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Rosa M, Scassellati C, Cattaneo A. Association of childhood trauma with cognitive domains in adult patients with mental disorders and in non-clinical populations: a systematic review. Front Psychol 2023; 14:1156415. [PMID: 37425159 PMCID: PMC10327487 DOI: 10.3389/fpsyg.2023.1156415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
Although the association between cognitive performances and the onset of psychiatric disorders has been widely investigated, limited research on the role of childhood trauma or early life stress (CT/ELS), and whether this role differs between clinical and non-clinical cohorts is available. This systematic review aims at filling this gap, testing whether the occurrence of CT/ELS and its subtypes are associated with cognitive domains (general cognitive ability, executive functions, working memory, attention, processing speed, verbal/visual memory) in patients with psychiatric disorders and in non-clinical populations. This study followed the PRISMA 2020 guidelines and the Newcastle-Ottawa scale for quality assessment. The search was performed until May 2022. Seventy-four studies were classified as eligible. The graphical representations of the results reported an association between exposure to CT/ELS and worse general cognitive ability, verbal/visual memory, processing speed and attention in patients affected by anxiety, mood and psychotic disorders, and that specific CT/ELS subtypes (physical neglect, physical/sexual abuse) can differentially influence specific cognitive abilities (executive functions, attention, working memory, verbal/visual memory). In non-clinical cohorts we found associations between CT/ELS exposure and impairments in executive functions, processing speed and working memory, while physical neglect was related to general cognitive ability and working memory. Concerning the emotional abuse/neglect subtypes in both populations, the results indicated their involvement in cognitive functioning; however, the few studies conducted are not enough to reach definitive conclusions. These findings suggest an association of CT/ELS with specific cognitive deficits and psychopathology.
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Affiliation(s)
- Melissa Rosa
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Catia Scassellati
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Annamaria Cattaneo
- Laboratory of Biological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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2
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Chavez-Baldini U, Nieman DH, Keestra A, Lok A, Mocking RJT, de Koning P, Krzhizhanovskaya VV, Bockting CL, van Rooijen G, Smit DJA, Sutterland AL, Verweij KJH, van Wingen G, Wigman JT, Vulink NC, Denys D. The relationship between cognitive functioning and psychopathology in patients with psychiatric disorders: a transdiagnostic network analysis. Psychol Med 2023; 53:476-485. [PMID: 34165065 PMCID: PMC9899564 DOI: 10.1017/s0033291721001781] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 03/05/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with psychiatric disorders often experience cognitive dysfunction, but the precise relationship between cognitive deficits and psychopathology remains unclear. We investigated the relationships between domains of cognitive functioning and psychopathology in a transdiagnostic sample using a data-driven approach. METHODS Cross-sectional network analyses were conducted to investigate the relationships between domains of psychopathology and cognitive functioning and detect clusters in the network. This naturalistic transdiagnostic sample consists of 1016 psychiatric patients who have a variety of psychiatric diagnoses, such as depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, and schizophrenia spectrum and other psychotic disorders. Psychopathology symptoms were assessed using various questionnaires. Core cognitive domains were assessed with a battery of automated tests. RESULTS Network analysis detected three clusters that we labelled: general psychopathology, substance use, and cognition. Depressive and anxiety symptoms, verbal memory, and visual attention were the most central nodes in the network. Most associations between cognitive functioning and symptoms were negative, i.e. increased symptom severity was associated with worse cognitive functioning. Cannabis use, (subclinical) psychotic experiences, and anhedonia had the strongest total negative relationships with cognitive variables. CONCLUSIONS Cognitive functioning and psychopathology are independent but related dimensions, which interact in a transdiagnostic manner. Depression, anxiety, verbal memory, and visual attention are especially relevant in this network and can be considered independent transdiagnostic targets for research and treatment in psychiatry. Moreover, future research on cognitive functioning in psychopathology should take a transdiagnostic approach, focusing on symptom-specific interactions with cognitive domains rather than investigating cognitive functioning within diagnostic categories.
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Affiliation(s)
- UnYoung Chavez-Baldini
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dorien H. Nieman
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Amos Keestra
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Roel J. T. Mocking
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Claudi L.H. Bockting
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dirk J. A. Smit
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Arjen L. Sutterland
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Karin J. H. Verweij
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johanna T.W. Wigman
- University Medical Center Groningen, University Center Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, CC72, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Nienke C. Vulink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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3
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Working memory updating in individuals with bipolar and unipolar depression: fMRI study. Transl Psychiatry 2022; 12:441. [PMID: 36220840 PMCID: PMC9553934 DOI: 10.1038/s41398-022-02211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 01/10/2023] Open
Abstract
Understanding neurobiological characteristics of cognitive dysfunction in distinct psychiatric disorders remains challenging. In this secondary data analysis, we examined neurobiological differences in brain response during working memory updating among individuals with bipolar disorder (BD), those with unipolar depression (UD), and healthy controls (HC). Individuals between 18-45 years of age with BD (n = 100), UD (n = 109), and HC (n = 172) were scanned using fMRI while performing 0-back (easy) and 2-back (difficult) tasks with letters as the stimuli and happy, fearful, or neutral faces as distractors. The 2(n-back) × 3(groups) × 3(distractors) ANCOVA examined reaction time (RT), accuracy, and brain activation during the task. HC showed more accurate and faster responses than individuals with BD and UD. Difficulty-related activation in the prefrontal, posterior parietal, paracingulate cortices, striatal, lateral occipital, precuneus, and thalamic regions differed among groups. Individuals with BD showed significantly lower difficulty-related activation differences in the left lateral occipital and the right paracingulate cortices than those with UD. In individuals with BD, greater difficulty-related worsening in accuracy was associated with smaller activity changes in the right precuneus, while greater difficulty-related slowing in RT was associated with smaller activity changes in the prefrontal, frontal opercular, paracingulate, posterior parietal, and lateral occipital cortices. Measures of current depression and mania did not correlate with the difficulty-related brain activation differences in either group. Our findings suggest that the alterations in the working memory circuitry may be a trait characteristic of reduced working memory capacity in mood disorders. Aberrant patterns of activation in the left lateral occipital and paracingulate cortices may be specific to BD.
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Visual electrophysiology and neuropsychology in bipolar disorders: a review on current state and perspectives. Neurosci Biobehav Rev 2022; 140:104764. [DOI: 10.1016/j.neubiorev.2022.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
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Garés-Caballer M, Sánchez-Ortí JV, Correa-Ghisays P, Balanzá-Martínez V, Selva-Vera G, Vila-Francés J, Magdalena-Benedito R, San-Martin C, Victor VM, Escribano-Lopez I, Hernandez-Mijares A, Vivas-Lalinde J, Vieta E, Leza JC, Tabarés-Seisdedos R. Immune–Inflammatory Biomarkers Predict Cognition and Social Functioning in Patients With Type 2 Diabetes Mellitus, Major Depressive Disorder, Bipolar Disorder, and Schizophrenia: A 1-Year Follow-Up Study. Front Neurol 2022; 13:883927. [PMID: 35720107 PMCID: PMC9201031 DOI: 10.3389/fneur.2022.883927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Systemic, low-grade immune–inflammatory activity, together with social and neurocognitive performance deficits are a transdiagnostic trait of people suffering from type 2 diabetes mellitus (T2DM) and severe mental illnesses (SMIs), such as schizophrenia (SZ), major depressive disorder (MDD), and bipolar disorder (BD). We aimed to determine if immune–inflammatory mediators were significantly altered in people with SMIs or T2DM compared with healthy controls (HC) and whether these biomarkers could help predict their cognition and social functioning 1 year after assessment. Methods We performed a prospective, 1-year follow-up cohort study with 165 participants at baseline (TB), including 30 with SZ, 42 with BD, 35 with MDD, 30 with T2DM, and 28 HC; and 125 at 1-year follow-up (TY), and determined executive domain (ED), global social functioning score (GSFS), and peripheral blood immune–inflammatory and oxidative stress biomarkers. Results Participants with SMIs and T2DM showed increased peripheral levels of inflammatory markers, such as interleukin-10 (p < 0.01; η2p = 0.07) and tumor necrosis factor-α (p < 0.05; η2p = 0.08); and oxidative stress biomarkers, such as reactive oxygen species (ROS) (p < 0.05; η2p = 0.07) and mitochondrial ROS (p < 0.01; η2p = 0.08). The different combinations of the exposed biomarkers anticipated 46–57.3% of the total ED and 23.8–35.7% of GSFS for the participants with SMIs. Limitations Participants' treatment, as usual, was continued without no specific interventions; thus, it was difficult to anticipate substantial changes related to the psychopharmacological pattern. Conclusion People with SMIs show significantly increased levels of peripheral immune–inflammatory biomarkers, which may contribute to the neurocognitive and social deficits observed in SMIs, T2DM, and other diseases with systemic immune–inflammatory activation of chronic development. These parameters could help identify the subset of patients who could benefit from immune–inflammatory modulator strategies to ameliorate their functional outcomes.
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Affiliation(s)
- Marta Garés-Caballer
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Joan Vicent Sánchez-Ortí
- INCLIVA—Health Research Institute, Valencia, Spain
- TMAP—Evaluation Unit of Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Faculty of Psychology and Speech Therapy, University of Valencia, Valencia, Spain
| | - Patricia Correa-Ghisays
- INCLIVA—Health Research Institute, Valencia, Spain
- TMAP—Evaluation Unit of Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Faculty of Psychology and Speech Therapy, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
- INCLIVA—Health Research Institute, Valencia, Spain
- TMAP—Evaluation Unit of Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- Mental Health Unit of Catarroja, Valencia, Spain
| | - Gabriel Selva-Vera
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
- INCLIVA—Health Research Institute, Valencia, Spain
- TMAP—Evaluation Unit of Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Joan Vila-Francés
- IDAL—Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | | | - Constanza San-Martin
- INCLIVA—Health Research Institute, Valencia, Spain
- TMAP—Evaluation Unit of Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Victor M. Victor
- Service of Endocrinology and Nutrition, University Hospital Dr. Peset, Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
- Department of Physiology, University of Valencia, Valencia, Spain
| | - Irene Escribano-Lopez
- Service of Endocrinology and Nutrition, University Hospital Dr. Peset, Valencia, Spain
| | | | | | - Eduard Vieta
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Catalonia, Spain
| | - Juan C. Leza
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- Department of Pharmacology and Toxicology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Rafael Tabarés-Seisdedos
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
- INCLIVA—Health Research Institute, Valencia, Spain
- TMAP—Evaluation Unit of Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- *Correspondence: Rafael Tabarés-Seisdedos
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Bonnín CDM, Solé B, Reinares M, García-Estela A, Samalin L, Martínez-Arán A, Sánchez-Moreno J, Colom F, Vieta E, Hidalgo-Mazzei D. Does cognitive impairment in bipolar disorder impact on a SIMPLe app use? J Affect Disord 2021; 282:488-494. [PMID: 33422826 DOI: 10.1016/j.jad.2020.12.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/13/2020] [Accepted: 12/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Smartphone apps are becoming increasingly used by service users in mental health care and research for diverse aims. However, it is well-known the high prevalence of cognitive impairment in some people suffering from severe mental illnesses such as bipolar disorder (BD), which impacts on their psychosocial functioning and quality of life. In this context, the main aim of this paper is to investigate through exploratory analyses the role of specific cognitive deficits in the retention, engagement, and usability of a psychoeducational smartphone app in a group of patients with BD. METHODS 51 remitted BD patients were asked to use the app for 3 months. Baseline and 3-months follow-up clinical and usability assessments were conducted. Twenty-seven independent results from a comprehensive neurocognitive test of the same participants were retrieved separately of the 2 years before or after the use of the app. Post-hoc exploratory analyses were carried out using Spearman correlations to identify significant cognitive deficits domains influencing the usability and retention with the app. RESULTS There were no statistically significant cognitive variables associated with the use, reported usability or retention with the app. Some variables associated with executive functions, verbal and visual memory correlated significantly with previous use of smartphones. LIMITATIONS Post-hoc analysis with a limited sample size. CONCLUSION These preliminary results suggests that patients with BD and mild cognitive deficits do not present any limitation in using mental health apps. In our case, the adoption of a user-centred design in the development process of the app could have mitigated the participants' difficulties when using the app.
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Affiliation(s)
- Caterina Del Mar Bonnín
- Bipolar and depressive disorders unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and depressive disorders unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and depressive disorders unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, EA 7280, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Anabel Martínez-Arán
- Bipolar and depressive disorders unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - José Sánchez-Moreno
- Bipolar and depressive disorders unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Francesc Colom
- Mental Health Group, IMIM-Hospital del Mar, Barcelona, Catalonia, Spain.
| | - Eduard Vieta
- Bipolar and depressive disorders unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Diego Hidalgo-Mazzei
- Bipolar and depressive disorders unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Rauer L, Trost S, Petrovic A, Gruber O. Cortical activation abnormalities in bipolar and schizophrenia patients in a combined oddball-incongruence paradigm. Eur Arch Psychiatry Clin Neurosci 2021; 271:1487-1499. [PMID: 32710172 PMCID: PMC8563619 DOI: 10.1007/s00406-020-01168-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/13/2020] [Indexed: 11/14/2022]
Abstract
Patients with bipolar disorder and schizophrenia often suffer from severe cognitive impairment even during times of remission. This study investigated the pathomechanisms underlying their deficits in cognitive control. A combined oddball-incongruence fMRI task was applied to examine similarities and differences of neural activation patterns between patients and healthy controls. Bipolar and schizophrenia patients demonstrated hyperactivations in the intraparietal cortex during the oddball condition. Furthermore, bipolar patients revealed diagnosis-specific hyperactivation in the left middle frontal gyrus, precentral gyrus, anteroventral prefrontal cortex and orbitofrontal cortex regions compared to schizophrenia patients and healthy individuals. In comparison to healthy controls the patients showed hypoactivations in the inferior frontal junction and ventral pathway during the cognitively more demanding incongruence. Taken together, bipolar patients seem to recruit frontal and parietal areas during the oddball condition to compensate for potential deficits in their attentional network. During more challenging tasks, i.e., the incongruence condition, their compensatory mechanisms seem to collapse leading to hypoactivations in the same frontal areas as well as the ventral pathway.
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Affiliation(s)
- Lisa Rauer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, University Hospital Heidelberg, 69115, Heidelberg, Germany.
| | - Sarah Trost
- grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, Center for Translational Research in Systems Neuroscience and Clinical Psychiatry, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Aleksandra Petrovic
- grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, Center for Translational Research in Systems Neuroscience and Clinical Psychiatry, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Oliver Gruber
- grid.5253.10000 0001 0328 4908Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, University Hospital Heidelberg, 69115 Heidelberg, Germany
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8
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Aliño-Dies M, Sánchez-Ortí JV, Correa-Ghisays P, Balanzá-Martínez V, Vila-Francés J, Selva-Vera G, Correa-Estrada P, Forés-Martos J, San-Martín Valenzuela C, Monfort-Pañego M, Ayesa-Arriola R, Ruiz-Veguilla M, Crespo-Facorro B, Tabarés-Seisdedos R. Grip Strength, Neurocognition, and Social Functioning in People WithType-2 Diabetes Mellitus, Major Depressive Disorder, Bipolar Disorder, and Schizophrenia. Front Psychol 2020; 11:525231. [PMID: 33324271 PMCID: PMC7723830 DOI: 10.3389/fpsyg.2020.525231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Frailty is a common syndrome among older adults and patients with several comorbidities. Grip strength (GS) is a representative parameter of frailty because it is a valid indicator of current and long-term physical conditions in the general population and patients with severe mental illnesses (SMIs). Physical and cognitive capacities of people with SMIs are usually impaired; however, their relationship with frailty or social functioning have not been studied to date. The current study aimed to determine if GS is a valid predictor of changes in cognitive performance and social functioning in patients with type-2 diabetes mellitus and SMIs. METHODS Assessments of social functioning, cognitive performance, and GS (measured with an electronic dynamometer) were conducted in 30 outpatients with type 2 diabetes mellitus, 35 with major depressive disorder, 42 with bipolar disorder, 30 with schizophrenia, and 28 healthy controls, twice during 1-year, follow-up period. Descriptive analyses were conducted using a one-way analysis of variance for continuous variables and the chi-squared test for categorical variables. Differences between groups for the motor, cognitive, and social variables at T1 and T2 were assessed using a one-way analysis of covariance, with sex and age as co-variates (p < 0.01). To test the predictive capacity of GS at baseline to explain the variance in cognitive performance and social functioning at T2, a linear regression analysis was performed (p < 0.05). RESULTS Predictive relationships were found among GS when implicated with clinical, cognitive, and social variables. These relationships explained changes in cognitive performance after one year of follow-up; the variability percentage was 67.7%, in patients with type-2 diabetes mellitus and 89.1% in patients with schizophrenia. Baseline GS along with other variables, also predicted changes in social functioning in major depressive disorder, bipolar disorder, and schizophrenia, with variability percentages of 67.3, 36, and 59%, respectively. CONCLUSION GS combined with other variables significantly predicted changes in cognitive performance and social functioning in people with SMIs or type-2 diabetes mellitus. Interventions aimed to improve the overall physical conditions of patients who have poor GS could be a therapeutic option that confers positive effects on cognitive performance and social functioning.
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Affiliation(s)
- María Aliño-Dies
- Department of Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Joan Vicent Sánchez-Ortí
- Department of Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- Faculty of Psychology, University of Valencia, Valencia, Spain
- TMAP – Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, University of Valencia, Valencia, Spain
| | - Patricia Correa-Ghisays
- Faculty of Psychology, University of Valencia, Valencia, Spain
- TMAP – Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, University of Valencia, Valencia, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Vicent Balanzá-Martínez
- Department of Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- TMAP – Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, University of Valencia, Valencia, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Joan Vila-Francés
- IDAL – Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Gabriel Selva-Vera
- Department of Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- TMAP – Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, University of Valencia, Valencia, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | | | - Jaume Forés-Martos
- Department of Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- TMAP – Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, University of Valencia, Valencia, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Constanza San-Martín Valenzuela
- TMAP – Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Manuel Monfort-Pañego
- Department of Physical Education Teacher Training, University of Valencia, Valencia, Spain
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Miguel Ruiz-Veguilla
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Hospital Universitario Virgen del Roció-IBIS, University of Sevilla, Seville, Spain
| | - Benedicto Crespo-Facorro
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Hospital Universitario Virgen del Roció-IBIS, University of Sevilla, Seville, Spain
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- TMAP – Unidad de Evaluación en Autonomía Personal, Dependencia y Trastornos Mentales Graves, University of Valencia, Valencia, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- INCLIVA Health Research Institute, Valencia, Spain
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Galimberti C, Bosi MF, Volontè M, Giordano F, Dell'Osso B, Viganò CA. Duration of untreated illness and depression severity are associated with cognitive impairment in mood disorders. Int J Psychiatry Clin Pract 2020; 24:227-235. [PMID: 32338553 DOI: 10.1080/13651501.2020.1757116] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: In this study we estimated the rate and the trajectory of cognitive impairment in a naturalistic sample of outpatients with major depressive disorder (MDD) and bipolar disorder (BD) and its correlation with different variables.Materials and methods: An overall sample of 109 outpatients with MDD or BD was assessed for multiple clinical variables, including duration of untreated illness (DUI), and tested using the Montreal Cognitive Assessment (MoCA) during Major Depressive Episodes (MDE) and after remission. Correlations between MoCA scores and the clinical variables were then computed.Results: About 50% of patients with MDD and BD showed mild cognitive impairment during MDE. Improvement of cognitive function between depression and remission was significant, even though residual symptoms were observed especially in the most impaired patients. Of note, cognitive performance during depression was negatively associated with depression severity and DUI.Discussion: Present findings confirm available evidence about patterns of cognitive impairment in mood disorders, in terms of prevalence and persistence beyond remission in most severe cases. Moreover, a longer DUI was associated with worse cognitive performance during depression, and consequently with poorer outcome, underlining the importance of prompt treatment of these disorders also in light of a cognitive perspective.KeypointsAlthough distinct entities, unipolar and bipolar depression determine similar patterns of cognitive impairment in terms of severity and types of altered domains.Depression (but not anxiety) severity is associated with cognitive performance in depression.Prolonged duration of untreated illness is associated with more severe cognitive impairment during depression, particularly but not specifically in bipolar disorder.
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Affiliation(s)
- Cesare Galimberti
- Psychiatry Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Monica Francesca Bosi
- Psychiatry Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Martina Volontè
- Psychiatry Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Francesca Giordano
- Psychiatry Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Bernardo Dell'Osso
- Psychiatry Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA.,CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Caterina Adele Viganò
- Psychiatry Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy
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10
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Abstract
Bipolar disorder is an illness characterised by periods of elated and depressed mood. These mood episodes are associated with changes in cognitive function and there is evidence to suggest that cognitive dysfunction persists during euthymia. The extent to which this is a function of the illness or a result of treatment is less clear. In this narrative review, we explore the impact of commonly used medications for bipolar disorder on cognitive function. Specific impairments in executive function and verbal memory have been noted in bipolar disorder. The impact of pharmacological treatments upon cognitive function is mixed with a number of studies reporting conflicting results. Interpretation of the data is further complicated by the variety of cognitive tests employed, study design, the relatively small numbers of patients included and confounding by indication. Overall, there is some evidence that while lithium improves some cognitive domains, it impedes others. Antipsychotics may be deleterious to cognition, although this may relate to the patient population in which they are prescribed. Sodium valproate is also associated with worse cognitive outcomes, while the impact of other antiepileptics is unclear. Overall the quality of evidence is poor and is derived from a relatively small number of studies that often do not account for the significant heterogeneity of the disorder or common comorbidities. The use of consistent methodologies and measures of cognition across studies, as well as in naturalistic settings, would enable more certain conclusions to be drawn.
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11
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Correa-Ghisays P, Sánchez-Ortí JV, Ayesa-Arriola R, Setién-Suero E, Balanzá-Martínez V, Selva-Vera G, Ruiz-Ruiz JC, Vila-Francés J, Martinez-Aran A, Vivas-Lalinde J, Conforte-Molina C, San-Martín C, Martínez-Pérez C, Fuentes-Durá I, Crespo-Facorro B, Tabarés-Seisdedos R. Visual memory dysfunction as a neurocognitive endophenotype in bipolar disorder patients and their unaffected relatives. Evidence from a 5-year follow-up Valencia study. J Affect Disord 2019; 257:31-37. [PMID: 31299402 DOI: 10.1016/j.jad.2019.06.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Scarce research has focused on Visual Memory (VM) deficits as a possible neurocognitive endophenotype of bipolar disorder (BD). The main aim of this longitudinal, family study with healthy controls was to explore whether VM dysfunction represents a neurocognitive endophenotype of BD. METHODS Assessment of VM by Rey-Osterrieth Complex Figure Test (ROCF) was carried out on a sample of 317 subjects, including 140 patients with BD, 60 unaffected first-degree relatives (BD-Rel), and 117 genetically-unrelated healthy controls (HC), on three occasions over a 5-year period (T1, T2, and T3). BD-Rel group scores were analyzed only at T1 and T2. RESULTS Performance of BD patients was significantly worse than the HC group (p < 0.01). Performance of BD-Rel was also significantly different from HC scores at T1 (p < 0.01) and T2 (p = 0.05), and showed an intermediate profile between the BD and HC groups. Only among BD patients, there were significant differences according to sex, with females performing worse than males (p = 0.03). Regarding other variables, education represented significant differences only in average scores of BD-Rel group (p = 0.01). LIMITATIONS Important attrition in BD-Rel group over time was detected, which precluded analysis at T3. CONCLUSIONS BD patients show significant deficits in VM that remain stable over time, even after controlling sociodemographic and clinical variables. Unaffected relatives also show stable deficits in VM. Accordingly, the deficit in VM could be considered a potential endophenotype of BD, which in turn may be useful as a predictor of the evolution of the disease. Further studies are needed to confirm these findings.
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Affiliation(s)
- Patricia Correa-Ghisays
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Faculty of Psychology, University of Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Joan Vicent Sánchez-Ortí
- Faculty of Psychology, University of Valencia, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; University Hospital Marqués de Valdecilla. Department of Psychiatry, IDIVAL, Santander, Spain; Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | - Esther Setién-Suero
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; University Hospital Marqués de Valdecilla. Department of Psychiatry, IDIVAL, Santander, Spain; Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | - Vicent Balanzá-Martínez
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Gabriel Selva-Vera
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; INCLIVA Health Research Institute, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | | | - Joan Vila-Francés
- IDAL - Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Anabel Martinez-Aran
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Bipolar Disorders Unit, Neurosciences Institute, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Catalonia, Spain
| | | | | | - Constanza San-Martín
- TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Departament of Physioterapiy, University of Valencia, Valencia, Spain
| | | | | | - Benedicto Crespo-Facorro
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Spain
| | - Rafael Tabarés-Seisdedos
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; INCLIVA Health Research Institute, Valencia, Spain; TMAP Unidad de evaluación en autonomía personal, dependencia y trastornos mentales graves, Department of Medicine, University of Valencia, Valencia, Spain; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain.
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12
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Sánchez-Morla EM, López-Villarreal A, Jiménez-López E, Aparicio AI, Martínez-Vizcaíno V, Roberto RJ, Vieta E, Santos JL. Impact of number of episodes on neurocognitive trajectory in bipolar disorder patients: a 5-year follow-up study. Psychol Med 2019; 49:1299-1307. [PMID: 30043716 DOI: 10.1017/s0033291718001885] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The neurocognitive trajectory in bipolar disorder (BD) is variable, with controversial findings, and most evidence come from cross-sectional studies. We aimed to examine the course of neurocognitive functioning in a sample of euthymic BD patients in comparison with a control group during a 5-year follow-up. METHODS Ninety-nine euthymic bipolar patients and 40 healthy controls were assessed using a comprehensive neurocognitive battery (six neurocognitive domains) at baseline (T1) and then at 5-year follow-up (T2) in a longitudinal study. RESULTS No evidence of a progression in neurocognitive dysfunction was found either in cognitive composite index or in any of the neurocognitive domains for the whole cohort. However, there was a negative correlation between number of manic episodes and hospitalisations due to manic episodes and change in neurocognitive composite index (NCI) during the follow-up. Moreover, patients with higher number of manic and hypomanic episodes have a greater decrease in NCI, working memory and visual memory. History of psychotic symptoms was not related to the trajectory of neurocognitive impairment. CONCLUSIONS Our results suggest that, although the progression of cognitive decline is not a general rule in BD, BD patients who have a greater number of manic or hypomanic episodes may constitute a subgroup characterised by the progression of neurocognitive impairment. Prevention of manic and hypomanic episodes could have a positive impact on the trajectory of cognitive function.
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Affiliation(s)
| | | | | | | | | | | | - Eduard Vieta
- CIBERSAM (Biomedical Research Networking Centre in Mental Health),Spain
| | - José-Luis Santos
- CIBERSAM (Biomedical Research Networking Centre in Mental Health),Spain
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13
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Ospina LH, Shanahan M, Perez-Rodriguez MM, Chan CC, Clari R, Burdick KE. Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder. Psychiatry Res 2019; 273:218-226. [PMID: 30658205 PMCID: PMC6561815 DOI: 10.1016/j.psychres.2019.01.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022]
Abstract
Alexithymia, or the inability to identify and describe one's emotions, is significantly higher in bipolar disorder (BD) and schizophrenia (SZ), compared to healthy controls (HC). Alexithymia has also been observed to predict psychosocial functioning in SZ. We investigated whether alexithymia predicted social and everyday functioning in BD, as well as transdiagnostically in HC, BD, and SZ patients. 56 BD, 45 SZ, and 50 HC were administered and compared on tests measuring neurocognition, social cognition, functioning and alexithymia. We conducted linear regressions assessing whether alexithymia predicted functional outcomes in BD. Next, we conducted hierarchical stepwise linear regressions investigating the predictive ability of neurocognition, social cognition and alexithymia on everyday and social functioning in our overall sample. BD and SZ patients were comparable on most demographics and demonstrated higher alexithymia compared to HCs. In BD, alexithymia predicted social functioning only. In the overall sample, difficulty identifying and describing feelings predicted everyday functioning; difficulty describing feelings predicted social functioning. Results suggest that aspects of alexithymia significantly predict functioning among these psychiatric groups, above and beyond the contributions of previously identified factors such as neurocognition and social cognition. Results may aid in developing proper interventions aimed at improving patients' ability to articulate their feelings.
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Affiliation(s)
- L H Ospina
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States.
| | - M Shanahan
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States; Brigham and Women's Hospital, Department of Psychiatry, Boston MA, United States
| | - M M Perez-Rodriguez
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - C C Chan
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - R Clari
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - K E Burdick
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States; Brigham and Women's Hospital, Department of Psychiatry, Boston MA, United States; James J. Peters VA Medical Center, Bronx NY, United States; Harvard Medical School, Department of Psychiatry, Boston, MA, United States
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14
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Chen CK, Lee CY, Lee Y, Hung CF, Huang YC, Lee SY, Huang MC, Chong MY, Chen YC, Wang LJ. Could schizoaffective disorder, schizophrenia and bipolar I disorder be distinguishable using cognitive profiles? Psychiatry Res 2018; 266:79-84. [PMID: 29852325 DOI: 10.1016/j.psychres.2018.05.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/09/2018] [Accepted: 05/23/2018] [Indexed: 10/16/2022]
Abstract
This study seeks to determine whether the cognition profiles of patients with schizoaffective disorder (SAD), schizophrenia and bipolar I disorder (BD) are distinguishable. A total of 227 participants, comprising 88 healthy control subjects, 50 patients with SAD, 48 patients with schizophrenia and 41 patients with BD, were recruited. The participants' cognitive functions were evaluated using the Brief Assessment of Cognition in Schizophrenia (BACS). A discriminant functions analysis (DFA) was conducted to determine whether using cognitive performance can be used to distinguish these participant groups. Relative to healthy control subjects, patients with SAD, schizophrenia and BD exhibited significant deficits in all cognitive domains (verbal memory, working memory, motor speed, verbal fluency, attention and processing speed, executive function and a composite BACS score). Among the three patient groups, the schizophrenia group exhibited particularly impaired motor speed, and the BD group performed best in attention, processing speed, executive function and the composite BACS score. The classification accuracy rates of patients with SAD, schizophrenia and BD in the DFA model were 38%, 47.9% and 46.3%, respectively. These findings suggest that the impairments of some cognitive domains were less severe in patients with BD than in patients with schizophrenia or SAD.
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Affiliation(s)
- Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Chun-Yi Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chyi Huang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chih Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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15
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Sagar R, Sahu A, Pattanayak RD, Chatterjee B. Assessment of cognitive functions in bipolar I disorder: A 1-year naturalistic follow-up study. Bipolar Disord 2018; 20:248-259. [PMID: 29314557 DOI: 10.1111/bdi.12584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Available findings from cross-sectional studies have demonstrated cognitive impairments in bipolar I disorder (BD-I) during various phases of illness. However, very little is known about the longitudinal course of these cognitive impairments. The purpose of the study was to explore the longitudinal pattern of changes in cognitive functioning of BD-I patients. METHODS A total of 129 BD-I subjects (manic, depressed and euthymic groups) and 49 healthy controls were recruited using predefined selection criteria. All four study groups were assessed on various clinical and cognitive parameters (for attention, memory, executive functions and working memory) at study intake and at 3-monthly intervals over the next year. RESULTS All three patient groups performed poorly compared to controls on all cognitive measures at study intake and on some cognitive measures at the 3-, 6-, 9- and 12-month assessments. No significant time effects were observed for any cognitive test. A significant group by time interaction effect was found for executive functions (β = -44.74; P = .018) and working memory (β = 0.77; P ≤ .019) in the depressed group at 12 months; for visual memory (β = 1.21; P = .039) and working memory (β = 1.17; P ≤ .029) in the manic group at 12 months; and for working memory (β = -0.52; P ≤ .036) in the euthymic group at 12 months. CONCLUSION The patient groups showed significant impairments in all or some test domains relative to controls at all time-points. The cognitive functions largely remained stable in all patient groups, with slight improvement over time in a few tests. Further investigation is warranted in larger samples in longitudinal studies.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anamika Sahu
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Biswadip Chatterjee
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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16
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Janacsek K, Borbély-Ipkovich E, Nemeth D, Gonda X. How can the depressed mind extract and remember predictive relationships of the environment? Evidence from implicit probabilistic sequence learning. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:17-24. [PMID: 28958916 DOI: 10.1016/j.pnpbp.2017.09.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 09/11/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
Abstract
A growing body of evidence suggests that emotion and cognition are fundamentally intertwined; impairments in explicit, more effortful and attention-dependent cognitive functions have widely been observed in negative mood. Here we aimed to test how negative mood affects implicit cognition that is less susceptible to motivational and attentional factors associated with negative mood. Therefore, we examined implicit learning and retention of predictive relationships in patients with major depressive episode (MDE). Additionally, we directly compared subgroups of patients with major depressive disorder (MDD) vs. bipolar disorder (BD) in order to gain a deeper understanding of how implicit cognition is affected by these conditions. Implicit probabilistic sequence learning was measured by the Alternating Serial Reaction Time Task. The acquired knowledge was retested after a 24-hour delay period. Consistent with the frontostriatal deficits frequently reported in depression, we found weaker learning in patients with MDE, with a more pronounced deficit in patients with MDD compared to BD. After the 24-hour delay, MDE patients (both subgroups) showed forgetting, while the controls retained the previously acquired knowledge. These results cannot be explained by alterations in motivation, attention and reward processing but suggest more profound impairments of implicit learning and retention of predictive relationships among neutral stimuli in depression. To the best of our knowledge, this is the first study investigating retention of implicitly acquired sequential knowledge and reporting deficits in this domain in MDE. Our findings not only contribute to a better understanding of the complex interplay between affect and cognition but can also help improve screening, diagnosis and treatment protocols of depression.
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Affiliation(s)
- Karolina Janacsek
- MTA ELTE NAP-B Brain, Memory and Language Lab, ICNP, RCNS, Hungarian Academy of Sciences, Budapest, Hungary; Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | | | - Dezso Nemeth
- MTA ELTE NAP-B Brain, Memory and Language Lab, ICNP, RCNS, Hungarian Academy of Sciences, Budapest, Hungary; Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
| | - Xénia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group of the Hungarian Academy of Sciences, Semmelweis University, Hungary
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17
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Tatay-Manteiga A, Correa-Ghisays P, Cauli O, Kapczinski FP, Tabarés-Seisdedos R, Balanzá-Martínez V. Staging, Neurocognition and Social Functioning in Bipolar Disorder. Front Psychiatry 2018; 9:709. [PMID: 30618879 PMCID: PMC6305735 DOI: 10.3389/fpsyt.2018.00709] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction: Bipolar disorder (BD) is associated with significant neurocognitive and functional impairment, which may progress across stages. The 'latent stage' of BD remains understudied. This cross-sectional study assessed staging, neurocognition and social functioning among BD patients and their healthy siblings. Methods: Four groups were included: euthymic type I BD patients in the early (n = 25) and late (n = 23) stages, their healthy siblings (latent stage; n = 23) and healthy controls (n = 21). All 92 subjects underwent a comprehensive neuropsychological battery of processing speed, verbal learning/memory, visual memory, working memory, verbal fluency, executive cognition, and motor speed. Social functioning was assessed using the FAST scale. Results: Siblings' social functioning was identical to that of controls, and significantly better than both early- (p < 0.005) and late- (p < 0.001) stage patients. Although all patients were strictly euthymic, those at late stages had a significantly worse social functioning than early-stage patients (p < 0.001). Compared to controls, increasingly greater neurocognitive dysfunction was observed across stages of BD (F = 1.59; p = 0.005). Healthy siblings' performance lied between those of controls and patients, with deficits in tasks of processing speed, executive attention, verbal memory/learning, and visual memory. Both early- and late-stage patients had a more severe and widespread dysfunction than siblings, with no significant differences between them. Conclusions: Genetic vulnerability to BD-I seems to be associated with neurocognitive impairments, whereas social dysfunction would be the result of the clinical phenotype. Staging models of BD should take into account these divergent findings in the latent stage.
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Affiliation(s)
- Amparo Tatay-Manteiga
- Department of Psychiatry, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Patricia Correa-Ghisays
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain
| | - Flavio P Kapczinski
- McMaster's Department of Psychiatry and Behavioral Neurosciences, Hamilton, ON, Canada.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Tabarés-Seisdedos
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Vicent Balanzá-Martínez
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,Catarroja Mental Health Unit, Valencia, Spain
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18
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Ryan KA, Assari S, Angers K, Marshall DF, Hinrichs K, Easter R, Babu P, Pester BD, Langenecker SA, McInnis MG. Equivalent linear change in cognition between individuals with bipolar disorder and healthy controls over 5 years. Bipolar Disord 2017; 19:689-697. [PMID: 28906586 PMCID: PMC5740000 DOI: 10.1111/bdi.12532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/06/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Cognitive dysfunction is a key feature of bipolar disorder (BD). However, not much is known about its temporal stability, as some studies have demonstrated a neurodegenerative model in BD while others have shown no change in cognitive functioning over time. Building upon our prior work, which examined the natural course of executive functioning, the current study aimed to investigate the natural course of memory, emotion processing, and fine motor dexterity over a 5-year period in BD and healthy control (HC) samples. METHODS Using a 5-year longitudinal cohort, 90 individuals with BD and 17 HCs were administered a battery of neuropsychological tests at study baseline and at 1 and 5 years after study entry that captured four areas of cognitive performance: visual memory, auditory memory, emotion processing, and fine motor dexterity. RESULTS Latent growth curve modeling showed no group differences in the slopes of any of the cognitive factors between the BD and HC groups. Age at baseline was negatively associated with visual memory, emotion processing, and fine motor dexterity. Education level was positively associated with auditory and visual memory and fine motor. Female gender was negatively associated with emotion processing. CONCLUSIONS Extending our prior work on longitudinal evaluation of executive functioning, individuals with BD show similar linear change in other areas of cognitive functioning including memory, emotion processing, and fine motor dexterity as compared to unaffected HCs. Age, education, and gender may have some differential effects on cognitive changes.
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Affiliation(s)
- Kelly A. Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
| | - Kaley Angers
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
| | - David F. Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
| | - Kristin Hinrichs
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan,SSM Health Rehabilitation Hospital, Bridgeton, Missouri
| | - Rebecca Easter
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
| | - Pallavi Babu
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
| | - Bethany D. Pester
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
| | | | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor,
Michigan
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Bora E, Özerdem A. Meta-analysis of longitudinal studies of cognition in bipolar disorder: comparison with healthy controls and schizophrenia. Psychol Med 2017; 47:2753-2766. [PMID: 28585513 DOI: 10.1017/s0033291717001490] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bipolar disorder (BP) is associated with significant cognitive impairment. Recent evidence suggests that cognitive deficits are already evident after first-episode mania. However, it is not clear whether BP is associated with further decline in cognitive functions in individuals with established illness. Aim of this meta-analytic review was to examine longitudinal neurocognitive changes in BP and to compare trajectory of cognitive deficits in BP with schizophrenia and healthy controls. METHODS Electronic databases were searched for the studies published between January 1987 and November 2016. In total 22 reports were included in the current meta-analysis. The main analysis assessed the longitudinal change in cognition in 643 patients with BP. Further analyses were conducted in studies investigating cognitive changes in BP along with healthy controls (459 BP and 367 healthy controls) and schizophrenia (172 BP and 168 schizophrenia). RESULTS There was no cognitive decline overtime neither in short-term (mean duration = 1.5 years) nor in long-term (mean duration = 5.5 years) follow-up studies in BP. In contrast, there was evidence for modest improvements in task performance in memory and working memory at follow-up. The trajectory of cognitive functioning in BP was not significantly different from changes in schizophrenia and healthy controls. CONCLUSIONS Together with the findings in early BP and individuals at genetic risk for BP, current findings suggest that neurodevelopmental factors might play a significant role in cognitive deficits in BP and do not support the notion of progressive cognitive decline in most patients with BP.
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Affiliation(s)
- E Bora
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,Izmir,Turkey
| | - A Özerdem
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,Izmir,Turkey
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Wu C, Dagg P, Molgat C. Measuring stability of cognitive impairment in inpatients with schizophrenia with alternate forms of the Montreal Cognitive Assessment during acute hospitalization. Psychiatry Res 2017; 258:299-304. [PMID: 28886902 DOI: 10.1016/j.psychres.2017.08.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/12/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
Cognitive impairment is a core feature of schizophrenia. Measuring the stability of cognitive impairment is important for further understanding of this disorder. The Montreal Cognitive Assessment (MoCA) has been demonstrated to be a brief and effective screening tool in detecting cognitive impairment in patients with schizophrenia. It has alternative versions designed for longitudinal settings. The current study retrospectively analyzed the total and subscores of two versions of the MoCA, administered to a group of inpatients with severe schizophrenia at admission and discharge, to measure their cognitive stability during hospitalization. The results revealed that the test-retest reliability coefficient of the MoCA had good reliability, suggesting the two alternative versions of the MoCA are reliable measurements for assessing cognitive impairment repeatedly in patients with schizophrenia. The paired-samples t-test showed that the overall cognitive impairment of patients measured by two forms of the MoCA remained stable during acute hospital stay and across symptom changes. Furthermore, the results showed that patients' cognitive stability was not related to their symptom/illness severity improvement, age, education, or length of stay.
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Affiliation(s)
- Caili Wu
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC, Canada V2C 2T1.
| | - Paul Dagg
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC, Canada V2C 2T1; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
| | - Carmen Molgat
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC, Canada V2C 2T1; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
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Cognitive impairments associated with alterations in synaptic proteins induced by the genetic loss of adenosine A 2A receptors in mice. Neuropharmacology 2017; 126:48-57. [DOI: 10.1016/j.neuropharm.2017.08.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/28/2017] [Accepted: 08/17/2017] [Indexed: 12/15/2022]
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Gruber SA, Dahlgren MK, Sagar KA, Gonenc A, Norris L, Cohen BM, Ongur D, Lewandowski KE. Decreased Cingulate Cortex activation during cognitive control processing in bipolar disorder. J Affect Disord 2017; 213:86-95. [PMID: 28199893 DOI: 10.1016/j.jad.2017.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/05/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive deficits are well-documented in patients with bipolar disorder (BPD) and may impact the efficacy of psychotherapy. Cognitive control, a form of executive functioning, is often used therapeutically to shift patients' thoughts and behaviors from automatic, maladaptive responses to adaptive coping strategies. This study examined cognitive control processing in patients with BPD using the Multi-Source Interference Task (MSIT). METHOD Twenty-nine patients diagnosed with BPD and 21 healthy control (HC) subjects completed the MSIT with concurrent functional magnetic resonance imaging (fMRI). RESULTS Patients with BPD generally performed worse on the MSIT relative to HC participants; the BPD group had significantly lower performance accuracy and made more omission errors. Further, fMRI analyses revealed differential patterns of activation between the groups during the MSIT. Region of interest (ROI) analyses revealed that relative to HC participants, patients with BPD activated significantly fewer voxels within the cingulate cortex (CC) and more voxels within prefrontal cortex (PFC), although the PFC findings did not survive more stringent significance thresholds. LIMITATIONS Patients and HCs were not matched for age, sex, and premorbid verbal IQ, however, these variables were controlled for statistically. Medication usage in the BPD group may have possibly impacted the results. Given a priori hypotheses, ROI analyses were utilized. CONCLUSIONS Decreased CC activation and increased PFC activation may be associated with impaired cognitive control, demonstrated by BPD patients when completing the MSIT. Identifying the neural mechanisms which underlie key cognitive abnormalities in BPD may aid in clarifying the pathophysiology of this disorder and inform selection of potential targets for cognition remediation in BPD.
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Affiliation(s)
- Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States.
| | - M Kathryn Dahlgren
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychology, Tufts University, Medford, MA 02155, United States
| | - Kelly A Sagar
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States
| | - Atilla Gonenc
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States
| | - Lesley Norris
- Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Bruce M Cohen
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Program for Neuropsychiatric Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Dost Ongur
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Program for Neuropsychiatric Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Kathryn E Lewandowski
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
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O'Donnell LA, Deldin PJ, Pester B, McInnis MG, Langenecker SA, Ryan KA. Cognitive flexibility: A trait of bipolar disorder that worsens with length of illness. J Clin Exp Neuropsychol 2017; 39:979-987. [PMID: 28276284 DOI: 10.1080/13803395.2017.1296935] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Deficits in cognitive flexibility, a difficulty altering thoughts and behavioral responses in a changing environment, are found in individuals with bipolar disorder (BD) and are associated with poor social and work functioning. However, the current literature is inconsistent in clarifying the long-term nature of these deficits for those with BD. We administered a common task of cognitive flexibility, the Wisconsin Card Sorting Task (WCST) and accounted for demographics, clinical, and cognitive features of BD, to determine the state versus trait characteristics of these deficits. METHOD The Wisconsin Card Sorting Test (WCST) was administered to 154 adults with BD and 95 healthy controls twice, one year apart. RESULTS The main findings show that cognitive inflexibility is a trait feature of BD, independent of clinical features, that may modestly worsen over time due to the presence of certain demographic, cognitive, and functional features of the disorder. In addition, improvements in WCST performance over an extended period of time in both those with and those without already existing cognitive flexibility deficits indicate potential practice effects. CONCLUSIONS These findings suggest that the implementation of early interventions before the illness progresses could potentially prevent further cognitive impairment, mitigate functional outcomes, and improve the quality of life of the individual with BD.
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Affiliation(s)
- Lisa A O'Donnell
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | - Patricia J Deldin
- b Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Bethany Pester
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | - Melvin G McInnis
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | - Scott A Langenecker
- c Department of Psychiatry , University of Illinois at Chicago , Chicago , IL , USA
| | - Kelly A Ryan
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
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Verbal fluency in bipolar disorders: A systematic review and meta-analysis. J Affect Disord 2017; 207:359-366. [PMID: 27744224 DOI: 10.1016/j.jad.2016.09.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/29/2016] [Accepted: 09/27/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND One of the main features of bipolar disorder (BD), besides mood dysregulation, is an alteration of the structure of language. Bipolar patients present changes in semantic contents, impaired verbal associations, abnormal prosody and abnormal speed of language highlighted with various experimental tasks. Verbal fluency tasks are widely used to assess the abilities of bipolar patients to retrieve and produce verbal material from the lexico-semantic memory. Studies using these tasks have however yielded discrepant results. The aim of this study was thus to determine the extent of the verbal fluency impairment in BD patients and to evaluate if the deficits are affected by the type of task or by mood states. METHODS A systematic literature search was conducted in MEDLINE, EBSCOHost and Google Scholar and relevant data were submitted to a meta-analysis. RESULTS Thirty-nine studies were retained providing data for 52 independent groups of BD patients. The overall meta-analysis revealed a moderate verbal fluency impairment in BD compared to healthy controls (effect size d=0.61). Comparisons between mood states showed significant differences only between euthymic and manic patients and only on category fluency performances. LIMITATIONS This review is limited by the heterogeneity between studies for the characteristics of BD populations. Also, few of the retained studies examined depressive or mixed episodes. CONCLUSIONS This work confirms that BD patients present with moderate verbal fluency impairments, and underlines the specific effect of mood state on category fluency. This emphasizes the need to distinguish semantic from phonological processes in verbal fluency assessments in BD.
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Ryan KA, Assari S, Pester BD, Hinrichs K, Angers K, Baker A, Marshall DF, Stringer D, Saunders EFH, Kamali M, McInnis MG, Langenecker SA. Similar Trajectory of Executive Functioning Performance over 5 years among individuals with Bipolar Disorder and Unaffected Controls using Latent Growth Modeling. J Affect Disord 2016; 199:87-94. [PMID: 27093492 DOI: 10.1016/j.jad.2016.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/22/2016] [Accepted: 04/11/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Executive Functioning (EF) deficits in bipolar disorder (BD) are commonly present regardless of mood state and therefore are considered core features of the illness. However, very little is known about the temporal stability of these deficits. We examined the natural course of EF over a five year period in BD and healthy control (HC) samples. METHOD Using a 5-year longitudinal cohort, 91 individuals with BD and 17 HC were administered a battery of neuropsychological tests that captured four main areas of EF: Processing Speed with Interference Resolution, Verbal Fluency with Processing Speed, Inhibitory Control, and Conceptual Reasoning and Set Shifting. Evaluations occurred at study entry, one, and five years later. RESULTS Latent Growth Curve Modeling demonstrated that the BD group performed significantly worse in all EF areas than the HC group. Changes in EF from baseline to 5-year follow-up were similar across both diagnostic groups. Older age at baseline, above and beyond education and diagnosis, was associated with worse initial performance in EF. Being of older age was associated with greater decline in Processing Speed with Interference Resolution, and Verbal Fluency with Processing Speed. Higher education was marginally associated with a smaller declining slope for Processing Speed with Interference Resolution. CONCLUSIONS Executive functioning deficits in BD persist over time, and in the context of normative age-related decline, may place individuals at greater risk for cognitive disability as the disease progresses. Age and having a BD diagnosis together, however, do not accelerate executive functioning decline over time.
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Affiliation(s)
- Kelly A Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Bethany D Pester
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristin Hinrichs
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Kaley Angers
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Amanda Baker
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Deborah Stringer
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Erika F H Saunders
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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Holliday ED, Gould TJ. Chronic Nicotine Treatment During Adolescence Attenuates the Effects of Acute Nicotine in Adult Contextual Fear Learning. Nicotine Tob Res 2016; 19:87-93. [PMID: 27613891 DOI: 10.1093/ntr/ntw176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/29/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Adolescent onset of nicotine abuse is correlated with worse chances at successful abstinence in adulthood. One reason for this may be due to enduring learning deficits resulting from nicotine use during adolescence. Previous work has indicated that chronic nicotine administration beginning in late adolescence (PND38) caused learning deficits in contextual fear when tested in adulthood. The purpose of this study was to determine if chronic nicotine treatment during adolescence would alter sensitivity to nicotine's cognitive enhancing properties in adulthood. METHODS C57BL/6J mice received saline or chronic nicotine (12.6mg/kg/day) during adolescence (postnatal day 38) or adulthood (postnatal day 54) for a period of 12 days. Following a 30-day protracted abstinence, mice received either an acute injection of saline or nicotine (0.045, 0.18, and 0.36mg/kg) prior to training and testing a mouse model of contextual fear. RESULTS It was found that chronic nicotine administration in adult mice did not alter sensitivity to acute nicotine following a protracted abstinence. In adolescent mice, chronic nicotine administration disrupted adult learning and decreased sensitivity to acute nicotine in adulthood as only the highest dose tested (0.36mg/kg) was able to enhance contextual fear learning. CONCLUSIONS These results suggest that adolescent nicotine exposure impairs learning in adulthood, which could increase the risk for continued nicotine use in adulthood by requiring administration of higher doses of nicotine to reverse learning impairments caused by adolescent nicotine exposure. IMPLICATIONS Results from this study add to the growing body of literature suggesting chronic nicotine exposure during adolescence leads to impaired learning in adulthood and demonstrates that nicotine exposure during adolescence attenuates the cognitive enhancing effects of acute nicotine in adulthood, which suggests altered cholinergic function.
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Affiliation(s)
- Erica D Holliday
- Department of Psychology, Neuroscience Program, Temple University, Philadelphia, PA
| | - Thomas J Gould
- Department of Psychology, Neuroscience Program, Temple University, Philadelphia, PA
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de la Serna E, Vila M, Sanchez-Gistau V, Moreno D, Romero S, Sugranyes G, Baeza I, Llorente C, Rodriguez-Toscano E, Sánchez-Gutierrez T, Castro-Fornieles J. Neuropsychological characteristics of child and adolescent offspring of patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:54-9. [PMID: 26343306 DOI: 10.1016/j.pnpbp.2015.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/07/2015] [Accepted: 08/28/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a severe mental disorder with a strong genetic component. The assessment of child and adolescent offspring of patients diagnosed with BD (BDoff) provides an opportunity to investigate vulnerability factors and the first abnormalities associated with the disorder. Previous literature in child and adolescent BDoff is scarce and controversial. However, some studies concur in identifying significant impairment in executive functions, memory and attention. The present study aims to compare global neuropsychological characteristics of child and adolescent offspring of patients with bipolar disorder with a group of offspring of parentswith no history of psychotic disorder, and to assess the influence of psychopathology on neuropsychological performance. METHODS This research was part of The Bipolar and Schizophrenia Young Offspring Study (BASYS). A group of BDoff (N= 90) and a group of offspring of parents with no history of psychotic disorder (CC) (N = 107) were assessed with a complete neuropsychological battery. Intellectual quotient, working memory, processing speed, verbal memory and learning, visual memory, attention and executive functions were included in the cognitive assessment. RESULTS BDoff showed significantly worse performance in processing speed and immediate recall of visual memory relative to CC. When the presence of any lifetime psychopathology was analysed, the results showed that belonging to the BDoff group was the main explicative factor for the scores obtained in both processing speed and visual memory immediate recall, regardless of the presence of psychopathology. CONCLUSIONS These findings suggest that processing speed and visualmemory should be taken into consideration in future research on vulnerability markers of BD.
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Affiliation(s)
- Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain..
| | - Monserrat Vila
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain
| | - Vanessa Sanchez-Gistau
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain
| | - Dolores Moreno
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Soledad Romero
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain.; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Immaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain
| | - Cloe Llorente
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Elisa Rodriguez-Toscano
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Teresa Sánchez-Gutierrez
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Josefina Castro-Fornieles
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain.; Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain; Department of Psychiatry and Clinical Psychology, University of Barcelona, Spain
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Kuswanto C, Chin R, Sum MY, Sengupta S, Fagiolini A, McIntyre RS, Vieta E, Sim K. Shared and divergent neurocognitive impairments in adult patients with schizophrenia and bipolar disorder: Whither the evidence? Neurosci Biobehav Rev 2016; 61:66-89. [DOI: 10.1016/j.neubiorev.2015.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
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Kerr DS, Stella F, Radanovic M, Aprahamian I, Bertollucci PHF, Forlenza OV. Apolipoprotein E genotype is not associated with cognitive impairment in older adults with bipolar disorder. Bipolar Disord 2016; 18:71-7. [PMID: 26877211 DOI: 10.1111/bdi.12367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/22/2015] [Accepted: 12/04/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Cognitive decline is part of the long-term outcome for many individuals with bipolar disorder (BD). The ε4 allele (APOE*4) of apolipoprotein E (APOE) is a well-established risk factor for dementia in Alzheimer's disease (AD). However, its contribution to the risk of cognitive deterioration in BD has not yet been determined. Our aim was to analyze the APOE genotype association with cognitive status in a sample of older adults with BD and compare this to the association in individuals with AD, individuals with mild cognitive impairment (MCI), and healthy controls. METHODS Participants (n = 475) were allocated to four groups: individuals with BD (n = 77), those with AD (n = 211), those with MCI (n = 43), and healthy controls (n = 144) according to clinical and neuropsychological assessment. APOE was genotyped by real-time polymerase chain reaction. Tukey's honest significant difference test and Pearson's chi-squared test were used to compare diagnostic groups. RESULTS Subjects with BD were similar to controls with respect to the distribution of the APOE genotype (p = 0.636) and allele frequencies (p = 0.481). Significant differences were found when comparing the AD group to the BD group or to controls (APOE genotype: p < 0.0002; allele frequencies: p < 0.001). APOE*4 was significantly increased in the AD group when compared to the BD group (p = 0.031) and controls (p < 0.0001). The cognitively impaired BD subgroup (Mini-Mental State Examination below the cutoff score and/or neuropsychological assessment compatible with MCI) had a statistically significant higher frequency of APOE*2 compared to the AD group (p = 0.003). CONCLUSIONS APOE*4 is not associated with the diagnosis of BD and does not impact the occurrence of dementia in BD. Given the distinct clinical and biological features of cognitive impairment in BD, we hypothesized that dementia in BD is unrelated to AD pathological mechanisms.
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Affiliation(s)
- Daniel Shikanai Kerr
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil.,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, SP, Brazil
| | - Florindo Stella
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil.,Biosciences Institute, UNESP-Universidade Estadual Paulista, São Paulo, SP, Brazil
| | - Márcia Radanovic
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Ivan Aprahamian
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | | | - Orestes Vicente Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil.,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, SP, Brazil
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Are there differences in pattern and magnitude of cognitive deficits between euthymic patients with bipolar I and bipolar II disorder? MIDDLE EAST CURRENT PSYCHIATRY 2016. [DOI: 10.1097/01.xme.0000475311.46243.2f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Porter RJ, Robinson LJ, Malhi GS, Gallagher P. The neurocognitive profile of mood disorders - a review of the evidence and methodological issues. Bipolar Disord 2015; 17 Suppl 2:21-40. [PMID: 26688288 DOI: 10.1111/bdi.12342] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/19/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Cognitive abnormalities are an established part of the symptomatology of mood disorders. However, questions still exist regarding the exact profile of these deficits in terms of the domains most affected, their origins, and their relationship to clinical subtypes. This review aims to examine the current state of the evidence and to examine ways in which the field may be advanced. METHODS Studies examining cognitive function in bipolar disorder (BD) and unipolar major depression (MDD) were examined. Given the number and variability of such studies, particular attention was paid to meta-analyses and to meta-regression analyses which examined the possible mediators of cognitive impairment. RESULTS Meta-analyses are available for MDD and BD in both depression and euthymia. Several analyses examine mediators. Results do not support the presence of domain specific deficits but rather a moderate deficit across a range of domains in BD and in MDD. The data on clinical mediators is inconsistent, even with regard to the effect of mood state. CONCLUSIONS A two-tiered approach, with the broad-based application of standardized measures on a large-scale, and the refined application of theoretically driven experimental development would significantly further our understanding of neurocognitive processing in mood disorder.
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Affiliation(s)
- Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia.,Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle, UK.,Newcastle University Institute for Ageing, Newcastle, UK
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Vierck E. Intact interference and inhibitory functions in participants with bipolar disorder and their first-degree relatives. J Clin Exp Neuropsychol 2015; 37:1124-35. [DOI: 10.1080/13803395.2015.1081157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Bora E, Pantelis C. Meta-analysis of Cognitive Impairment in First-Episode Bipolar Disorder: Comparison With First-Episode Schizophrenia and Healthy Controls. Schizophr Bull 2015; 41:1095-104. [PMID: 25616505 PMCID: PMC4535631 DOI: 10.1093/schbul/sbu198] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Neurocognitive deficits are evident both in established schizophrenia and bipolar disorder (BP). However, it has been suggested that schizophrenia, but not BP, is characterized by neurodevelopmental abnormalities that can lead to cognitive deficits at the earliest stages of the illness. The aim of this meta-analytic review was to compare neurocognitive deficits in first-episode BP (FEBP) with healthy controls and first-episode schizophrenia (FES) patients. The current meta-analysis included a total of 22 adult studies and involved comparisons of 533 FEBP patients with 1417 healthy controls and 605 FEBP and 822 FES patients. FEBP patients were significantly impaired in all cognitive domains (d = 0.26-0.80) and individual tasks (d = 0.22-0.66) investigated. FES patients significantly underperformed FEBP patients in most cognitive domains (d = 0.05-0.63) and on individual tasks (d = 0.13-0.77). Neuropsychological impairment, which is comparable to chronic BP, was evident in FEBP. Similar to chronic patients, cognitive functions in FEBP lie intermediate between FES and healthy controls. Neurodevelopmental factors are likely to play a significant role not only in schizophrenia but also in BP.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Victoria, Australia
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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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Balanzá-Martínez V, Crespo-Facorro B, González-Pinto A, Vieta E. Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates. Front Physiol 2015; 6:108. [PMID: 25904869 PMCID: PMC4387475 DOI: 10.3389/fphys.2015.00108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/17/2015] [Indexed: 12/20/2022] Open
Abstract
Bipolar disorder (BD) and alcohol use disorders (AUDs) are usually comorbid, and both have been associated with significant neurocognitive impairment. Patients with the BD-AUD comorbidity (dual diagnosis) may have more severe neurocognitive deficits than those with a single diagnosis, but there is paucity of research in this area. To explore this hypothesis more thoroughly, we carried out a systematic literature review through January 2015. Eight studies have examined the effect of AUDs on the neurocognitive functioning of BD patients. Most studies found that BD patients with current or past history of comorbid AUDs show more severe impairments, especially in verbal memory and executive cognition, than their non-dual counterparts. Greater neurocognitive dysfunction is another facet of this severe comorbid presentation. Implications for clinical practice and research are discussed. Specifically, the application of holistic approaches, such as clinical staging and systems biology, may open new avenues of discoveries related to the BD-AUD comorbidity.
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Affiliation(s)
- Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry, Deparment of Medicine, School of Medicine, La Fe University and Polytechnic Hospital, University of Valencia, CIBERSAM, ISNPR Valencia, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria-IDIVAL, CIBERSAM Santander, Spain
| | - Ana González-Pinto
- Álava University Hospital, CIBERSAM, University of the Basque Country Kronikgune, Vitoria, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM Barcelona, Spain
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Neuropsychological and functional outcomes in recent-onset major depression, bipolar disorder and schizophrenia-spectrum disorders: a longitudinal cohort study. Transl Psychiatry 2015; 5:e555. [PMID: 25918992 PMCID: PMC4462613 DOI: 10.1038/tp.2015.50] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/02/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022] Open
Abstract
Functional disability is the lead contributor to burden of mental illness. Cognitive deficits frequently limit functional recovery, although whether changes in cognition and disability are longitudinally associated in recent-onset individuals remains unclear. Using a prospective, cohort design, 311 patients were recruited and assessed at baseline. One hundred and sixty-seven patients met eligibility criteria (M=21.5 years old, s.d.=4.8) and returned for follow-up (M=20.6 months later, s.d.=7.8). Two-hundred and thirty participants were included in the final analysis, comprising clinically stable patients with major depression (n=71), bipolar disorder (BD; n=61), schizophrenia-spectrum disorders (n=35) and 63 healthy controls. Neuropsychological functioning and self-rated functional disability were examined using mixed-design, repeated-measures analysis, across diagnoses and cognitive clusters, covarying for relevant confounds. Clinical, neuropsychological and functional changes did not differ between diagnoses (all P>0.05). Three reliable neuropsychological subgroups emerged through cluster analysis, characterized by psychomotor slowing, improved sustained attention, and improved verbal memory. Controlling for diagnosis and changes in residual symptoms, clusters with improved neuropsychological functioning observed greater reductions in functional disability than the psychomotor slowing cluster, which instead demonstrated a worsening in disability (P<0.01). Improved sustained attention was independently associated with greater likelihood of follow-up employment (P<0.01). Diagnosis of BD uniquely predicted both follow-up employment and independent living. Neuropsychological course appears to be independently predictive of subjective and objective functional outcomes. Importantly, cognitive phenotypes may reflect distinct pathophysiologies shared across major psychiatric conditions, and be ideal targets for personalized early intervention.
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Baş TÖ, Poyraz CA, Baş A, Poyraz BÇ, Tosun M. The impact of cognitive impairment, neurological soft signs and subdepressive symptoms on functional outcome in bipolar disorder. J Affect Disord 2015; 174:336-41. [PMID: 25545601 DOI: 10.1016/j.jad.2014.12.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/06/2014] [Accepted: 12/06/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive impairments and subsyndromal depressive symptoms are present during euthymic periods of bipolar disorder (BD). Most studies have determined that cognitive impairments and residual depressive symptoms have major impacts on psychosocial functioning. The aim of the present study was to identify the major factor responsible for low psychosocial functioning in a subgroup of patients with BD despite clinical recovery. METHODS Sixty patients with bipolar I disorder and 41 healthy subjects were enrolled in this study. Cognitive performance, neurological soft signs (NSSs), psychosocial functioning, residual mood symptoms and illness characteristics were assessed. Using the median value of the Functioning Assessment Short Test (FAST) as the cut-off point, the patients were divided into two groups, high- (n=29) or low-functioning (n=31), and they were compared based on total NSS, residual depressive symptoms, cognitive performance and clinical variables. RESULTS Performances on the verbal memory tests and social functioning were significantly worse in the euthymic patients with BD. Increased rates of NSS were identified in the patients compared with the normal controls. The low-functioning patients performed significantly worse on verbal memory, and their NSS and residual depressive symptoms were significantly higher compared to high-functioning patients. In the regression analysis, subsyndromal depressive symptoms and verbal learning measures were identified as the best predictors of psychosocial functioning. LIMITATIONS The patients were artificially separated into two groups based on a FAST score cut-off. CONCLUSIONS In this study, residual depressive symptoms and verbal memory impairments were the most prominent factors associated with the level of functioning.
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Affiliation(s)
- Tuba Öcek Baş
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Alper Baş
- Department of Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Burç Çağrı Poyraz
- Department of Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Musa Tosun
- Department of Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Zaninotto L, Guglielmo R, Calati R, Ioime L, Camardese G, Janiri L, Bria P, Serretti A. Cognitive markers of psychotic unipolar depression: a meta-analytic study. J Affect Disord 2015; 174:580-8. [PMID: 25560194 DOI: 10.1016/j.jad.2014.11.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/15/2014] [Accepted: 11/15/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND The goal of the current meta-analysis was to review and examine in detail the features of cognitive performance in psychotic (MDDP) versus non-psychotic (MDD) major depressive disorder. METHODS An electronic literature search was performed to find studies comparing cognitive performance in MDDP versus MDD. A meta-analysis of broad cognitive domains (processing speed, reasoning/problem solving, verbal learning, visual learning, attention/working memory) and individual cognitive tasks was conducted on all included studies (n=12). Demographic and clinical features were investigated via meta-regression analysis as moderators of cognitive performance. RESULTS No difference in socio-demographic and clinical variables was detected between groups. In general, a poorer cognitive performance was detected in MDDP versus MDD subjects (ES=0.38), with a greater effect size in drug-free patients (ES=0.69). MDDP patients were more impaired in verbal learning (ES=0.67), visual learning (ES=0.62) and processing speed (ES=0.71) tasks. A significantly poorer performance was also detected in MDDP patients for individual tasks as Trail Making Test A, WAIS-R digit span backward and WAIS-R digit symbol. Age resulted to have a negative effect on tasks involved in working memory performance. CONCLUSION In line with previous meta-analyses, our findings seem to support an association between psychosis and cognitive deficits in the context of affective disorders. Psychosis during the course of MDD is associated with poorer cognitive performance in some specific cognitive domains, such as visual and verbal learning and executive functions.
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Affiliation(s)
- Leonardo Zaninotto
- Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy; Department of Biomedical and Neuro-Motor Sciences, University of Bologna, Bologna, Italy
| | - Riccardo Guglielmo
- Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy
| | - Raffaella Calati
- INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France
| | - Lucia Ioime
- Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy; Department of Human Sciences, Lumsa University, Rome, Italy
| | - Giovanni Camardese
- Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Bria
- Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuro-Motor Sciences, University of Bologna, Bologna, Italy.
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Tsitsipa E, Fountoulakis KN. The neurocognitive functioning in bipolar disorder: a systematic review of data. Ann Gen Psychiatry 2015; 14:42. [PMID: 26628905 PMCID: PMC4666163 DOI: 10.1186/s12991-015-0081-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND During the last decades, there have been many different opinions concerning the neurocognitive function in Bipolar disorder (BD). The aim of the current study was to perform a systematic review of the literature and to synthesize the data in a comprehensive picture of the neurocognitive dysfunction in BD. METHODS Papers were located with searches in PubMed/MEDLINE, through June 1st 2015. The review followed a modified version of the recommendations of the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses statement. RESULTS The initial search returned 110,403 papers. After the deletion of duplicates, 11,771 papers remained for further evaluation. Eventually, 250 were included in the analysis. CONCLUSION The current review supports the presence of a neurocognitive deficit in BD, in almost all neurocognitive domains. This deficit is qualitative similar to that observed in schizophrenia but it is less severe. There are no differences between BD subtypes. Its origin is unclear. It seems it is an enduring component and represents a core primary characteristic of the illness, rather than being secondary to the mood state or medication. This core deficit is confounded (either increased or attenuated) by the disease phase, specific personal characteristics of the patients (age, gender, education, etc.), current symptomatology and its treatment (especially psychotic features) and long-term course and long-term exposure to medication, psychiatric and somatic comorbidity and alcohol and/or substance abuse.
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Affiliation(s)
| | - Konstantinos N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos street (1st Parodos, Ampelonon str.) 55536 Pournari Pylaia, Thessaloniki, Greece
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Lewandowski KE, Sperry SH, Malloy MC, Forester BP. Age as a predictor of cognitive decline in bipolar disorder. Am J Geriatr Psychiatry 2014; 22:1462-8. [PMID: 24262287 PMCID: PMC3977013 DOI: 10.1016/j.jagp.2013.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/06/2013] [Accepted: 10/02/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Cognitive dysfunction is a core feature of bipolar disorder (BD) in both adult and geriatric patients. However, little is known about whether cognitive functioning declines at a faster rate in patients with BD, and there are conflicting reports regarding the relationship between age and cognitive functioning in this population. This cross-sectional study examined the relationship between age and cognitive functioning in patients with BD. METHODS Patients with BD I (N = 113) and healthy adults (N = 64) ages 18-87 completed measures of processing speed, attention, executive functioning, verbal fluency, and clinical symptomatology. Groupwise comparisons were used to examine differences between patients and the comparison group and adult and geriatric BD cohorts. A series of linear regressions was conducted to examine the relationship of age and cognitive functioning and clinical variables and cognition. RESULTS Patients performed significantly worse than the comparison group on all neuropsychological measures. Age was a significant predictor of Trails A scores with older age associated with worse performance. CONCLUSIONS Older age was associated with poorer performance on Trails A in patients with BD but not healthy adults. These results are suggestive of greater dysfunction in processing speed with older age in patients with BD compared with a healthy comparison group. Because cognitive functioning is associated with community outcomes, these findings suggest a need for treatments targeting cognitive symptoms across the life span. Future research exploring neurobiologic evidence for neurodegenerative processes in BD will pave the way for potential therapeutic interventions.
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Affiliation(s)
- Kathryn E. Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA,Harvard Medical School, Department of Psychiatry, Landmark Ctr., 401 Park Dr., Boston, MA, 02215, USA
| | - Sarah H. Sperry
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA
| | - Mary C. Malloy
- Geriatric Mood Disorders Research Program, McLean Hospital, 115 Mill St., Belmont, MA 02478 USA
| | - Brent P. Forester
- Harvard Medical School, Department of Psychiatry, Landmark Ctr., 401 Park Dr., Boston, MA, 02215, USA,Geriatric Mood Disorders Research Program, McLean Hospital, 115 Mill St., Belmont, MA 02478 USA
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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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Santos JL, Aparicio A, Bagney A, Sánchez-Morla EM, Rodríguez-Jiménez R, Mateo J, Jiménez-Arriero MÁ. A five-year follow-up study of neurocognitive functioning in bipolar disorder. Bipolar Disord 2014; 16:722-31. [PMID: 24909395 DOI: 10.1111/bdi.12215] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 08/27/2013] [Accepted: 10/16/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Cognitive dysfunction in bipolar disorder has been well-established in cross-sectional studies; however, there are few data regarding the longitudinal course of cognitive performance in bipolar disorder. The aim of this study was to examine the course of cognitive function in a sample of euthymic patients with bipolar disorder during a five-year follow-up period. METHODS Eighty euthymic outpatients with a DSM-IV diagnosis of bipolar disorder and 40 healthy control comparison subjects were neuropsychologically assessed at baseline (T1) and then at follow-up of five years (T2). A neurocognitive battery including the main cognitive domains of speed of processing, working memory, attention, verbal memory, visual memory, and executive function was used to evaluate cognitive performance. RESULTS Repeated-measures multivariate analyses showed that progression of cognitive dysfunction in patients was not different to that of control subjects in any of the six cognitive domains examined. Only a measure from the verbal memory domain, delayed free recall, worsened more in patients with bipolar disorder. Additionally, it was found that clinical course during the follow-up period did not influence the course of cognitive dysfunction. CONCLUSIONS Cognitive dysfunction that is characteristic of bipolar disorder is persistent and stable over time. Only dysfunction in verbal recall was found to show a progressive course that cannot be explained by clinical or treatment variables.
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Affiliation(s)
- José Luis Santos
- Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
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Asaad T, Okasha T, Ramy H, Fekry M, Zaki N, Azzam H, Rabie MA, Elghoneimy S, Sultan M, Hamed H, Refaat O, Shorab I, Elhabiby M, Elgweily T, ElShinnawy H, Nasr M, Fathy H, Meguid MA, Nader D, Elserafi D, Enaba D, Ibrahim D, Elmissiry M, Mohsen N, Ahmed S. Correlates of psychiatric co-morbidity in a sample of Egyptian patients with bipolar disorder. J Affect Disord 2014; 166:347-52. [PMID: 24981131 DOI: 10.1016/j.jad.2014.04.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/25/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Bipolar disorder (BD) is a complex, chronic mood disorder involving repeated episodes of depression and mania/hypomania. Two thirds of patients with bipolar disorder have a comorbid psychiatric condition. This study aims to assess the prevalence of Axis I diagnosis with its socio-demographic and clinical correlates among a sample of Egyptian patients with bipolar disorder. METHODS Out of the 400 patients who were enrolled in the study from number of governmental and private psychiatric hospitals in Cairo, Egypt, 350 patients diagnosed with bipolar affective disorders (157 females and 193 males) with age ranging from 18 to 55years were selected. Patients were assessed using the Structured Clinical Interview for DSM-IV Axis I disorder (Research Version) (SCID-I). RESULTS Prevalence of psychiatric comorbidity among BD patients was 20.3% (71 patients) among which 63 patients (18%) had comorbid substance abuse and 8 patients (2.3%) had comorbid anxiety disorders. LIMITATIONS The study was limited by its cross sectional design with some patients having florid symptoms during assessment, not having a well representative community sample. This might have decreased the reliability and prevalence of lifetime psychiatric comorbidity due to uncooperativeness or memory bias. The study group was composed of bipolar patients attending tertiary care service which limits the possibility of generalizing these results on different treatment settings. CONCLUSIONS Substance abuse followed by anxiety disorders was found to be the most common psychiatric comorbidity. Family history of psychiatric disorders and substance abuse as well as current psychotic features were highly correlated with comorbidity.
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Affiliation(s)
- Tarek Asaad
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Tarek Okasha
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Hisham Ramy
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Mohamed Fekry
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Nivert Zaki
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Hanan Azzam
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | | | - Soheir Elghoneimy
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Marwa Sultan
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Hani Hamed
- Institute of Psychiatry, Cairo University, Egypt
| | - Osama Refaat
- Institute of Psychiatry, Cairo University, Egypt
| | - Iman Shorab
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Mahmoud Elhabiby
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | | | | | - Mohamed Nasr
- Institute of Psychiatry, Cairo University, Egypt
| | - Heba Fathy
- Institute of Psychiatry, Cairo University, Egypt
| | - Marwa A Meguid
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Doaa Nader
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Doha Elserafi
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Dalia Enaba
- Institute of Psychiatry, Cairo University, Egypt
| | - Dina Ibrahim
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Marwa Elmissiry
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Nesreen Mohsen
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
| | - Sherin Ahmed
- Institute of Psychiatry, Ain Shams University, PO Box: 11657, Cairo, Egypt
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Melcher T, Wolter S, Falck S, Wild E, Wild F, Gruber E, Falkai P, Gruber O. Common and disease-specific dysfunctions of brain systems underlying attentional and executive control in schizophrenia and bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2014; 264:517-32. [PMID: 24061607 DOI: 10.1007/s00406-013-0445-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022]
Abstract
Schizophrenia and bipolar disorder broadly overlap in multiple areas involving clinical phenomenology, genetics, and neurobiology. Still, the investigation into specific elementary (sub-)processes of executive functioning may help to define clear points of distinction between these categorical diagnoses to validate the nosological dichotomy and, indirectly, to further elucidate their pathophysiological underpinnings. In the present behavioral study, we sought to separate common from diagnosis-specific deficits in a series of specific elementary sub-functions of executive processing in patients with schizophrenia and bipolar disorder. For our purpose, we administered a modern and multi-purpose neuropsychological task paradigm to equal-sized and matched groups of schizophrenia patients, patients with bipolar disorder, and healthy control subjects. First, schizophrenia patients compared to the bipolar group exhibited a more pronounced deficit in general measures of task performance comprising both response speed and accuracy. Additionally, bipolar patients showed increased advance task preparation, i.e., were better able to compensate for response speed deficits when longer preparation intervals were provided. Set-shifting, on the other hand, was impaired to a similar degree in both patient groups. Finally, schizophrenia patients exhibited a specific deficit in conflict processing (inhibitory control) and the shielding of task-relevant processing from distraction (i.e., attentional maintenance). The present investigation suggests that specific neuropsychological measures of elementary executive functions may represent important points of dissociation between schizophrenia and bipolar disorder, which may help to differentiate the pathophysiological underpinnings of these major psychiatric disorders. In this context, the present findings highlight the measures of inhibitory control and attentional maintenance as promising candidates.
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Affiliation(s)
- Tobias Melcher
- Centre for Translational Research in Systems Neuroscience and Clinical Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany,
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Investigation of the component processes involved in verbal declarative memory function in bipolar disorder: utility of the Hopkins Verbal Learning Test-Revised. J Int Neuropsychol Soc 2014; 20:727-35. [PMID: 24870365 DOI: 10.1017/s1355617714000484] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Evidence suggests that standard learning and recall indexes are sensitive markers of verbal declarative memory ability in bipolar disorder (BD), but no study has examined performance across the full range of component process measures on the Hopkins Verbal Learning Test (HVLT-R) in a BD cohort. As the HVLT-R is part of a widely used battery of cognitive functioning backed by the U.S. Federal Drug Administration as the accepted battery for use in pro-cognitive trials assessing cognitive-enhancing drugs in the related disorder schizophrenia, estimating the utility of its measures in BD is important. Forty-nine BD patients and 51 healthy controls completed the HVLT-R, which was scored for 13 variables of interest, across 4 indices: recall and learning, recognition, strategic organization, and errors. BD patients had greater difficulty in learning the HVLT-R word list compared to controls. They also demonstrated impairment in delayed recall/recognition. There were no differences between the groups in terms of their slope of learning, retrieval index, retention percentage, semantic or serial clustering, errors, or level of retrieval. This pattern was consistent across symptomatic and euthymic patients. The HVLT-R has some utility in characterizing the component processes involved in memory function in BD, such that memory impairments appear to be attributable to deficient encoding processes during the acquisition phase of learning. In the case of planning pro-cognitive clinical trials, the encoding deficits in BD observed here may be sensitive enough to potentially respond to medications designed to enhance the verbal memory performance.
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Samamé C, Martino DJ, Strejilevich SA. Longitudinal course of cognitive deficits in bipolar disorder: a meta-analytic study. J Affect Disord 2014; 164:130-8. [PMID: 24856566 DOI: 10.1016/j.jad.2014.04.028] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/11/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Persistent cognitive deficits in bipolar disorder represent a major impediment to functional adjustment, but their static or progressive nature remains to be ascertained. The aim of this study was to synthesize findings from longitudinal research in order to examine the trajectory of cognitive impairment in bipolar disorder. METHOD A literature search was conducted through online databases covering the period between January 1990 and February 2014. Two approaches were undertaken. First, the results of longitudinal studies including neuropsychological assessment of stable bipolar patients at baseline and after a follow-up period of at least one year were meta-analyzed so as to obtain overall test-retest effect sizes for neurocognitive domains. Second, meta-analysis was restricted to longitudinal studies of bipolar patients including a control group. Patients' and controls' overall test-retest effect sizes were compared. RESULTS Bipolar patients' performance on 14 cognitive measures remained stable after a mean follow-up period of 4.62 years. When meta-analysis was restricted to controlled studies, no patient-control differences were found regarding longitudinal cognitive outcomes. LIMITATIONS Test-retest differences for medication variables and mood state could not be controlled. Sufficient data were not available to investigate a wider array of neuropsychological domains. Furthermore, most primary studies included relatively short test-restest intervals. CONCLUSION To date, the available evidence from longitudinal studies is not in accordance with the hypothesis of a progressive nature of cognitive deficits in BD. The implications of this finding for further research are discussed.
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Affiliation(s)
- Cecilia Samamé
- Bipolar Disorders Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Diego J Martino
- Bipolar Disorders Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Sergio A Strejilevich
- Bipolar Disorders Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina.
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Woudstra FH, van de Poel-Mustafayeva AT, van der Ploeg MV, de Vries JJ, van der Lek RFR, Izaks GJ. Symptoms mimicking dementia in a 60-year-old woman with bipolar disorder: a case report. BMC Res Notes 2014; 7:381. [PMID: 24951023 PMCID: PMC4078009 DOI: 10.1186/1756-0500-7-381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background Dementia is generally considered an irreversible process of cognitive decline that can be caused by different neurodegenerative diseases. However, in some cases, dementia is caused by a non-neurodegenerative disease, such as an affective disorder. In these cases, the dementia can be reversible. Nevertheless, cognitive symptoms due to an affective disorder are often difficult to distinguish from a depressed mood due to a neurodegenerative disease. Especially in elderly patients with a history of affective disorder, a potentially reversible cause can be missed. Case presentation We describe a 60-year-old white woman with bipolar disorder, depressive symptoms, a movement disorder and severe cognitive impairment, in whom a neurodegenerative disease was seriously considered. She was referred to our clinic for further investigation because initial treatment of the depressive episode with antidepressants, mood stabilizers and electroconvulsive therapy (ECT) had not been successful. However, despite extensive evaluation, we could not find evidence for a neurodegenerative disease and the patient mostly recovered after discontinuation of different psychotropic medications and treatment with nortriptyline. Conclusions Our case shows that improvement of severe cognitive impairment in individual cases is possible. In our opinion, this underlines the necessity of a careful re-evaluation of the patient’s symptoms at presentation and the course of the disease as well as a critical review of the prescribed medications.
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Affiliation(s)
| | | | | | | | | | - Gerbrand J Izaks
- University of Groningen, University Medical Centre Groningen, University Centre for Geriatric Medicine, Internal Postcode AA43, P,O, Box 30,001, Groningen 9700 RB, The Netherlands.
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Reilly JL, Sweeney JA. Generalized and specific neurocognitive deficits in psychotic disorders: utility for evaluating pharmacological treatment effects and as intermediate phenotypes for gene discovery. Schizophr Bull 2014; 40:516-22. [PMID: 24574307 PMCID: PMC3984526 DOI: 10.1093/schbul/sbu013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A growing body of research suggests that schizophrenia and bipolar disorder share overlapping clinical, neurobiological, and genetic features, raising important questions about the boundaries and distinctiveness of these 2 major psychiatric disorders. A generalized cognitive impairment has long been understood to be a core feature of schizophrenia. More recently, it has become apparent that cognitive impairment also occurs in bipolar disorder, particularly in those patients with a history of psychotic symptoms. Whether a generalized deficit exists across a spectrum of psychotic disorders is less clearly established. Additionally, in the context of a broad impairment, it remains a significant challenge to identify deficits in specific cognitive processes that may have distinct neurochemical or regional brain substrates and linkages to particular risk-associated genetic factors. In this article, we review the findings from neuropsychological studies across a spectrum that includes schizophrenia, schizoaffective and bipolar disorders, and conclude the available evidence strongly supports that a generalized deficit is present across psychotic disorders that differs in severity more so than form. We then consider the implications of generalized and specific deficits in psychosis for 2 areas of research--the evaluation of pharmacological treatments targeting cognitive deficits, and the investigation of cognitive intermediate phenotypes in family genetic studies. Examples from the literature that touch on the relevance of the generalized deficit in these contexts are provided, as well as consideration for the continued need to identify specific impairments that are separable from the generalized deficit in order to advance drug and gene discovery.
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Affiliation(s)
- James L. Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL;,*To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Street Suite 7–100, Chicago, IL, US; tel: 312-503-4809, fax: 312-503-0527, e-mail:
| | - John A. Sweeney
- Departments of Psychiatry and Pediatrics, UT Southwestern Medical Center, Dallas, TX
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Savitz JB, Price JL, Drevets WC. Neuropathological and neuromorphometric abnormalities in bipolar disorder: view from the medial prefrontal cortical network. Neurosci Biobehav Rev 2014; 42:132-47. [PMID: 24603026 DOI: 10.1016/j.neubiorev.2014.02.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/20/2014] [Accepted: 02/19/2014] [Indexed: 12/15/2022]
Abstract
The question of whether BD is primarily a developmental disorder or a progressive, neurodegenerative disorder remains unresolved. Here, we review the morphometric postmortem and neuroimaging literature relevant to the neuropathology of bipolar disorder (BD). We focus on the medial prefrontal cortex (mPFC) network, a key system in the regulation of emotional, behavioral, endocrine, and innate immunological responses to stress. We draw four main conclusions: the mPFC is characterized by (1) a decrease in volume, (2) reductions in neuronal size, and/or changes in neuronal density, (3) reductions in glial cell density, and (4) changes in gene expression. These data suggest the presence of dendritic atrophy of neurons and the loss of oligodendroglial cells in BD, although some data additionally suggest a reduction in the cell counts of specific subpopulations of GABAergic interneurons. Based on the weight of the postmortem and neuroimaging literature discussed herein, we favor a complex hypothesis that BD primarily constitutes a developmental disorder, but that additional, progressive, histopathological processes also are associated with recurrent or chronic illness. Conceivably BD may be best conceptualized as a progressive neurodevelopmental disorder.
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Affiliation(s)
- Jonathan B Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA; Faculty of Community Medicine, University of Tulsa, Tulsa, OK, USA.
| | - Joseph L Price
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wayne C Drevets
- Laureate Institute for Brain Research, Tulsa, OK, USA; Janssen Pharmaceuticals of Johnson & Johnson, Inc., Titusville, NJ, USA
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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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