had significantly lower global cognitive scores (p = 0.025) compared to patients in the age-congruent tertile (brainPAD range -5.3 to 2.4 yrs), and significantly lower verbal memory scores (p = 0.001) compared to the age-congruent and accelerated (brainPAD range 2.8 to 16.1 yrs) tertiles. CONCLUSION These results provide evidence linking cognitive dysfunction in the early stage of BDI to apparent delay in typical age-related brain changes. Further studies are required to assess how age-related brain changes and cognitive functioning evolve over time.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Sophia Frangou
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
- Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Ivan J. Torres
- British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ruiyang Ge
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
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3
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Kjærstad HL, Haldorsen T, Vinberg M, Kessing LV, Miskowiak KW. Associations between emotional and non-emotional cognition and subsequent mood episodes in recently diagnosed patients with bipolar disorder: A 16-month follow-up study. J Affect Disord 2023; 324:16-23. [PMID: 36565963 DOI: 10.1016/j.jad.2022.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with impairments in both emotional and non-emotional cognition. Recently, cognitive impairments have attracted increasing research interest as markers of prognosis and possible treatment targets in patients with BD. However, there is a paucity of studies investigating cognitive predictors of prognosis in BD. METHODS We assessed 148 recently diagnosed, symptomatically stable patients with BD with a battery of emotional and non-emotional cognitive tests and followed them up over 16 months as part of an ongoing cohort study. Multiple linear regression analyses were conducted to examine the associations between cognitive performance at baseline and the recurrence and duration of (hypo)manic and depressive episodes, respectively, with adjustment for age, sex, subsyndromal symptoms and time between assessments. RESULTS Poorer recognition of negative facial expressions and more negative emotions in neutral daily life scenarios were associated with greater frequency (ps ≤ .04) and longer duration (ps ≤ .03) of subsequent (hypo)manic episodes over the 16-month follow-up period. In addition, poorer global cognition, attention and psychomotor speed, and verbal fluency were associated with more (hypo)manic episodes (ps ≤ .04). Finally, more difficulty down-regulating emotion in negative social scenarios was associated with depressive relapse (p = .007). It was a limitation that patients had a delayed diagnosis of seven years from their first mood episode despite being recently diagnosed. CONCLUSION Trait-related cognitive impairments influence the early course in recently diagnosed patients with BD, particularly (hypo)manic relapse. Early prophylactic strategies targeting cognitive impairments may increase resilience and the course of illness in recently diagnosed patients with BD.
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Affiliation(s)
- Hanne Lie Kjærstad
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Thea Haldorsen
- Department of Psychology, University of Copenhagen, Denmark
| | - Maj Vinberg
- Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
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Baena-Oquendo S, García Valencia J, Vargas C, López-Jaramillo C. Neuropsychological aspects of bipolar disorder. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:218-226. [PMID: 36075855 DOI: 10.1016/j.rcpeng.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/10/2020] [Indexed: 06/15/2023]
Abstract
Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and aprevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in this review.
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Affiliation(s)
- Stephen Baena-Oquendo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Jenny García Valencia
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Cristian Vargas
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Carlos López-Jaramillo
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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5
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Miskowiak KW, Mariegaard J, Jahn FS, Kjærstad HL. Associations between cognition and subsequent mood episodes in patients with bipolar disorder and their unaffected relatives: A systematic review. J Affect Disord 2022; 297:176-188. [PMID: 34699850 DOI: 10.1016/j.jad.2021.10.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is highly recurrent and prevention of relapse and illness onset is an urgent treatment priority. This systematic review examined whether cognitive assessments can aid prediction of recurrence in patients with BD and/or illness onset in individuals at familial risk. METHODS The review included longitudinal studies of patients with BD or individuals at familial risk of mood disorder that examined the association between cognitive functions and subsequent relapse or illness onset, respectively. We followed the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed/MEDLINE, EMBASE and PsychInfo databases from inception up until May 10th 2021. RESULTS We identified 19 eligible studies; 12 studies investigated cognitive predictors of recurrence in BD (N = 36-76) and seven investigated cognitive predictors of illness onset in at-risk individuals (N = 84-234). In BD, general cognitive impairment, poorer verbal memory and executive function and positive bias were associated with subsequent (hypo)manic relapse -but with not depressive relapse or mood episodes in general. In first-degree relatives, impairments in attention, verbal memory and executive functions and positive bias were associated with subsequent illness onset. LIMITATIONS The findings should be considered preliminary given the small-to-moderate sample sizes and scarcity of studies. CONCLUSIONS Subject to replication, the associations between cognitive impairment and (hypo)mania relapse and illness onset may provide a platform for personalised treatment and prophylactic strategies.
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Affiliation(s)
- Kamilla Woznica Miskowiak
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | - Johanna Mariegaard
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Frida Simon Jahn
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Lie Kjærstad
- Neurocognition and Emotion in Affective Disorder (NEAD) Group, Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University hospital, Rigshospitalet, Denmark
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6
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Aidelbaum R, Goghari V. A Visual Task-Based Assessment of Theory of Mind and Social Perception Within Bipolar Disorder. J Nerv Ment Dis 2022; 210:37-44. [PMID: 34743085 DOI: 10.1097/nmd.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Evidence suggests that theory of mind (TOM) and social perception (SP) may be impaired within bipolar disorder (BD). However, it remains unclear whether these deficits are facet specific and predictive of functioning. This study assessed the manifestation of TOM and SP in a BD sample. Twenty-six individuals diagnosed with BD and 25 controls were recruited and assessed for TOM, SP, and functioning. Whereas differences were observed regarding functional outcome, differences were not observed regarding social cognitive performance, regardless of facet. Correlations between social cognitive and functional outcome domains were nonsignificant, whereas significant associations were observed between the social cognitive measures. Results suggest that despite functional differences, TOM and SP, independent of facet assessed, seem preserved within the BD sample. Although evidence was not provided supporting the utility of TOM and SP in the prediction of functional outcome, evidence supports the possible dependence of these social cognitive domains on shared underlying processes.
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Affiliation(s)
- Robert Aidelbaum
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
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7
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Lomastro MJ, Valerio MP, Szmulewicz AG, Martino DJ. Manic morbidity and executive function impairment as determinants of long-term psychosocial dysfunction in bipolar disorder. Acta Psychiatr Scand 2021; 144:72-81. [PMID: 33792890 DOI: 10.1111/acps.13303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/28/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the role of cognitive performance and measures of clinical course-including both syndromal and subsyndromal symptomatology-as determinants of the functional outcome of patients with Bipolar Disorder (BD) during a mean follow-up period of more than 4 years. METHODS Seventy patients with euthymic BD completed a neurocognitive battery at study entry. Clinical course was assessed prospectively for a period longer than 48 months by two measures: time spent ill (documented using a modified life charting technique) and density of affective episodes (defined as the number of depressive and hypo/manic episodes per year of follow-up). Psychosocial functioning was assessed during euthymia using the Functioning Assessment Short Test (FAST) total score at the end of follow-up period. RESULTS Baseline deficits in phonological fluency, a measure of executive functions (β = -2.49; 95% CI = -3.98, -0.99), and density of hypo/manic episodes during follow-up (β = 6.54; 95% CI = 0.43, 12.65) were independently associated with FAST total score at the end of study. CONCLUSIONS Although interrelated, manic morbidity and executive function impairments independently contribute to long-term psychosocial dysfunction in BD and could be potential targets of intervention.
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Affiliation(s)
| | - Marina P Valerio
- Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET, Buenos Aires, Argentina
| | | | - Diego J Martino
- National Council of Scientific and Technical Research (CONICET, Buenos Aires, Argentina.,Institute of Cognitive and Translational Neuroscience (INCyT, INECO Foundation, Favaloro University, Buenos Aires, Argentina
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8
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Gebeyehu DA, Mulatie M. Risky sexual behavior and its associated factors among patients with severe mental disorder in University of Gondar Comprehensive Specialized Hospital, 2018. BMC Psychiatry 2021; 21:51. [PMID: 33478422 PMCID: PMC7818773 DOI: 10.1186/s12888-021-03054-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/13/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND People with severe mental disorders are more likely to engage in high-risk sexual behaviors. As a result of these high-risk behaviors, they might contract sexually transmitted infections and become pregnant unintentionally. Despite the high burden of this problem, very little is known about the association between mental disorders and high-risk sexual behaviors; for this reason, the current study aimed at determining the association between these two behaviors in patients with mental disorders attending an outpatient clinic at the University of Gondar Comprehensive Specialized Hospital, Psychiatric Clinic. METHODS A total of 223 study participants were recruited via a stratified sampling followed by a systematic sampling technique. An institutional-based cross-sectional study was conducted from April to May 2018. Data were collected using a pretested interviewer-based questionnaire. A four-item questionnaire was adopted from a behavioral surveillance survey and different literature sources. A multivariable logistic regression model was fitted to assess the strength in addition to the direction of the association between risky sexual behavior and independent variables. An interpretation was made based on the adjusted odds ratio and p-value at a 95% confidence interval (CI). RESULT Nearly half of the study participants (49.8, 95% CI; 43.9-56.5%) presented risky sexual behavior. The study found that male gender (2.98; adjusted odds ration [AOR] = 2.98; 95% CI; 1.49-5.95), no ability to read and write (3.99; AOR = 3.99; 95% CI: 1.53-10.4), history of hospitalization (3.95; AOR = 3.95; 95% CI: 1.87-8.32), perceived internal stigma (2.45, AOR = 2.45; 95% CI: 1.18-5.11), and poor social support (3.07, AOR = 3.07; 95% CI: 1.29-7.30) were significant predictors of risky sexual behaviors among patients with severe mental disorder. CONCLUSION Risky sexual behavior among patients with a severe mental disorders was high (49.8%). Special attention should be given to male patients, incorporating people with severe mental disorders into the adult education programs, continuous health education regarding risky sexual behavior and utilization of condoms, building self-esteem, and engaging others to provide good social support systems are strongly recommended to alleviate this type of behavior in this population.
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Affiliation(s)
- Daniel Ayelegne Gebeyehu
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Missaye Mulatie
- Department of Psychology, College of Social Sciences and the Humanities, University of Gondar, Gondar, Ethiopia
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9
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Baena-Oquendo S, Valencia JG, Vargas C, López-Jaramillo C. Neuropsychological Aspects of Bipolar Disorder. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(20)30092-5. [PMID: 33735035 DOI: 10.1016/j.rcp.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and a prevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in the review.
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Affiliation(s)
- Stephen Baena-Oquendo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Jenny García Valencia
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Cristian Vargas
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Carlos López-Jaramillo
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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10
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Torres IJ, Qian H, Basivireddy J, Chakrabarty T, Wong H, Lam RW, Yatham LN. Three-year longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Acta Psychiatr Scand 2020; 141:98-109. [PMID: 31840225 DOI: 10.1111/acps.13141] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The longitudinal course of neuropsychological functioning after the first manic episode in bipolar disorder is unknown. The present study evaluated cognitive change in bipolar disorder in the first 3 years after the initial manic episode. METHODS Ninety-one newly diagnosed patients with bipolar disorder and 61 demographically similar healthy participants received a neuropsychological evaluation assessing multiple cognitive domains at baseline, 1-year, and 3-year time points. Patients also received clinical assessments including mood ratings at all time points. RESULTS Patients showed deficits in all domains at baseline, but similar longitudinal trajectories across time relative to healthy participants in most cognitive domains. For processing speed, patients showed more gains than controls from baseline to 1 year, but these gains stabilized thereafter. Patients with alcohol/substance abuse showed an initial delay but subsequent recovery in executive functioning. Patients who discontinued antipsychotic treatment showed better cognitive outcomes in verbal memory. CONCLUSION Appropriately treated patients with bipolar disorder showed favorable cognitive outcome in the first 3 years after experiencing an initial manic episode, arguing against cognitive neuroprogression at this stage of the illness. Discontinuation of antipsychotic treatment may be associated with better cognitive outcomes, but clarification of the role of antipsychotics on cognitive functioning requires further investigation.
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Affiliation(s)
- I J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - H Qian
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - J Basivireddy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - T Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - H Wong
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - R W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - L N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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11
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Grunze H, Born C. The Impact of Subsyndromal Bipolar Symptoms on Patient's Functionality and Quality of Life. Front Psychiatry 2020; 11:510. [PMID: 32595531 PMCID: PMC7304232 DOI: 10.3389/fpsyt.2020.00510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
Subsyndromal symptoms have rarely been in the focus of bipolar research. This may be, in part, due to the fact that there is neither a uniform definition nor do they constitute an indication of regulatory and commercial interest. Nevertheless, they do have a decisive impact on the long-term course of bipolar disorder (BD), and the degree of functionality and quality of life (QoL) is more likely determined by their presence or absence than by acute episodes. Summarizing the literature an estimated 20-50% of patients suffer inter-episodically or chronically from subsyndromal BD. The most prominent symptoms that interfere with functionality are subsyndromal depression, disturbances of sleep, and perceived cognitive impairment, whereas anxiety negatively impacts on QoL. In the absence of evidence-based pharmacological treatments for subsyndromal BD, clinical practice adopts guidelines designed for treatment-resistant full-blown episodes of BD, supplemented by cognitive-behavioral, family focused or social-rhythm-based psychotherapies.
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12
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Obo CS, Sori LM, Abegaz TM, Molla BT. Risky sexual behavior and associated factors among patients with bipolar disorders in Ethiopia. BMC Psychiatry 2019; 19:313. [PMID: 31653241 PMCID: PMC6815011 DOI: 10.1186/s12888-019-2313-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 10/09/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND People with bipolar disorder are highly vulnerable to risky sexual behaviors (RSBs). The magnitude of RSBs among bipolar disorders was not studied in our population. The present study aimed to explore the prevalence of RSBs and associated factors among patients with bipolar disorder. METHOD An institution based cross-sectional study was conducted from 1 April to 30 May 2017 among people living with bipolar disorder at outpatient departments of Amanuel Mental Health Hospital, Addis Ababa. Systematic random sampling was used to select participants. Risky sexual behavior was defined as having sex with two or more sexual partners, having unprotected sexual intercourse, sex after alcohol consumption, exchanged money for sex in a previous 12 months. Data collection was conducted through face-to-face interview by a structured questionnaire adopted from behavioral surveillance survey. Binary logistic regression was conducted to identify factors associated with RSBs. RESULT A total of 424 participants were enrolled in the study, giving overall response rate of 96%. About 223(52.6%) were males. The prevalence of risky sexual behavior was 49.1% among bipolar patients. Male patients (Adjusted Odds Ratio (AOR) =2.23,95% CI = 1.27,3.92), patients in age group of 18-24(AOR = 2.08,95% CI = 1.47,3.81),current manic phase of the illness (AOR = 2.3195% CI,1.24,4.32) and current alcohol drinking (AOR = 3.70,95% CI = 2.01,6.78) had significant association with RSB. CONCLUSION Almost half of bipolar patients reported a risky sexual behavior. Current manic episode and the consumption of alcohol were independently associated with RSB. To reduce the burden of RSBs, mental health services which focuses on sexual behaviors of bipolar patients is required.
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Affiliation(s)
| | - Lamesa Melese Sori
- Department of Psychiatry, University of Gondar Hospital, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- University of South Australia, School of Pharmacy and Medical Sciences, Adelaide, Australia
| | - Bizuneh Tesfaye Molla
- Department of Psychiatry, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
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Bonnín CDM, Reinares M, Martínez-Arán A, Jiménez E, Sánchez-Moreno J, Solé B, Montejo L, Vieta E. Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. Int J Neuropsychopharmacol 2019; 22:467-477. [PMID: 31093646 PMCID: PMC6672628 DOI: 10.1093/ijnp/pyz018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022] Open
Abstract
People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described.
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Affiliation(s)
- Caterina del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,Correspondence: Anabel Martínez-Arán, PhD, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Catalonia ()
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Sánchez-Moreno
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Chakrabarty T, Torres IJ, Bond DJ, Yatham LN. Inflammatory cytokines and cognitive functioning in early-stage bipolar I disorder. J Affect Disord 2019; 245:679-685. [PMID: 30447566 DOI: 10.1016/j.jad.2018.11.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/25/2018] [Accepted: 11/03/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Increased circulating inflammatory cytokines is a replicated finding in bipolar I disorder (BDI). Pro-inflammatory cytokines such as TNFα, IL-6 and IL-1 have also been associated with poorer cognitive functioning in patients with longer illness duration. However, the effect of inflammatory cytokines on cognition in early stage patients is not yet known. Here, we investigate the relationship between cytokines and cognition in BDI patients within three years of diagnosis. METHODS Serum pro-inflammatory (TNFα, IL-6 and IL-1α) and anti-inflammatory (IL-4 and IL-10) cytokine levels were compared between 51 early stage BDI patients and 20 healthy controls. 46 patients completed neuropsychological testing, and multiple regression analysis was used to assess the association between cytokine levels and cognition after accounting for relevant clinical and demographic variables. RESULTS TNFα was elevated at trend level significance in BDI patients compared to healthy controls, and was negatively associated with global cognition, processing speed, and working memory in patients. IL-6, IL-1α, IL-4 and IL-10 levels were comparable between groups and were not significantly associated with cognition. LIMITATIONS Direct causation cannot be established in this cross-sectional study; in addition, cytokine levels were not taken on the same day as neuropsychological testing for all patients. CONCLUSIONS TNFα may negatively impact cognition in early BDI. While replication is required in larger samples, these results suggest that inhibition of TNFα activity might be a strategy to preserve cognition in newly diagnosed BDI patients.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Room 2C7-2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Room 2C7-2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - David J Bond
- University of Minnesota Medical School, F282/2A West Building, 2450 Riverside Avenue South, Minneapolis, MN 55454, United States
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Room 2C7-2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
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Deng W, Zhang B, Zou W, Zhang X, Cheng X, Guan L, Lin Y, Lao G, Ye B, Li X, Yang C, Ning Y, Cao L. Abnormal Degree Centrality Associated With Cognitive Dysfunctions in Early Bipolar Disorder. Front Psychiatry 2019; 10:140. [PMID: 30949078 PMCID: PMC6435527 DOI: 10.3389/fpsyt.2019.00140] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
Delayed diagnosis of bipolar disorder (BD) is common. However, diagnostic validity may be enhanced using reliable neurobiological markers for BD. Degree centrality (DC) is one such potential marker that enables researchers to visualize neuronal network abnormalities in the early stages of some neuropsychiatric disorders. In the present study, we measured resting-state DC abnormalities and cognitive deficits in order to identify early neurobiological markers for BD. We recruited 23 patients with BD who had recently experienced manic episodes (duration of illness <2 years) and 46 matched healthy controls. Our findings indicated that patients with BD exhibited DC abnormalities in frontal areas, temporal areas, the right postcentral gyrus, and the posterior lobe of the cerebellum. Moreover, correlation analysis revealed that psychomotor speed indicators were associated with DC in the superior temporal and inferior temporal gyri, while attention indicators were associated with DC in the inferior temporal gyrus, in patients with early BD. Our findings suggest that DC abnormalities in neural emotion regulation circuits are present in patients with early BD, and that correlations between attention/psychomotor speed deficits and temporal DC abnormalities may represent early markers of BD.
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Affiliation(s)
- Wenhao Deng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjin Zou
- Department of Radiology, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaofei Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiongchao Cheng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijie Guan
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yin Lin
- Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohui Lao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Biyu Ye
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuan Li
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chanjuan Yang
- Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Mental Health Institute, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Cao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Vlad M, Raucher-Chéné D, Henry A, Kaladjian A. Functional outcome and social cognition in bipolar disorder: Is there a connection? Eur Psychiatry 2018; 52:116-125. [PMID: 29787961 DOI: 10.1016/j.eurpsy.2018.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Interest in social cognition in bipolar disorder (BD) has increased considerably over the past decade, with studies highlighting major impairments, especially in mental state reasoning, even during euthymia. A causal relationship between social cognition deficits and social functioning has already been established in individuals with schizophrenia, but there is still little information about links between social cognition and social functioning in BD. Our aim was therefore to review the relationship between functional outcome and social cognition in patients with BD. METHODS We conducted a systematic review of the literature. Relevant articles were identified through literature searches in the MEDLINE/PubMed, EBSCOHost and Google Scholar databases for the years 2000-2017, using the keywords bipolar, social cognition, theory of mind, mentalizing, emotion recognition, emotion processing, and functioning. A total of 20 studies met our inclusion/exclusion criteria. RESULTS We found that functioning was significantly correlated with three domains of social cognition (ToM, emotion processing, and attribution bias). Twelve of 13 studies reported a correlation with emotion processing, but a correlation with ToM was only found in three of the 11 studies that assessed it. Six studies found an effect of depressive symptoms on emotion processing and no significant association was found with manic symptomatology. CONCLUSIONS To the best of our knowledge, the present review is the first to specifically explore the relationship between social cognition and social functioning in patients with BD. This exploration is of interest, as it enhances current understanding of this disorder and, by so doing, should improve patient outcomes.
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Affiliation(s)
- Maria Vlad
- Psychiatry Department, University Hospital, Reims, France
| | - Delphine Raucher-Chéné
- Psychiatry Department, University Hospital, Reims, France; Cognition, Health & Society (C2S - EA 6291) Laboratory, University of Reims Champagne-Ardenne, Reims, France.
| | - Audrey Henry
- Psychiatry Department, University Hospital, Reims, France; Cognition, Health & Society (C2S - EA 6291) Laboratory, University of Reims Champagne-Ardenne, Reims, France
| | - Arthur Kaladjian
- Psychiatry Department, University Hospital, Reims, France; Cognition, Health & Society (C2S - EA 6291) Laboratory, University of Reims Champagne-Ardenne, Reims, France; Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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Coppola F, Courtet P, Olié E. [Neuropsychological Profile and Working Memory in Bipolar Disorder]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:314-321. [PMID: 29186974 PMCID: PMC5912298 DOI: 10.1177/0706743717744777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
According to the World Health Organization (WHO), the bipolar disorder is one of the ten costliest and most incapacitating diseases in the world. Management of this pathology usually involves a psychiatric follow-up at a pace adapted to the thymic state, and the initiating of a mood-stabilizing treatment. However, what will become of patients with bipolar disorder remains unsatisfying. Psychosocial impacts, increased by often present physical and psychological comorbidities are important (Bonnin et al., 2010) and can be incapacitating: socioprofessional deintegration, social withdrawal, family-related repercussions, low socioeconomic status, lesser quality of life. A functional impairment is found in acute decompensation phases, but also in intercritical periods where different factors might be involved: thymic or cognitive residual symptomatology, as episode consequences, presence of comorbidities…Actually, in this stage of the disease, 30% of bipolar patients present cognitive impairments, that neuropsychological testing can objectify (Gualtieri and Morgan, 2008). Almost 2 thirds present subjective cognitive complaints (Martinez-Aran et al., 2005) that are negatively correlated with quality of life. Among these impairments, harm to working memory is reported in several studies (Bora et al., 2009; Robinson et al., 2006), and seems to play a leading role in functional impairment. Managing cognitive impairments seems an important issue to improve patient functioning, quality of life and disorder stability. However, cognitive remediation techniques, largely developed for patients with schizophrenia, remain limited in bipolar disorder, in spite of the great impact of cognitive impairments in this disorder. This objective of this article was an update on bipolar patient neuropsychological profile in an intercritical period, while putting forward working memory critical role in functional impairment. We will also discuss current therapeutic advances allowing to manage these impairments and improve patient functioning.
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Affiliation(s)
- Frédéric Coppola
- 1 Département Urgences et Post-Urgences Psychiatriques, Montpellier, France
| | - Philippe Courtet
- 1 Département Urgences et Post-Urgences Psychiatriques, Montpellier, France.,2 INSERM U1061, Université-Montpellier, Montpellier, France
| | - Emilie Olié
- 1 Département Urgences et Post-Urgences Psychiatriques, Montpellier, France.,2 INSERM U1061, Université-Montpellier, Montpellier, France
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18
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Szmulewicz AG, Valerio MP, Lomastro J, Smith JM, Chiappe V, Martino DJ, Igoa A. Neurocognitive functioning in first-episode Bipolar Disorder: Relationship with functional status. J Affect Disord 2018; 228:97-100. [PMID: 29245093 DOI: 10.1016/j.jad.2017.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/18/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to assess if an association between neurocognitive deficits and psychosocial functioning exists in first-episode BD patients. METHODS Twenty-five euthymic first-episode BD patients and thirty-seven healthy controls were recruited. History of suicide attempts, psychiatric comorbidities, pharmacological exposure, and previous depressive episodes were investigated. Performances on neurocognitive domains (verbal memory, attention, processing speed, and executive functions) as well as a measure of psychosocial functioning were used as outcomes. RESULTS First-episode BD patients showed medium-to-large size deficits on measures of attention, processing speed, and executive functions. A significant association between verbal memory and psychosocial functioning at the moment of BD diagnosis was detected (beta coefficient -3.9, IC 95% -6.7 to -1.2, p < 0.01). CONCLUSIONS A relationship between cognitive performance at the moment of BD diagnosis and psychosocial functioning was detected. Possible therapeutic implications of this finding are discussed.
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Affiliation(s)
- Alejandro G Szmulewicz
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
| | - Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Julieta Lomastro
- Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - José M Smith
- Psychiatric Department, Medical Education and Clinical Research Center Norberto Quirno, CEMIC, Buenos Aires, Argentina
| | - Virginia Chiappe
- Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Ana Igoa
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
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19
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Wu MJ, Mwangi B, Passos IC, Bauer IE, Cao B, Frazier TW, Zunta-Soares GB, Soares JC. Prediction of vulnerability to bipolar disorder using multivariate neurocognitive patterns: a pilot study. Int J Bipolar Disord 2017; 5:32. [PMID: 28861763 PMCID: PMC5578943 DOI: 10.1186/s40345-017-0101-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/19/2017] [Indexed: 12/03/2022] Open
Abstract
Bipolar disorder (BD) is a common disorder with high reoccurrence rate in general population. It is critical to have objective biomarkers to identify BD patients at an individual level. Neurocognitive signatures including affective Go/No-go task and Cambridge Gambling task showed the potential to distinguish BD patients from health controls as well as identify individual siblings of BD patients. Moreover, these neurocognitive signatures showed the ability to be replicated at two independent cohorts which indicates the possibility for generalization. Future studies will examine the possibility of combining neurocognitive data with other biological data to develop more accurate signatures.
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Affiliation(s)
- Mon-Ju Wu
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA. .,Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, TX, 77054, USA.
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Ives Cavalcante Passos
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Isabelle E Bauer
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Bo Cao
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Thomas W Frazier
- Cleveland Clinic Children's Hospital Center for Pediatric Behavioral Health, Cleveland, OH, USA
| | - Giovana B Zunta-Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
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Elias LR, Miskowiak KW, Vale AMO, Köhler CA, Kjærstad HL, Stubbs B, Kessing LV, Vieta E, Maes M, Goldstein BI, Carvalho AF. Cognitive Impairment in Euthymic Pediatric Bipolar Disorder: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry 2017; 56:286-296. [PMID: 28335872 DOI: 10.1016/j.jaac.2017.01.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/21/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of studies investigating neurocognition in euthymic youths with bipolar disorder (BD) compared to healthy controls (HCs). METHOD A systematic literature search was conducted in the PubMed/MEDLINE, PsycINFO, and EMBASE databases from inception up until March 23, 2016, for original peer-reviewed articles that investigated neurocognition in euthymic youths with BD compared to HCs. Effect sizes (ES) for individual tests were extracted. In addition, results were grouped according to cognitive domain. This review complied with the PRISMA statement guidelines. RESULTS A total of 24 studies met inclusion criteria (N = 1,146; 510 with BD). Overall, euthymic youths with BD were significantly impaired in verbal learning, verbal memory, working memory, visual learning, and visual memory, with moderate to large ESs (Hedge's g 0.76-0.99); significant impairments were not observed for attention/vigilance, reasoning and problem solving, and/or processing speed. Heterogeneity was moderate to large (I2 ≥ 50%) for most ES estimates. Differences in the definition of euthymia across studies explained the heterogeneity in the ES estimate for verbal learning and memory. We also found evidence for other potential sources of heterogeneity in several ES estimates including co-occurring attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders, and the use of medications. In addition, the use of different neuropsychological tests appeared to contribute to heterogeneity of some estimates (e.g., attention/vigilance domain). CONCLUSION Euthymic youths with BD exhibit significant cognitive dysfunction encompassing verbal learning and memory, working memory, and/or visual learning and memory domains. These data indicate that for a subset of individuals with BD, neurodevelopmental factors may contribute to cognitive dysfunction.
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Affiliation(s)
- Liana R Elias
- Translational Psychiatry Research Group Federal University of Ceará, Fortaleza, CE, Brazil
| | - Kamilla W Miskowiak
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Antônio M O Vale
- Translational Psychiatry Research Group Federal University of Ceará, Fortaleza, CE, Brazil
| | - Cristiano A Köhler
- Translational Psychiatry Research Group Federal University of Ceará, Fortaleza, CE, Brazil
| | - Hanne L Kjærstad
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK, and South London and Maudsley National Health Service Foundation Trust, Denmark Hill, London
| | - Lars V Kessing
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eduard Vieta
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro para la Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Michael Maes
- Chulalongkorn University, Bangkok, Thailand, and IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - André F Carvalho
- Translational Psychiatry Research Group Federal University of Ceará, Fortaleza, CE, Brazil.
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Abstract
BACKGROUND Verbal memory (VM) impairment is prominent in bipolar disorder (BD) and is linked to functional outcomes. However, the intricacies of VM impairment have not yet been studied in a large sample of BD patients. Moreover, some have proposed VM deficits that may be mediated by organizational strategies, such as semantic or serial clustering. Thus, the exact nature of VM break-down in BD patients is not well understood, limiting remediation efforts. We investigated the intricacies of VM deficits in BD patients versus healthy controls (HCs) and examined whether verbal learning differences were mediated by use of clustering strategies. METHODS The California Verbal Learning Test (CVLT) was administered to 113 affectively stable BD patients and 106 HCs. We compared diagnostic groups on all CVLT indices and investigated whether group differences in verbal learning were mediated by clustering strategies. RESULTS Although BD patients showed significantly poorer attention, learning, and memory, these indices were only mildly impaired. However, BD patients evidenced poorer use of effective learning strategies and lower recall consistency, with these indices falling in the moderately impaired range. Moreover, relative reliance on semantic clustering fully mediated the relationship between diagnostic category and verbal learning, while reliance on serial clustering partially mediated this relationship. CONCLUSIONS VM deficits in affectively stable bipolar patients were widespread but were generally mildly impaired. However, patients displayed inadequate use of organizational strategies with clear separation from HCs on semantic and serial clustering. Remediation efforts may benefit from education about mnemonic devices or "chunking" techniques to attenuate VM deficits in BD. (JINS, 2017, 23, 358-366).
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22
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Yatham LN, Mackala S, Basivireddy J, Ahn S, Walji N, Hu C, Lam RW, Torres IJ. Lurasidone versus treatment as usual for cognitive impairment in euthymic patients with bipolar I disorder: a randomised, open-label, pilot study. Lancet Psychiatry 2017; 4:208-217. [PMID: 28185899 DOI: 10.1016/s2215-0366(17)30046-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cognitive impairment is present in euthymic patients with bipolar disorder and correlates with impairments in everyday functioning. We aimed to examine the efficacy of lurasidone adjunctive therapy compared with treatment as usual (TAU) in improving cognition. METHODS For this randomised, open-label, pilot study, we recruited patients aged 19-65 years with euthymic bipolar I disorder from the Mood Disorder Centre in UBC Hospital (Vancouver, Canada). We included patients who were taking lithium, or valproate, or an atypical antipsychotic, or a combination of these for mood stabilisation and who showed reduced cognitive functioning (SD≤ -0·25 relative to demographics-corrected norms) on either the Trail Making Test-B or the California Verbal Learning Test-II. Patients were randomly assigned using a randomised block design with a block size of four to TAU or lurasidone adjunctive therapy (20-80 mg/day) for 6 weeks. A research coordinator masked to group allocation administered the International Society for Bipolar Disorders Battery for Assessment of Neurocognition (ISBD-BANC) at baseline and at endpoint. The primary outcome was change in global cognition score, which consisted of the mean demographics-corrected t-score value of the several ISBD-BANC measures, analysed in all patients who completed both tests. This trial is registered on ClinicalTrials.gov, number NCT02147379. FINDINGS Between July 2, 2014, and Oct 19, 2015, 34 patients were randomly allocated to lurasidone adjunctive therapy (17 patients) or TAU (17 patients). Two patients from each group did not complete the study. The mean lurasidone dose was 48·24 (SD 15·90) mg/day. Lurasidone adjunctive therapy was more effective than TAU in improving the primary efficacy measure of ISBD-BANC global cognition score (mean difference 2·92 [95% CI 0·27-5·57]; time × treatment interaction F=5·09; p=0·032). The between-group effect size (0·82) on baseline versus study-end difference scores in the ISBD global cognition score was of moderate to large magnitude. The magnitude of benefit with lurasidone adjunctive therapy in improving global cognition (effect size 0·46) was greater compared with the improvement observed in the TAU group (0·04). Adverse events were reported by nine (60%) patients in the luradisone group and two (13%) in the TAU group. INTERPRETATION Our results provide some preliminary evidence for the efficacy of lurasidone in improving cognition in euthymic patients with bipolar I disorder. The strengths of this study were the characterisation of the sample and use of tests sensitive to cognitive impairment in bipolar disorder. Its limitations were the sample size and inability to completely control for other medication use. Larger double-blind trials are warranted to investigate this further. FUNDING Sumitomo Dainippon Pharma.
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Affiliation(s)
- Lakshmi N Yatham
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada.
| | - Sylvia Mackala
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
| | - Jayasree Basivireddy
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
| | - Sharon Ahn
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
| | - Nazlin Walji
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
| | - Chen Hu
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, BC, Canada
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23
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Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder: A naturalistic study. J Affect Disord 2017; 208:521-527. [PMID: 27816324 DOI: 10.1016/j.jad.2016.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/30/2016] [Accepted: 10/22/2016] [Indexed: 11/23/2022]
Abstract
AIM In a naturalistic clinical study of patients in the early stages of bipolar disorders the aim was to assess differences between patients with bipolar I (BD I) and bipolar II (BD II) disorders on clinical characteristics including affective symptoms, subjective cognitive complaints, functional level, the presence of comorbid personality disorders and coping strategies. METHODS Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status using the Functional Assessment Short Test. Cognitive complaints were assessed using the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, the presence of comorbid personality disorders using the Standardized Assessment of Personality - Abbreviated Scale and coping style using the Coping Inventory for Stressful Situations. RESULTS In total, 344 patients were included (BD I (n=163) and BD II (n=181). Patients with BD II presented with significantly more depressive symptoms, more cognitive complaints, lower overall functioning, and a higher prevalence of comorbid personality disorders. Finally, they exhibited a trend towards using less adaptive coping styles. LIMITATION It cannot be omitted that some patients may have progressed from BD II to BD I. Most measures were based on patient self report. CONCLUSIONS Overall, BD II was associated with a higher disease burden. Clinically, it is important to differentiate BD II from BD I and research wise, there is a need for tailoring and testing specific interventions towards BD II.
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Daglas R, Allott K, Yücel M, Pantelis C, Macneil CA, Berk M, Cotton SM. The trajectory of cognitive functioning following first episode mania: A 12-month follow-up study. Aust N Z J Psychiatry 2016; 50:1186-1197. [PMID: 26698823 DOI: 10.1177/0004867415622272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cognitive deficits are apparent in the early stages of bipolar disorder; however, the timing and trajectory of cognitive functioning following a first episode of mania remains unclear. The aim of this study was to assess the trajectory of cognitive functioning in people following a first episode of mania over a 12-month period, relative to healthy controls. METHOD The cohort included 61 participants who had recently stabilised from a first treated manic episode, and 21 demographically similar healthy controls. These groups were compared on changes observed over time using an extensive cognitive battery, over a 12-month follow-up period. RESULTS A significant group by time interaction was observed in one measure of processing speed (Trail Making Test - part A,) and immediate verbal memory (Rey Auditory Verbal Learning Test - trial 1), with an improved performance in people following a first episode of mania relative to healthy controls. On the contrary, there was a significant group by time interaction observed on another processing speed task pertaining to focussed reaction time (Go/No-Go, missed go responses), with first episode of mania participants performing significantly slower in comparison with healthy controls. Furthermore, a significant group by time interaction was observed in inhibitory effortful control (Stroop effect), in which healthy controls showed an improvement over time relative to first episode of mania participants. There were no other significant interactions of group by time related to other measures of cognition over the 12-month period. CONCLUSION Our findings revealed cognitive change in processing speed, immediate memory and one measure of executive functioning over a 12-month period in first episode of mania participants relative to healthy controls. There was no evidence of change over time for all other cognitive domains. Further studies focussed on the at-risk period, subgroup analysis, and the effects of medication on the cognitive trajectory following first episode of mania are needed.
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Affiliation(s)
- Rothanthi Daglas
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia .,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Murat Yücel
- Brain & Mental Health Laboratory (BMH), School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia
| | | | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia.,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,Barwon Health and the Geelong Clinic, Swanston Centre, Geelong, VIC, Australia
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Fornaro M, Nardi AE, De Berardis D, Carta MG. Experimental drugs for bipolar psychosis. Expert Opin Investig Drugs 2016; 25:1371-1375. [DOI: 10.1080/13543784.2016.1256390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review. Int J Bipolar Disord 2016; 4:19. [PMID: 27613276 PMCID: PMC5017982 DOI: 10.1186/s40345-016-0060-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/30/2016] [Indexed: 12/15/2022] Open
Abstract
Background We aimed to investigate a key element of the early intervention approach; whether treatment at an earlier stage of bipolar disorder is more effective than later in its course. Methods A comprehensive literature review using Medline, Embase, Psychinfo, PsycArticle and Web of Science as data sources, with a subsequent narrative synthesis. Study quality was assessed using the Cochrane risk of bias method. Results Our search strategy yielded eight primary papers and two meta-analyses (of psychological therapies and Olanzapine) in total representing 8942 patients. Five studies focused on comparisons between first and multiple episode; the others on fewer vs more episode categories. There was a consistent finding suggesting treatment in earlier illness stage resulted in better outcomes in terms of response, relapse rate, time to recurrence, symptomatic recovery, remission, psychosocial functioning and employment. This effect was found for pharmacological (Lithium, Olanzapine, Divalproex) and psychological treatment. Limitations There was high risk of selection, performance and attrition bias in most studies. First admission or presentation is unlikely to equate to first episode because of duration of untreated illness. Some patients having experienced multiple episodes could be “treatment resistant”. Study heterogeneity precluded meta-analysis. Conclusions Psychological and pharmacological treatment in the early stages of illness is more effective than in later stages of bipolar disorder across multiple domains. There is a first episode and early phase effect. Consistent with the staging model of illness findings provide evidence for the clinical utility of an early intervention approach in bipolar disorder to improve patient outcomes.
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Douglas KM, Van Rheenen TE. Current Treatment Options for Cognitive Impairment in Bipolar Disorder: a Review. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40501-016-0092-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Griffiths KR, Lagopoulos J, Hermens DF, Lee RSC, Guastella AJ, Hickie IB, Balleine BW. Impaired causal awareness and associated cortical-basal ganglia structural changes in youth psychiatric disorders. NEUROIMAGE-CLINICAL 2016; 12:285-92. [PMID: 27551665 PMCID: PMC4983644 DOI: 10.1016/j.nicl.2016.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/11/2016] [Accepted: 06/22/2016] [Indexed: 02/06/2023]
Abstract
Background Cognitive impairments contribute significantly to disease burden in young individuals presenting with major psychiatric disorders. The capacity to encode the consequences of one's actions may be of particular importance for real-world functioning due to its fundamental role in goal-directed behavior. Methods Here, we investigated a dimensional measure of causal awareness during a probabilistic learning task in 92 young individuals with an admixture of major mood and psychotic illnesses, at early and more established stages. Using automated gray matter segmentation of T1-weighted images, we estimated the volume and shapes of major subcortical structures and investigated their association with causal awareness. Results The low causal awareness (LCA) group (n = 35) reported increased social disability (p = .004) and reduced right pallidal size, specifically within the dorsolateral surfaces (p = .02), relative to the unimpaired high causal awareness (HCA) patients (n = 57). In early-stage illness, LCA had a smaller right thalamus (p = .002) relative to HCA. Exploratory investigations suggested that in developed psychotic syndromes, causal awareness was correlated with left hippocampal size (p = .006) whereas, in more persistent affective disorders, causal awareness was correlated with left amygdala size (p = .013), specifically within the anterior aspect. Discussion Low causal awareness occurs across diagnoses and stages of illness and is associated with poor functional outcomes. Our results suggest that there may be shared neural underpinnings of its dysfunction in the early course of mood and psychotic disorders, however in more established illness, there is greater neurobiological divergence in causal awareness correlates between diagnoses. Impaired awareness of causal relationships occurs trans-diagnostically. Participants with low causal awareness have poorer functional outcomes. Low causal awareness was associated with reduced right pallidal size Low causal awareness was associated with a lateralized limbic-pallidal circuit. Results suggest common neural dysfunction in early mood and psychotic disorders.
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Affiliation(s)
| | | | | | - Rico S C Lee
- Brain and Mind Centre, University of Sydney, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Australia
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Torres IJ, Mackala SA, Kozicky JM, Yatham LN. Metacognitive knowledge and experience in recently diagnosed patients with bipolar disorder. J Clin Exp Neuropsychol 2016; 38:730-44. [PMID: 27144722 DOI: 10.1080/13803395.2016.1161733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Metacognition, which refers to an individual's ability to assess their own cognitive ability or performance, is poorly understood in bipolar disorder. This study was conducted to evaluate two aspects of metacognitive ability in recently diagnosed patients with bipolar disorder: (a) metacognitive knowledge, pertaining to awareness of one's own general cognitive functioning; and (b) metacognitive experience, referring to awareness of one's cognitive performance on a specific, online cognitive task. METHOD Participants consisted of 50 clinically euthymic patients recently diagnosed with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) bipolar I disorder who were within three months of resolution of their first manic episode, and a comparison group of 38 demographically similar healthy volunteers. To assess metacognitive knowledge, participants provided a general rating of their estimated cognitive ability prior to completing a neuropsychological battery, and self-ratings were compared to actual ability based on a composite score of overall cognitive functioning. To assess metacognitive experience, subjects provided a postdiction rating of their perceived memory performance after completing a list learning verbal memory test, and self-ratings were compared to actual memory performance. Measures of both relative and absolute accuracy of ratings were obtained. RESULTS Results indicated that patients showed diminished accuracy in rating their general cognitive ability, implying deficits in metacognitive knowledge. In contrast, patients were accurate in rating their online memory performance, suggesting intact metacognitive experience. CONCLUSIONS Findings suggest that in patients with bipolar disorder, intact task-specific cognitive self-appraisals may fail to generalize to or to modify inaccurate global cognitive self-appraisals. Further research using more comprehensive metacognitive tasks is warranted in bipolar disorder.
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Affiliation(s)
- Ivan J Torres
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.,b BC Psychosis Program: British Columbia Mental Health and Substance Use Services , Vancouver , BC , Canada
| | - Sylvia A Mackala
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Jan-Marie Kozicky
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Lakshmi N Yatham
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
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Tan D, Özerdem A, Güntekin B, Atagün MI, Tülay E, Karadağ F, Başar E. Increased Beta Frequency (15-30 Hz) Oscillatory Responses in Euthymic Bipolar Patients Under Lithium Monotherapy. Clin EEG Neurosci 2016; 47:87-95. [PMID: 25465436 DOI: 10.1177/1550059414561056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
The effect of lithium on neurocognition is not still fully explored. Brain oscillatory activity is altered in bipolar disorder. We aimed to assess the oscillatory responses of euthymic bipolar patients and how they are affected by lithium monotherapy. Event-related oscillations in response to visual target stimulus during an oddball paradigm in 16 euthymic drug-free and 13 euthymic lithium-treated bipolar patients were compared with 16 healthy controls. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta (15-30 Hz) responses in the 0- to 300-ms time window over frontal (F3, Fz, F4), central (C3, Cz, C4), temporal (T7, T8), temporo-parietal (TP7, TP8), parietal (P3, Pz, P4), and occipital (O1, Oz, O2) areas. Patients under lithium monotherapy had significantly higher beta responses to visual target stimuli than healthy controls (P=.017) and drug-free patients (P=.015). The increase in beta response was observed at all electrode locations, however, the difference was statistically significant for the left (T7; P=.016) and right (T8; P=.031) temporal beta responses. Increased beta responses in drug-free patients and further significant increase in lithium-treated patients may be indicative of a core pathophysiological process of bipolar disorder and how it is affected by lithium. Whether the finding corresponds to lithium's corrective effect on the underlying pathology or to its neurocognitive side effect remains to be further explored. In either case, the finding is a sign that the oscillatory activity may be useful in tracking medication effect in bipolar disorder.
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Affiliation(s)
- Devran Tan
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Ayşegül Özerdem
- Department of Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey Department of Neuroscience, Dokuz Eylul University Health Sciences Institute, Izmir, Turkey Multidisciplinary Brain Dynamics Research Center, Dokuz Eylul University, Izmir, Turkey
| | - Bahar Güntekin
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - M Ilhan Atagün
- Department of Psychiatry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Elif Tülay
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - Figen Karadağ
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Erol Başar
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
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Demmo C, Lagerberg TV, Aminoff SR, Hellvin T, Kvitland LR, Simonsen C, Andreassen OA, Melle I, Ueland T. History of psychosis and previous episodes as potential explanatory factors for neurocognitive impairment in first-treatment bipolar I disorder. Bipolar Disord 2016; 18:136-47. [PMID: 26990158 DOI: 10.1111/bdi.12377] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 12/08/2015] [Accepted: 12/30/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Explanatory factors for the observed neurocognitive impairment in early-stage bipolar I disorder (BD-I) have received little attention. The current study investigated neurocognitive functioning in first-treatment (FT) BD-I compared to FT schizophrenia (SCZ), and healthy controls (HCs), and the effect of history of psychosis and previous episodes in the two clinical groups. METHODS A total of 202 FT patients with BD-I (n = 101) and SCZ spectrum disorder (n = 101), in addition to HCs (n = 101), were included. A comprehensive neurocognitive test battery was used to assess verbal learning and memory, executive functioning, processing speed, and attention and working memory. Neurocognitive functioning and the effect of history of psychosis and number of previous episodes were analyzed using separate multivariate analyses of variance and correlation analysis. RESULTS FT patients with BD-I performed intermediately between FT SCZ spectrum patients and HCs on all measures. Compared to HCs, FT BD-I showed impaired functioning across all neurocognitive domains. No differences in neurocognitive functioning were observed in psychotic versus nonpsychotic FT patients with BD-I. With the exception of an association between number of manic episodes and two measures of executive function in FT BD-I, no associations were found between number of episodes and neurocognitive performance. CONCLUSIONS Neurocognitive impairments were present in FT BD-I, and were not explained by history of psychosis or number of previous psychotic or depressive episodes. There were indications that executive function could be associated with number of previous manic episodes.
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Affiliation(s)
- Christine Demmo
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sofie R Aminoff
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Specialized Inpatient Treatment, Division of Mental Health Services, Akershus University Hospital, Oslo, Norway
| | - Tone Hellvin
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Levi R Kvitland
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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Wu MJ, Passos IC, Bauer IE, Lavagnino L, Cao B, Zunta-Soares GB, Kapczinski F, Mwangi B, Soares JC. Individualized identification of euthymic bipolar disorder using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and machine learning. J Affect Disord 2016; 192:219-25. [PMID: 26748737 PMCID: PMC4727980 DOI: 10.1016/j.jad.2015.12.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/17/2015] [Accepted: 12/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have reported that patients with bipolar disorder (BD) present with cognitive impairments during mood episodes as well as euthymic phase. However, it is still unknown whether reported neurocognitive abnormalities can objectively identify individual BD patients from healthy controls (HC). METHODS A total of 21 euthymic BD patients and 21 demographically matched HC were included in the current study. Participants performed the computerized Cambridge Neurocognitive Test Automated Battery (CANTAB) to assess cognitive performance. The least absolute shrinkage selection operator (LASSO) machine learning algorithm was implemented to identify neurocognitive signatures to distinguish individual BD patients from HC. RESULTS The LASSO machine learning algorithm identified individual BD patients from HC with an accuracy of 71%, area under receiver operating characteristic curve of 0.7143 and significant at p=0.0053. The LASSO algorithm assigned individual subjects with a probability score (0-healthy, 1-patient). Patients with rapid cycling (RC) were assigned increased probability scores as compared to patients without RC. A multivariate pattern of neurocognitive abnormalities comprising of affective Go/No-go and the Cambridge gambling task was relevant in distinguishing individual patients from HC. LIMITATIONS Our study sample was small as we only considered euthymic BD patients and demographically matched HC. CONCLUSION Neurocognitive abnormalities can distinguish individual euthymic BD patients from HC with relatively high accuracy. In addition, patients with RC had more cognitive impairments compared to patients without RC. The predictive neurocognitive signature identified in the current study can potentially be used to provide individualized clinical inferences on BD patients.
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Affiliation(s)
- Mon-Ju Wu
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Ives Cavalcante Passos
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA,Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Isabelle E. Bauer
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Luca Lavagnino
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Bo Cao
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Giovana B. Zunta-Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Flávio Kapczinski
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA,Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA.
| | - Jair C. Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
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Boland EM, Stange JP, Molz Adams A, LaBelle DR, Ong ML, Hamilton JL, Connolly SL, Black CL, Cedeño AB, Alloy LB. Associations between sleep disturbance, cognitive functioning and work disability in Bipolar Disorder. Psychiatry Res 2015; 230:567-74. [PMID: 26474660 PMCID: PMC4655200 DOI: 10.1016/j.psychres.2015.09.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 08/05/2015] [Accepted: 09/30/2015] [Indexed: 01/18/2023]
Abstract
Bipolar Disorder (BD) is associated with impairment in a number of areas including poor work functioning, often despite the remission of mood symptoms. The present study aimed to examine the role of sleep disturbance and cognitive functioning in occupational impairment in BD. Twenty-four euthymic BD participants and 24 healthy control participants completed a week of prospective assessment of sleep disruption via self-report and actigraphy, a battery of neuropsychological tests of executive functioning, working memory, and verbal learning, and assessments of work functioning. BD participants experienced significantly poorer cognitive functioning as well as greater months of unemployment and greater incidence of being fired than controls. Moderation analyses revealed that both poor sleep and cognitive functioning were associated with poor work performance in BD participants, but not control participants. Sleep and cognitive functioning may be impaired in euthymic BD and are associated with poor work functioning in this population. More research should be conducted to better understand how sleep and cognitive functioning may interact in BD.
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Affiliation(s)
- Elaine M Boland
- Mental Illness Research Education and Clinical Centers, Corporal Michael J. Crescenz Veterans Affairs Medical Center and the University of Pennsylvania School of Medicine Behavioral Health Service and Department of Psychiatry, Philadelphia, PA, USA.
| | | | | | - Denise R LaBelle
- Temple University Department of Psychology, Philadelphia, PA, USA
| | - Mian-Li Ong
- University of North Carolina, Chapel Hill Department of Psychology, Chapel Hill, NC, USA
| | | | | | - Chelsea L Black
- Temple University Department of Psychology, Philadelphia, PA, USA
| | - Angelo B Cedeño
- Temple University Department of Psychology, Philadelphia, PA, USA
| | - Lauren B Alloy
- Temple University Department of Psychology, Philadelphia, PA, USA
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Baune BT, Malhi GS. A review on the impact of cognitive dysfunction on social, occupational, and general functional outcomes in bipolar disorder. Bipolar Disord 2015; 17 Suppl 2:41-55. [PMID: 26688289 DOI: 10.1111/bdi.12341] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/25/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Bipolar disorder (BD) is associated with significant impairment in cognitive performance across multiple domains of function that often persist after clinical recovery. It remains unclear, however, as to whether this process is related to the clinical status of BD being depressed, manic/hypomanic, or euthymic. In this review, we examine the literature on the cross-sectional and longitudinal relationships between cognitive function and general function depending on the clinical phase of BD. METHODS A systematic review of original research that studied both cognitive function and general function in adults (18-60 years), restricted to BD, was conducted in a total of 18 studies meeting inclusion/exclusion criteria. RESULTS Results show cross-sectional and prospective relationships between cognitive function and general function in patients with BD in both symptomatic and euthymic patients with BD. While studies using general measures of function (e.g., Global Assessment of Function scale) show more inconsistent associations with cognitive function, those employing assessments of domain specific function, suggest a consistent relationship between social and occupational function and cognitive performance. Executive function is commonly affected by cognitive deficits in these patients, but in addition a variety of domains show associations with functional outcomes (e.g., social function, occupational function). Notably, the emerging evidence suggests that cognitive function may be a better predictor of future general function than affective symptom severity. CONCLUSIONS Despite some inconsistencies, in sum the literature on the relationship between cognitive function and general function in BD implicates both cross-sectional and longitudinal associations, both in symptomatic and euthymic patients with BD. And in terms of capturing these changes functional scales in particular domain-specific measures seem superior to general measures.
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Affiliation(s)
- Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.,Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Logan RW, McClung CA. Animal models of bipolar mania: The past, present and future. Neuroscience 2015; 321:163-188. [PMID: 26314632 DOI: 10.1016/j.neuroscience.2015.08.041] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 12/19/2022]
Abstract
Bipolar disorder (BD) is the sixth leading cause of disability in the world according to the World Health Organization and affects nearly six million (∼2.5% of the population) adults in the United State alone each year. BD is primarily characterized by mood cycling of depressive (e.g., helplessness, reduced energy and activity, and anhedonia) and manic (e.g., increased energy and hyperactivity, reduced need for sleep, impulsivity, reduced anxiety and depression), episodes. The following review describes several animal models of bipolar mania with a focus on more recent findings using genetically modified mice, including several with the potential of investigating the mechanisms underlying 'mood' cycling (or behavioral switching in rodents). We discuss whether each of these models satisfy criteria of validity (i.e., face, predictive, and construct), while highlighting their strengths and limitations. Animal models are helping to address critical questions related to pathophysiology of bipolar mania, in an effort to more clearly define necessary targets of first-line medications, lithium and valproic acid, and to discover novel mechanisms with the hope of developing more effective therapeutics. Future studies will leverage new technologies and strategies for integrating animal and human data to reveal important insights into the etiology, pathophysiology, and treatment of BD.
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Affiliation(s)
- R W Logan
- University of Pittsburgh School of Medicine, Department of Psychiatry, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, United States
| | - C A McClung
- University of Pittsburgh School of Medicine, Department of Psychiatry, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, United States.
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van Enkhuizen J, Geyer MA, Minassian A, Perry W, Henry BL, Young JW. Investigating the underlying mechanisms of aberrant behaviors in bipolar disorder from patients to models: Rodent and human studies. Neurosci Biobehav Rev 2015; 58:4-18. [PMID: 26297513 DOI: 10.1016/j.neubiorev.2015.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/03/2015] [Accepted: 08/16/2015] [Indexed: 11/18/2022]
Abstract
Psychiatric patients with bipolar disorder suffer from states of depression and mania, during which a variety of symptoms are present. Current treatments are limited and neurocognitive deficits in particular often remain untreated. Targeted therapies based on the biological mechanisms of bipolar disorder could fill this gap and benefit patients and their families. Developing targeted therapies would benefit from appropriate animal models which are challenging to establish, but remain a vital tool. In this review, we summarize approaches to create a valid model relevant to bipolar disorder. We focus on studies that use translational tests of multivariate exploratory behavior, sensorimotor gating, decision-making under risk, and attentional functioning to discover profiles that are consistent between patients and rodent models. Using this battery of translational tests, similar behavior profiles in bipolar mania patients and mice with reduced dopamine transporter activity have been identified. Future investigations should combine other animal models that are biologically relevant to the neuropsychiatric disorder with translational behavioral assessment as outlined here. This methodology can be utilized to develop novel targeted therapies that relieve symptoms for more patients without common side effects caused by current treatments.
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Affiliation(s)
- Jordy van Enkhuizen
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States; Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States
| | - William Perry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States
| | - Brook L Henry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States
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Bonnín CM, Reinares M, Hidalgo-Mazzei D, Undurraga J, Mur M, Sáez C, Nieto E, Vázquez GH, Balanzá-Martínez V, Tabarés-Seisdedos R, Vieta E. Predictors of functional outcome after a manic episode. J Affect Disord 2015; 182:121-5. [PMID: 25985381 DOI: 10.1016/j.jad.2015.04.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode. METHODS We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable. RESULTS Number of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode. LIMITATIONS The main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness. CONCLUSIONS Psychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies.
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Affiliation(s)
- C Mar Bonnín
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain
| | - María Reinares
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain
| | - Juan Undurraga
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain; Department of Psychiatry, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Maria Mur
- Psychiatric Service, Santa Maria Hospital, IRB Lleida (Biomedicine Research, Institute), University of Lleida, Catalonia, Lleida, Spain
| | - Cristina Sáez
- University Psychiatric Hospital, Institut Pere Mata, CIBERSAM, Reus, Catalonia, Spain
| | - Evaristo Nieto
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - Gustavo H Vázquez
- Department of Neuroscience, Palermo University, Buenos Aires, Argentina
| | - Vicent Balanzá-Martínez
- Psychiatric Service, La Fe University and Polytechnic Hospital, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain; Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia, Spain
| | - Rafael Tabarés-Seisdedos
- Psychiatric Service, La Fe University and Polytechnic Hospital, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain.
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Chakrabarty T, Kozicky JM, Torres IJ, Lam RW, Yatham LN. Verbal memory impairment in new onset bipolar disorder: Relationship with frontal and medial temporal morphology. World J Biol Psychiatry 2015; 16:249-60. [PMID: 25708742 DOI: 10.3109/15622975.2014.1000373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Verbal memory (VM) impairment is a trait feature of bipolar I disorder (BDI) that is present at illness onset and associated with functional outcome. However, little is known about the morphological abnormalities underlying this deficit early in the disease course. This study examined the neurobiological correlates of VM impairment in euthymic newly diagnosed patients, with attention to frontal and medial temporal (MT) structures known to contribute to VM. METHODS Euthymic patients with BDI recently recovered from their first episode of mania (n = 42) were compared with healthy subjects (n = 37) using measures of the California Verbal Learning Test (CVLT-II) associated with frontal and MT functioning. A subset of participants had 3T MRI scan (n = 31 patient group, n = 30 healthy subject group). Hippocampal and prefrontal volumes were analyzed using FreeSurfer 5.1 and correlated with their corresponding CVLT-II subscores. RESULTS Patients showed decreased performance in total learning as well as short and long delay verbal recall. Consistent with MT dysfunction, they also showed deficits in recognition discriminability and learning slope. In the patient group only, left hippocampal volumes were negatively correlated with these measures. CONCLUSIONS These results suggest that anomalous MT functioning is involved with VM impairment early in the course of BDI.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia , Vancouver, BC , Canada
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Smith DJ, Anderson J, Zammit S, Meyer TD, Pell JP, Mackay D. Childhood IQ and risk of bipolar disorder in adulthood: prospective birth cohort study. BJPsych Open 2015; 1:74-80. [PMID: 27703726 PMCID: PMC4995557 DOI: 10.1192/bjpo.bp.115.000455] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/06/2015] [Accepted: 06/26/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intellectual ability may be an endophenotypic marker for bipolar disorder. AIMS Within a large birth cohort, we aimed to assess whether childhood IQ (including both verbal IQ (VIQ) and performance IQ (PIQ) subscales) was predictive of lifetime features of bipolar disorder assessed in young adulthood. METHOD We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large UK birth cohort, to test for an association between measures of childhood IQ at age 8 years and lifetime manic features assessed at age 22-23 years using the Hypomania Checklist-32 (HCL-32; n=1881 individuals). An ordinary least squares linear regression model was used, with normal childhood IQ (range 90-109) as the referent group. We adjusted analyses for confounding factors, including gender, ethnicity, handedness, maternal social class at recruitment, maternal age, maternal history of depression and maternal education. RESULTS There was a positive association between IQ at age 8 years and lifetime manic features at age 22-23 years (Pearson's correlation coefficient 0.159 (95% CI 0.120-0.198), P>0.001). Individuals in the lowest decile of manic features had a mean full-scale IQ (FSIQ) which was almost 10 points lower than those in the highest decile of manic features: mean FSIQ 100.71 (95% CI 98.74-102.6) v. 110.14 (95% CI 107.79-112.50), P>0.001. The association between IQ and manic features was present for FSIQ, VIQ and for PIQ but was strongest for VIQ. CONCLUSIONS A higher childhood IQ score, and high VIQ in particular, may represent a marker of risk for the later development of bipolar disorder. This finding has implications for understanding of how liability to bipolar disorder may have been selected through generations. It will also inform future genetic studies at the interface of intelligence, creativity and bipolar disorder and is relevant to the developmental trajectory of bipolar disorder. It may also improve approaches to earlier detection and treatment of bipolar disorder in adolescents and young adults. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Daniel J Smith
- , MD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Jana Anderson
- , PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Stanley Zammit
- , PhD, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, Wales, UK
| | - Thomas D Meyer
- , PhD, Department of Psychiatry & Behavioral Sciences, University of Texas Medical School at Houston, Houston, TX, USA
| | - Jill P Pell
- , MD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Daniel Mackay
- , PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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Muralidharan K, Kozicky JM, Bücker J, Silveira LE, Torres IJ, Yatham LN. Are cognitive deficits similar in remitted early bipolar I disorder patients treated with lithium or valproate? Data from the STOP-EM study. Eur Neuropsychopharmacol 2015; 25:223-30. [PMID: 25261261 DOI: 10.1016/j.euroneuro.2014.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 07/29/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
In bipolar disorder (BD), lithium and valproate are both reportedly associated with mild cognitive deficits with impaired psychomotor speed and verbal memory ascribed to both while impairments in learning and attention are mainly attributed to valproate. However, there are few direct comparisons of the impact of lithium and valproate on cognitive function in early BD. Using data from the STOP-EM study, we compared neurocognitive functioning in BD patients, who had recently recovered from a first episode of mania, and were on treatment with lithium (n = 34) or valproate (n = 38), to a comparable sample of healthy controls (HC; n = 40), on the domains of processing speed, attention, verbal memory, nonverbal memory, working memory and executive functions. The three groups were comparable on socio-demographic (all p > 0.12) and clinical variables (all p > 0.08). MANOVA revealed a significant difference between the three groups on overall cognitive functioning (Wilk's lambda = 0.644; F = 3.775; p < 0.001). On post-hoc Tukey test, the valproate group performed poorer on working memory compared to the lithium (p = 0.001) and HC groups (p < 0.001). There was no significant difference between the lithium and valproate groups on other cognitive domains (all p > 0.13). Treatment with valproate and not lithium may be associated with working memory deficits early in the course of BD.
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Affiliation(s)
- Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India; Mood Disorders Centre, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1
| | - Jan-Marie Kozicky
- Mood Disorders Centre, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1
| | - Joana Bücker
- Mood Disorders Centre, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1; Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil
| | - Leonardo E Silveira
- Mood Disorders Centre, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1; Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brazil
| | - Ivan J Torres
- Mood Disorders Centre, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1
| | - Lakshmi N Yatham
- Mood Disorders Centre, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1.
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Abstract
Verbal memory is impaired in neurological and psychiatric conditions and provides one of the main targets of intervention. Specifically, this cognitive domain has been shown to provide a major determinant of outcome in schizophrenia and mood disorders. Therefore, verbal memory disturbances should be focused in the development of novel pharmacological and psychosocial therapeutics. Effective integration between preclinical and clinical studies should provide a key to the pursuit of drugs enhancing verbal memory.
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Affiliation(s)
- Tomiki Sumiyoshi
- Department of Clinical Research Promotion, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi-cho, Kodaira, Tokyo, Japan,
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42
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Silveira LE, Kozicky JM, Muralidharan K, Bücker J, Torres IJ, Bond DJ, Kapczinski F, Kauer-Sant’Anna M, Lam RW, Yatham LN. Neurocognitive functioning in overweight and obese patients with bipolar disorder: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:639-48. [PMID: 25702364 PMCID: PMC4304583 DOI: 10.1177/070674371405901205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Obesity is frequent in people with bipolar I disorder (BD I) and has a major impact on the course of the illness. Although obesity negatively influences cognitive function in patients with BD, its impact in the early phase of the disorder is unknown. We investigated the impact of overweight and obesity on cognitive functioning in clinically stable patients with BD recently recovered from their first manic episode. METHOD Sixty-five patients with BD (25 overweight or obese and 40 normal weight) recently remitted from a first episode of mania and 37 age- and sex-matched healthy control. subjects (9 overweight or obese and 28 normal weight) were included in this analysis from the Systematic Treatment Optimization Program for Early Mania (commonly referred to as STOP-EM). All subjects had their cognitive function assessed using a standard neurocognitive battery. We compared cognitive function between normal weight patients, overweight-obese patients, and normal weight healthy control subjects. RESULTS There was a negative affect of BD diagnosis on the domains of attention, verbal memory, nonverbal memory, working memory, and executive function, but we were unable to find an additional effect of weight on cognitive functioning in patients. There was a trend for a negative correlation between body mass index and nonverbal memory in the patient group. CONCLUSIONS These data suggest that overweight-obesity does not negatively influence cognitive function early in the course of BD. Given that there is evidence for a negative impact of obesity later in the course of illness, there may be an opportunity to address obesity early in the course of BD.
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Affiliation(s)
- Leonardo E Silveira
- Clinical and Research Fellow, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Student, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia, for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil; Student, Postgraduate Program in Medicine: Psychiatry, Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jan-Marie Kozicky
- Postdoctoral Fellow, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Kesavan Muralidharan
- Associate Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Joana Bücker
- Research Fellow, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Student, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil; Student, Postgraduate Program in Medicine: Psychiatry, Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ivan J Torres
- Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Professor, British Columbia Mental Health and Addictions Services, Vancouver, British Columbia
| | - David J Bond
- Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Professor, Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Flavio Kapczinski
- Professor, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcia Kauer-Sant’Anna
- Professor, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and Instituto Nacional de Ciencia e Tecnologia for Translational Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raymond W Lam
- Professor, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Lakshmi N Yatham
- Professor of Psychiatry, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
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Kapczinski F, Magalhães PVS, Balanzá-Martinez V, Dias VV, Frangou S, Gama CS, Gonzalez-Pinto A, Grande I, Ha K, Kauer-Sant'Anna M, Kunz M, Kupka R, Leboyer M, Lopez-Jaramillo C, Post RM, Rybakowski JK, Scott J, Strejilevitch S, Tohen M, Vazquez G, Yatham L, Vieta E, Berk M. Staging systems in bipolar disorder: an International Society for Bipolar Disorders Task Force Report. Acta Psychiatr Scand 2014; 130:354-63. [PMID: 24961757 DOI: 10.1111/acps.12305] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We discuss the rationale behind staging systems described specifically for bipolar disorders. Current applications, future directions and research gaps in clinical staging models for bipolar disorders are outlined. METHOD We reviewed the literature pertaining to bipolar disorders, focusing on the first episode onwards. We systematically searched data on staging models for bipolar disorders and allied studies that could inform the concept of staging. RESULTS We report on several dimensions that are relevant to staging concepts in bipolar disorder. We consider whether staging offers a refinement to current diagnoses by reviewing clinical studies of treatment and functioning and the potential utility of neurocognitive, neuroimaging and peripheral biomarkers. CONCLUSION Most studies to date indicate that globally defined late-stage patients have a worse overall prognosis and poorer response to standard treatment, consistent with patterns for end-stage medical disorders. We believe it is possible at this juncture to speak broadly of 'early'- and 'late'-stage bipolar disorder. Next steps require further collaborative efforts to consider the details of preillness onset and intermediary stages, and how many additional stages are optimal.
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Affiliation(s)
- F Kapczinski
- National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Mackala SA, Torres IJ, Kozicky J, Michalak EE, Yatham LN. Cognitive performance and quality of life early in the course of bipolar disorder. J Affect Disord 2014; 168:119-24. [PMID: 25043323 DOI: 10.1016/j.jad.2014.06.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Several studies have reported cognitive functioning as a significant predictor of quality of life (QoL) in patients with established bipolar disorder (BD), in addition to mood symptoms. However, it is unclear whether cognitive functioning predicts QoL early in the course of illness. The purpose of this study was therefore to evaluate the relationship between mood and neuropsychological variables and self-reported QoL early in the course of BD. METHODS Patients with BD-I (n=54) completed a neuropsychological battery and clinical assessment within 3 months of resolution of their first manic episode. QoL was assessed 6 months later using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Cognitive predictors of QoL were assessed through Pearson correlations and hierarchical multiple regression. RESULTS After accounting for mood rating scores at the time of cognitive testing (ΔR²=.27, p<.001), measures of sustained attention (ΔR²=.08, p<.05), verbal memory (ΔR²=.09, p<.01), working memory (ΔR²=.06, p<.05), and executive functioning (ΔR²=.08, p<.05) each predicted QoL when entered independently in separate regression models. When entered simultaneously, the cognitive domains explained 15% (R(2)=.42, p<.05) of the variance in QoL beyond mood. LIMITATIONS Some aspects of QoL that are particularly important in BD may be missing as a result of using the Q-LES-Q, because the measure was not specifically developed to assess QoL in BD. CONCLUSIONS In addition to mood symptoms, poorer cognitive functioning is a significant predictor of reduced QoL early in the course of BD. Recently diagnosed patients with BD may benefit from early cognitive-enhancing interventions to maintain or restore their QoL.
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Affiliation(s)
- Sylvia A Mackala
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Addictions Services, Vancouver, BC, Canada
| | - Jan Kozicky
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Conus P, Macneil C, McGorry PD. Public health significance of bipolar disorder: implications for early intervention and prevention. Bipolar Disord 2014; 16:548-56. [PMID: 24127825 DOI: 10.1111/bdi.12137] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 05/27/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Early intervention and preventive strategies have become major targets of research and service development in psychiatry over the last few years. Compared to schizophrenia, bipolar disorder (BD) has received limited attention in this regard. In this paper, we review the available literature in order to explore the public health significance of BD and the extent to which this may justify the development of early intervention strategies for this disorder. METHODS The main computerized psychiatric literature databases were accessed. This included Medline and PsychInfo, using the following keywords: bipolar, early intervention, staging model, burden, caregiver, public health, and manic depression. RESULTS BD is often recurrent and has an impact that goes well beyond symptomatic pathology. The burden it incurs is linked not only to its cardinal clinical features, but also to cognitive dysfunction, poor functional outcome, poor physical health, high rate of comorbidities, and suicide. At a societal level, BD induces enormous direct and indirect costs and has a major impact on caregivers. The available literature reveals a usually long delay between illness onset and the start of treatment, and the absence of specific guidelines for the treatment of the early phase of BD. CONCLUSIONS Considering the major impact of BD on patients and society, there is an urgent need for the development of early intervention strategies aimed at earlier detection and more specific treatment of the early phase of the disorder.
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Affiliation(s)
- Philippe Conus
- Service de Psychiatrie Générale, Département Universitaire de Psychiatrie CHUV, Lausanne University, Clinique de Cery, Prilly, Switzerland
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Cao L, Deng W, Guan L, Yang Z, Lin Y, Ma X, Li X, Liu Y, Ye B, Lao G, Chen Y, Liang H, Wu Y, Ou Y, Huang W, Liu W, Wang Q, Wang Y, Zhao L, Li T, Hu X. Association of the 3' region of the neuregulin 1 gene with bipolar I disorder in the Chinese Han population. J Affect Disord 2014; 162:81-8. [PMID: 24767010 DOI: 10.1016/j.jad.2014.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Based on the function of neuregulin 1 (NRG1) in neurodevelopment, susceptibility to bipolar disorder presumably involves this gene. The 3' region of NRG1 contains the majority of the coding exons, and transcripts from this region encode 8 of the 9 known NRG1 isoforms; therefore, this region is likely to be predominant versus the 5' region in terms of their relative contributions to NRG1 function. We investigated the association between the 3' region of the NRG1 gene and bipolar I disorder (BPI) in the Chinese Han population and performed further analyses depending on the presence or absence of psychotic features. METHODS A total of 385 BPI patients and 475 healthy controls were recruited for this study. Thirty tag single nucleotide polymorphisms (SNPs) across the 3' region of the NRG1 gene were genotyped for allelic and haplotypic associations with BPI and subgroups with psychotic features (BPI-P) or without psychotic features (BPI-NP). RESULTS Individual marker analysis showed that 2 SNPs (rs12547858 and rs6468121) in this region were significantly associated with BPI. Moreover, subgroup analyses showed significant but marginal associations of rs6468121 with BPI-P and rs3757933 with BPI-NP. Haplotype analyses showed that 6 haplotypes were associated with BPI only. LIMITATIONS The sample size was relatively small. The investigated tag SNPs only represented 83% of the information on the targeted region. There might be a retrospective bias in the subgroup analyses. CONCLUSION The results suggest that the 3' region of the NRG1 gene plays a role in BPI susceptibility in the Chinese Han population. In addition, the preliminary results show that BPI with psychotic features and BPI without psychotic features may constitute different sub-phenotypes; however, this finding should be confirmed in a larger population sample.
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Affiliation(s)
- Liping Cao
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China.
| | - Wenhao Deng
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Lijie Guan
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Zhenxing Yang
- Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yin Lin
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China; Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaohong Ma
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China; Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xuan Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Yuping Liu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Biyu Ye
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Guohui Lao
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Yuwei Chen
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Huiwei Liang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Yuanfei Wu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Yufen Ou
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Weijie Huang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Wentao Liu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China
| | - Qiang Wang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China; Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yingcheng Wang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Brain Hospital, Guangzhou, Guangdong, PR China; Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liansheng Zhao
- Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Tao Li
- Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xun Hu
- Psychiatric Laboratory and Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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47
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Van Rheenen TE, Rossell SL. Objective and subjective psychosocial functioning in bipolar disorder: an investigation of the relative importance of neurocognition, social cognition and emotion regulation. J Affect Disord 2014; 162:134-41. [PMID: 24767018 DOI: 10.1016/j.jad.2014.03.043] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with bipolar disorder (BD) experience significant psychosocial impairment. Understandings of the nature and causes of such impairment is limited by the lack of research exploring the extent to which subjectively reported functioning should be valued as an indicator of objective dysfunction, or examining the relative influence of neurocognition, social cognition and emotion regulation on these important, but different aspects of psychosocial functioning in the context of mania and depression symptoms. This study aimed to address this paucity of research by conducting a comprehensive investigation of psychosocial functioning in a well characterised group of BD patients. METHODS Fifty-one BD patients were compared to 52 healthy controls on objectively and subjectively assessed psychosocial outcomes. Relationships between current mood symptoms, psychosocial function and neurocognitive, social cognitive and emotion regulation measures were also examined in the patient group. RESULTS Patients had significantly worse scores on the global objective and subjective functioning measures relative to controls. In the patient group, although these scores were correlated, regression analyses showed that variance in each of the measures was explained by different predictors. Depressive symptomatology was the most important predictor of global subjective functioning, and neurocognition had a concurrent and important influence with depressive symptoms on objective psychosocial function. Emotion regulation also had an indirect effect on psychosocial functioning via its influence on depressive symptomatology. LIMITATIONS As this study was cross-sectional in nature, we are unable to draw precise conclusions regarding contributing pathways involved in psychosocial functioning in BD. CONCLUSIONS These results suggest that patients' own evaluations of their subjective functioning represent important indicators of the extent to which their observable function is impaired. They also highlight the importance of incorporating cognitive and emotion regulation assessments into clinical practice when working to reduce psychosocial dysfunction with patients diagnosed with BD.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Brain and Psychological Sciences Research Centre (BPsyC), School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University, Melbourne, Australia.
| | - Susan L Rossell
- Brain and Psychological Sciences Research Centre (BPsyC), School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University, Melbourne, Australia
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48
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Affiliation(s)
- E Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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49
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Torres IJ, Kozicky J, Popuri S, Bond DJ, Honer WG, Lam RW, Yatham LN. 12-month longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disord 2014; 16:159-71. [PMID: 24636366 DOI: 10.1111/bdi.12154] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although cognitive deficits are observed in the early stages of bipolar disorder, the longitudinal course of neuropsychological functioning during this period is unknown. Such knowledge could provide etiologic clues into the cognitive deficits associated with the illness, and could inform early treatment interventions. The purpose of the present study was to evaluate cognitive change in bipolar disorder in the first year after the initial manic episode. METHODS From an initial pool of 65 newly diagnosed patients with bipolar disorder (within three months of the end of the first manic or mixed episode) and 36 demographically similar healthy participants, 42 patients [mean age 22.9 years, standard deviation (SD) = 4.0] and 23 healthy participants [mean age 22.9 years (SD = 4.9)] completed baseline, six-month, and one-year neuropsychological assessments of multiple domains including processing speed, attention, verbal and nonverbal memory, working memory, and executive function. Patients also received clinical assessments, including mood ratings. RESULTS Although patients showed consistently poorer cognitive performance than healthy individuals in most cognitive domains, patients showed a linear improvement over time in processing speed (p = 0.008) and executive function (p = 0.004) relative to the comparison group. Among patients, those without a history of alcohol/substance abuse or who were taken off an antipsychotic treatment during the study showed better improvement. CONCLUSIONS The early course of cognitive functioning in bipolar disorder is likely influenced by multiple factors. Nevertheless, patients with bipolar disorder showed select cognitive improvements in the first year after resolution of their initial manic episode. Several clinical variables were associated with better recovery, including absence of substance abuse and discontinuation of antipsychotic treatment during the study. These and other factors require further investigation to better understand their contributions to longitudinal cognitive functioning in early bipolar disorder.
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Affiliation(s)
- Ivan J Torres
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
- British Columbia Mental Health and Addictions Services; Vancouver BC Canada
| | - Jan Kozicky
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - Swetha Popuri
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - David J Bond
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - William G Honer
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
- British Columbia Mental Health and Addictions Services; Vancouver BC Canada
| | - Raymond W Lam
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - Lakshmi N Yatham
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
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50
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Van Rheenen TE, Rossell SL. Phenomenological predictors of psychosocial function in bipolar disorder: is there evidence that social cognitive and emotion regulation abnormalities contribute? Aust N Z J Psychiatry 2014; 48:26-35. [PMID: 24126607 DOI: 10.1177/0004867413508452] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Neurocognitive ability and mood have often been discussed as contributing mechanisms to the severe psychosocial dysfunction experienced in bipolar disorder (BD). In contrast, there has been little discussion on the contribution of social cognition or emotion regulation. This paper aims to assert a potential role for these constructs in psychosocial functioning in BD, with an overarching goal to highlight the necessary importance of considering them in future research examining psychosocial outcomes in the disorder. METHODS This paper provides a theoretical synthesis of available and indirect evidence for an influence of (1) social cognition and (2) emotion regulation on psychosocial functioning; it acknowledges important clinical questions that need addressing, and discusses how current research might be translated to improve the treatment of psychosocial dysfunction in BD. RESULTS Given their assumed roles in facilitating social interactions and modulating behaviours, it is certainly plausible that abnormalities in social cognition and emotion regulation are detrimental to psychosocial functioning. Currently, there is only minimal direct evidence examining their influence, although existing BD studies are preliminarily supportive of relationships between these constructs. CONCLUSIONS There are reasonable theoretical grounds, supported by indirect and preliminary evidence, to suggest that social cognition and emotion regulation may be important in the prediction of psychosocial outcome in BD. However, this proposition is limited by the paucity of empirical research directly examining this matter.
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Affiliation(s)
- Tamsyn E Van Rheenen
- 1Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Life and Social Sciences, Swinburne University, Melbourne, Australia
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