1
|
Khedr MA, El-Ashry AM, El-Sayed MM, Elkot MA, Hussein RM. The effect of physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders: A randomized control trial. Arch Psychiatr Nurs 2024; 49:83-92. [PMID: 38734459 DOI: 10.1016/j.apnu.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/15/2023] [Accepted: 02/09/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Despite evidence that physical exercises have been helpful in the treatment of various psychiatric disorders, it is unclear whether these data can be generalized to bipolar disorder. The use of physical exercises is challenging and hopeful among patients with bipolar disorders. Few studies have examined the efficacy of physical exercise for patients with bipolar disorders. OBJECTIVE Investigate the effect of applying physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders. METHODS This study followed a randomized control trial design "pre and post-test." Patients were randomly allocated to intervention (n = 25) and control groups (Waiting list) (n = 25). The Social Functioning Scale, Toronto Alexithymia Scale, and Sense of Coherence scales were applied in the study. Pre-test and post-tests were administered to investigate the effect of applying the physical exercises program between December 2022 to March 2023. RESULTS A statistically significant increase in the mean sense of coherence and social functioning scores among the study group. Mean alexithymia scores were significantly decreased among the study group between pre, immediately after, and after a three-month follow-up period. CONCLUSION Physical exercises are an adjunctive treatment modality that is helpful for patients with bipolar disorders. Nurse educators and service providers should reconsider the physical health care requirements for patients with bipolar disorders to equip them to manage the common comorbidities in people with mental illness.
Collapse
Affiliation(s)
- Mahmoud Abdelwahab Khedr
- Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia.
| | - Ayman Mohamed El-Ashry
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mona Metwally El-Sayed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mohamed Ali Elkot
- Department of Exercises, Faculty of Sports Education for Men, Alexandria University, Egypt.
| | - Rash Mohamed Hussein
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt; Department of Community and Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraidah, Saudi Arabia.
| |
Collapse
|
2
|
Miguel N, Marquez-Arrico JE, Jodar M, Navarro JF, Adan A. Neuropsychological functioning of patients with major depression or bipolar disorder comorbid to substance use disorders: A systematic review. Eur Neuropsychopharmacol 2023; 75:41-58. [PMID: 37453267 DOI: 10.1016/j.euroneuro.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Major depression disorder (MDD) and bipolar disorder (BD) are usual comorbidities in patients with substance use disorders (SUD), a condition known as dual disorder (DD). MDD, BD and SUD are associated with cognitive impairment, potentially leading to a greater functional impairment in the context of DD. OBJECTIVES To review the existing data on the cognitive impairment in DD patients with comorbid MDD or BD, considering the influence of the depressive symptomatology. METHODS Following the PRISMA protocol 19 studies were selected from the last 17 years, 13 of which focused on BD, five on MDD and one included both diagnoses. RESULTS Studies based in BD+SUD showed that the most affected cognitive domains were attention and executive functions, but not all of them found a greater impairment due to the comorbidity. While fewer studies were found for depression, MDD+SUD works point to a similar impairment cognitive pattern. Furthermore, depression improvement could be associated to better cognitive performance. LIMITATIONS More standardized research is needed regarding the influence of depression on cognitive performance of DD patients, especially on those with comorbid MDD. Factors such as main substance, abstinence, or MDD/BD-related variables should be considered. Unstudied factors, like gender or circadian rhythms, are proposed to improve knowledge in this area. CONCLUSIONS Current studies suggest that DD could potentiate cognitive impairment in BD, MDD and SUD. However, additional research is needed to improve the understanding of comorbidity to apply more individualized therapies in the treatment of these patients, considering the interference of their neurocognitive functioning.
Collapse
Affiliation(s)
- Nuria Miguel
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain
| | - Julia E Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain; Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Spain
| | - Mercè Jodar
- Neurology Service, Hospital Universitari Parc Taulí, Sabadell, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud mental (CIBERSAM), Instituto de salud Carlos III, Madrid, Spain
| | | | - Ana Adan
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain; Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Spain.
| |
Collapse
|
3
|
Lippard ETC, Kirsch DE, Kosted R, Le V, Almeida JRC, Fromme K, Strakowski SM. Subjective response to alcohol in young adults with bipolar disorder and recent alcohol use: a within-subject randomized placebo-controlled alcohol administration study. Psychopharmacology (Berl) 2023; 240:739-753. [PMID: 36695842 PMCID: PMC10084816 DOI: 10.1007/s00213-023-06315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
Limited data exists on mechanisms contributing to elevated risk for alcohol use disorder (AUD) in bipolar disorder. Variation in subjective response to alcohol may relate to alcohol use and risk for AUD. This study used a randomized, placebo-controlled, cross-over, within-subjects design to investigate differences in subjective response to alcohol in 50 euthymic young adults (n = 24 with and n = 26 without bipolar disorder type I). Eighty-three percent of participants with bipolar disorder were medicated. Participants completed assessments of clinical history, alcohol expectancies, and recent alcohol use. Participants were dosed to a .08 g% breath alcohol concentration. The placebo condition occurred on a separate counter-balanced day. Subjective response to alcohol was investigated at similar time points during both conditions. Group, condition, and group-by-condition interactions were modeled, with condition and time of subjective response assessment as repeated within-subject variables, and subjective response to alcohol as the dependent variable. Greater stimulating effects and liking of alcohol were reported in people with bipolar disorder (group-by-condition interactions, p < .05) than healthy young adults. While young adults with bipolar disorder reported anticipating feeling less "mellow/relaxed" when drinking (p = .02), during both beverage conditions they reported feeling more "mellow/relaxed" (main effect of group, p = .006). Feeling more "mellow/relaxed" during the alcohol condition related to greater recent alcohol use in bipolar disorder (p = .001). Exploratory analyses suggested anticonvulsants and sedatives/antihistamines may relate to differences in subjective response to alcohol in bipolar disorder. Results suggest young adults with bipolar disorder may differ in alcohol expectancies and experience alcohol intoxication differently-with distinct relations between subjective response to alcohol and alcohol use-compared to healthy young adults.
Collapse
Affiliation(s)
- Elizabeth T C Lippard
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA.
- Department of Psychology, University of Texas, Austin, TX, USA.
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA.
- Institute for Neuroscience, University of Texas, Austin, TX, USA.
- Institute of Early Life Adversity Research, University of Texas, Austin, TX, USA.
| | - Dylan E Kirsch
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA
- Institute for Neuroscience, University of Texas, Austin, TX, USA
| | - Raquel Kosted
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
| | - Vanessa Le
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
| | - Jorge R C Almeida
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
| | - Kim Fromme
- Department of Psychology, University of Texas, Austin, TX, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA
| | - Stephen M Strakowski
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
- Department of Psychology, University of Texas, Austin, TX, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA
- Institute for Neuroscience, University of Texas, Austin, TX, USA
| |
Collapse
|
4
|
Radua J, Fortea L, Goikolea JM, Zorrilla I, Bernardo M, Arrojo M, Cunill R, Castells X, Becoña E, López-Durán A, Torrens M, Tirado-Muñoz J, Fonseca F, Arranz B, Garriga M, Sáiz PA, Flórez G, San L, González-Pinto A. Meta-analysis of the effects of adjuvant drugs in co-occurring bipolar and substance use disorder. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2023:S1888-9891(23)00006-X. [PMID: 37689524 DOI: 10.1016/j.rpsm.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) often have co-occurring substance use disorders (SUDs), which substantially impoverish the course of illness. Despite the importance of this dual diagnosis, the evidence of the efficacy and safety of adjuvant treatments is mostly unknown. OBJECTIVE To perform a meta-analysis to evaluate the efficacy and safety of adjuvant drugs in patients with co-occurring BD and SUD. METHODS We searched PubMed, Scopus, and Web of Knowledge until 30th April 2022 for randomized clinical trials (RCT) evaluating the efficacy and safety of adjuvant drugs compared to placebo in patients with a dual diagnosis of BD and SUD. We meta-analyzed the effect of adjuvant drugs on general outcomes (illness severity, mania, depression, anxiety, abstinence, substance craving, substance use, gamma-GT, adherence, and adverse events) and used the results to objectively assess the quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. For completeness, we also report the specific effects of specific adjuvant drugs in patients with specific substance disorders. RESULTS We included 15 RCT studies (9 alcohol, 3 cocaine, 2 nicotine, and 1 cannabis) comprising 628 patients allocated to treatment and 622 to placebo. There was low-quality evidence that adjuvant drugs may reduce illness severity (g=-0.25, 95% CI: -0.44, -0.06), and very-low quality evidence that they may decrease substance use (g=-0.23, 95% CI: -0.44, -0.02) and increase substance abstinence (g=0.21, 95% CI: 0.04, 0.38). DISCUSSION There is low-quality evidence that adjuvant drugs may help reduce illness severity, probably via facilitating abstinence and lower substance use. However, the evidence is weak; thus, these results should be considered cautiously until better evidence exists.
Collapse
Affiliation(s)
- Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain.
| | - José Manuel Goikolea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Iñaki Zorrilla
- Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario, CIBERSAM, UPV/EHU, Vitoria, Spain
| | - Miquel Bernardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Manuel Arrojo
- Servicio de Psiquiatría, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago, Servicio Gallego de Salud (SERGAS) de Santiago de Compostela, Spain
| | - Ruth Cunill
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Xavi Castells
- Grupo de Investigación TransLab, Departamento de Ciencias Médicas, Universitat de Girona, Spain
| | - Elisardo Becoña
- Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología, Universidad de Santiago de Compostela, Spain
| | - Ana López-Durán
- Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología, Universidad de Santiago de Compostela, Spain
| | - Marta Torrens
- Institut de Neuropsiquiatria Addiccions - Hospìtal del Mar, Universitat Autònoma de Barcelona, Universitat de Vic-Central de Catalunya, Red de Investigación en Atención Primaria de Adicciones-RIAPAD, Barcelona, Spain
| | - Judit Tirado-Muñoz
- Departamento de Psicología, Facultad de Ciencias Biomédicas y de la Salud, Grupo de Investigación en Conducta, Emociones y Salud, Universidad Europea de Madrid, Madrid, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria Addiccions - Hospìtal del Mar, Universitat Autònoma de Barcelona, Universitat de Vic-Central de Catalunya, Red de Investigación en Atención Primaria de Adicciones-RIAPAD, Barcelona, Spain
| | - Belén Arranz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Marina Garriga
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Pilar A Sáiz
- Universidad de Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Gerardo Flórez
- Unidad de Conductas Adictivas, Complejo Hospitalario de Ourense, CIBERSAM, Ourense, Spain
| | - Luis San
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Ana González-Pinto
- Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario, CIBERSAM, UPV/EHU, Vitoria, Spain
| |
Collapse
|
5
|
Gogia M, Shah AQ, Kapczinski F, de Azevedo Cardoso T. The impact of substance use disorder comorbidity on cognition of individuals with bipolar disorder: A systematic review. Psychiatry Res 2022; 311:114525. [PMID: 35364335 DOI: 10.1016/j.psychres.2022.114525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 12/14/2022]
Abstract
The aim of this study is to describe whether Bipolar Disorder (BD) with Substance Use Disorder (SUD) comorbidity is associated with an increased cognitive impairment as compared to BD without SUD comorbidity. This is a systematic review. The literature search was conducted in three databases: PubMed, PsycINFO and Embase. A total of 2032 studies were screened after removing duplicates. 29 articles were included for full text screening, and a total of 14 articles were included in the systematic review. Multiple cognitive domains were assessed, including verbal, spatial and visual memory, and psychomotor and executive functioning. Over half the articles (64.3%, n=9) identified cognitive impairments in individuals with BD+SUD comorbidity as compared to individuals with BD without SUD comorbidity. In addition, individuals with the comorbidity exhibited more severe impairments on tests of executive functioning, and greater impairments in verbal and visual memory. The studies included in this systematic review reinforce that individual with comorbidity of BD and SUD have increased cognitive impairment as compared to individuals with BD without SUD comorbidity. Executive functioning was the most impaired cognitive domain found across the studies included in this review. Intervention strategies focused on executive functioning would be beneficial for this specific population.
Collapse
Affiliation(s)
- Manan Gogia
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Aimun Qadeer Shah
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Rio Grande do Sul, Brazil; Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Taiane de Azevedo Cardoso
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
6
|
Yoldi-Negrete M, Palacios-Cruz L, Tirado-Durán E, Jiménez-Rodríguez LI, Jiménez-Pavón J, Hernández S, Aguilar A, Morales-Cedillo IP, Jiménez-Tirado M, Fresán-Orellana A, Juárez García F, Becerra-Palars C, Camarena-Medellin B. Looking for factors affecting functioning in euthymic patients with bipolar I disorder: the importance of cognitive complaints and BDNF's Val66Met polymorphism. J Affect Disord 2022; 302:131-138. [PMID: 34990638 DOI: 10.1016/j.jad.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/14/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Functioning in Bipolar Disorder (BD) is affected in a substantial proportion of patients. The impact of demographic, clinical, cognitive, and genetic factors on functioning has been shown individually; however, as a complex phenomenon, a global approach to identify the most relevant as well as possible interactions is needed. METHODS 102 patients with type I BD in euthymia were invited for evaluation of demographic, clinical, and cognitive characteristics as well as genotype for Val66Met polymorphism of BDNF gene to determine those associated with poor functioning according to the FAST scale cut-off score. Clinical evaluation included assessment of residual affective symptoms and anxiety. Cognitive evaluation included the COBRA scale, verbal memory, and executive functions testing. RESULTS Residual depressive symptoms, anxiety, cognitive complaints and being a Met carrier were more frequent in the poor functioning group and were entered in a logistic regression model. Being a Met carrier (OR=4.46, CI=1.19-16.67) and cognitive complaints (OR=1.29, CI= 1.13-1.46) were the most important predictors of poor functioning in type I BD. LIMITATIONS Cross-sectional study, with select population limiting generalizability of findings. CONCLUSIONS A better understanding of underlying factors affecting cognition, including the possible involvement of BDNF Val66Met polymorphism, its systematic evaluation and a continued search for targeted treatment, along with recognition and attention of residual affective and anxious symptoms might improve psychosocial outcomes such as functioning in this population.
Collapse
Affiliation(s)
- María Yoldi-Negrete
- Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Lino Palacios-Cruz
- Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Elsa Tirado-Durán
- Departamento de Neuropsicología, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Laura Ivonne Jiménez-Rodríguez
- Departamento de Neuropsicología, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Joanna Jiménez-Pavón
- Clínica de Trastornos Afectivos, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Sandra Hernández
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Alejandro Aguilar
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Ingrid Pamela Morales-Cedillo
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | | | - Ana Fresán-Orellana
- Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Francisco Juárez García
- Dirección de Investigaciones Epidemiológicas y Sociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Claudia Becerra-Palars
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Beatriz Camarena-Medellin
- Departamento de Farmacogenética, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico.
| |
Collapse
|
7
|
Kirsch DE, Tretyak V, Le V, Huffman A, Fromme K, Strakowski SM, Lippard ET. Alcohol Use and Prefrontal Cortex Volume Trajectories in Young Adults with Mood Disorders and Associated Clinical Outcomes. Behav Sci (Basel) 2022; 12:bs12030057. [PMID: 35323376 PMCID: PMC8945008 DOI: 10.3390/bs12030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Alcohol use in the course of mood disorders is associated with worse clinical outcomes. The mechanisms by which alcohol use alters the course of illness are unclear but may relate to prefrontal cortical (PFC) sensitivity to alcohol. We investigated associations between alcohol use and PFC structural trajectories in young adults with a mood disorder compared to typically developing peers. (2) Methods: 41 young adults (24 with a mood disorder, agemean = 21 ± 2 years) completed clinical evaluations, assessment of alcohol use, and two structural MRI scans approximately one year apart. Freesurfer was used to segment PFC regions of interest (ROIs) (anterior cingulate, orbitofrontal cortex, and frontal pole). Effects of group, alcohol use, time, and interactions among these variables on PFC ROIs at baseline and follow-up were modeled. Associations were examined between alcohol use and longitudinal changes in PFC ROIs with prospective mood. (3) Results: Greater alcohol use was prospectively associated with decreased frontal pole volume in participants with a mood disorder, but not typically developing comparison participants (time-by-group-by-alcohol interaction; p = 0.007); however, this interaction became a statistical trend in a sensitivity analysis excluding one outlier in terms of alcohol use. Greater alcohol use and a decrease in frontal pole volume related to longer duration of major depression during follow-up (p’s < 0.05). (4) Conclusion: Preliminary findings support more research on alcohol use, PFC trajectories, and depression recurrence in young adults with a mood disorder including individuals with heavier drinking patterns.
Collapse
Affiliation(s)
- Dylan E. Kirsch
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX 78712, USA; (V.T.); (V.L.); (A.H.); (S.M.S.)
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX 78712, USA;
- Institute for Neuroscience, University of Texas, Austin, TX 78712, USA
- Correspondence: (D.E.K.); (E.T.C.L.)
| | - Valeria Tretyak
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX 78712, USA; (V.T.); (V.L.); (A.H.); (S.M.S.)
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX 78712, USA;
- Department of Psychology, University of Texas, Austin, TX 78712, USA
| | - Vanessa Le
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX 78712, USA; (V.T.); (V.L.); (A.H.); (S.M.S.)
| | - Ansley Huffman
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX 78712, USA; (V.T.); (V.L.); (A.H.); (S.M.S.)
| | - Kim Fromme
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX 78712, USA;
- Department of Psychology, University of Texas, Austin, TX 78712, USA
| | - Stephen M. Strakowski
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX 78712, USA; (V.T.); (V.L.); (A.H.); (S.M.S.)
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX 78712, USA;
- Institute for Neuroscience, University of Texas, Austin, TX 78712, USA
- Department of Psychology, University of Texas, Austin, TX 78712, USA
| | - Elizabeth T.C. Lippard
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX 78712, USA; (V.T.); (V.L.); (A.H.); (S.M.S.)
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX 78712, USA;
- Institute for Neuroscience, University of Texas, Austin, TX 78712, USA
- Department of Psychology, University of Texas, Austin, TX 78712, USA
- Institute of Early Life Adversity Research, University of Texas, Austin, TX 78712, USA
- Correspondence: (D.E.K.); (E.T.C.L.)
| |
Collapse
|
8
|
Lapomarda G, Pappaianni E, Siugzdaite R, Sanfey AG, Rumiati RI, Grecucci A. Out of control: An altered parieto-occipital-cerebellar network for impulsivity in bipolar disorder. Behav Brain Res 2021; 406:113228. [PMID: 33684426 DOI: 10.1016/j.bbr.2021.113228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Bipolar disorder is an affective disorder characterized by rapid fluctuations in mood ranging from episodes of depression to mania, as well as by increased impulsivity. Previous studies investigated the neural substrates of bipolar disorder mainly using univariate methods, with a particular focus on the neural circuitry underlying emotion regulation difficulties. In the present study, capitalizing on an innovative whole-brain multivariate method to structural analysis known as Source-based Morphometry, we investigated the neural substrates of bipolar disorder and their relation with impulsivity, assessed with both self-report measures and performance-based tasks. Structural images from 46 patients with diagnosis of bipolar disorder and 60 healthy controls were analysed. Compared to healthy controls, patients showed decreased gray matter concentration in a parietal-occipital-cerebellar network. Notably, the lower the gray matter concentration in this circuit, the higher the self-reported impulsivity. In conclusion, we provided new evidence of an altered brain network in bipolar disorder patients related to their abnormal impulsivity. Taken together, these findings extend our understanding of the neural and symptomatic characterization of bipolar disorder.
Collapse
Affiliation(s)
- Gaia Lapomarda
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy.
| | - Edoardo Pappaianni
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Roma Siugzdaite
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Alan G Sanfey
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Raffaella I Rumiati
- Scuola Internazionale Superiore di Studi Avanzati (SISSA), University of Trieste, Trieste, Italy
| | - Alessandro Grecucci
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
| |
Collapse
|
9
|
Le V, Kirsch DE, Tretyak V, Weber W, Strakowski SM, Lippard ETC. Recent Perceived Stress, Amygdala Reactivity to Acute Psychosocial Stress, and Alcohol and Cannabis Use in Adolescents and Young Adults With Bipolar Disorder. Front Psychiatry 2021; 12:767309. [PMID: 34867554 PMCID: PMC8634636 DOI: 10.3389/fpsyt.2021.767309] [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: 08/30/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Psychosocial stress negatively affects the clinical course of bipolar disorder. Studies primarily focused on adults with bipolar disorder suggest the impact of stress is progressive, i.e., stress response sensitizes with age. Neural mechanisms underlying stress sensitization are unknown. As stress-related mechanisms contribute to alcohol/substance use disorders, variation in stress response in youth with bipolar disorder may contribute to development of co-occurring alcohol/substance use disorders. This study investigated relations between psychosocial stress, amygdala reactivity, and alcohol and cannabis use in youth with bipolar disorder, compared to typically developing youth. Methods: Forty-two adolescents/young adults [19 with bipolar disorder, 23 typically developing, 71% female, agemean ± SD = 21 ± 2 years] completed the Perceived Stress Scale (PSS), Daily Drinking Questionnaire modified for heaviest drinking week, and a modified Montreal Imaging Stress functional MRI Task. Amygdala activation was measured for both the control and stress conditions. Main effects of group, condition, total PSS, and their interactions on amygdala activation were modeled. Relationships between amygdala response to acute stress with recent alcohol/cannabis use were investigated. Results: Greater perceived stress related to increased right amygdala activation in response to the stress, compared to control, condition in bipolar disorder, but not in typically developing youth (group × condition × PSS interaction, p = 0.02). Greater amygdala reactivity to acute stress correlated with greater quantity and frequency of alcohol use and frequency of cannabis use in bipolar disorder. Conclusion: Recent perceived stress is associated with changes in amygdala activation during acute stress with amygdala reactivity related to alcohol/cannabis use in youth with bipolar disorder.
Collapse
Affiliation(s)
- Vanessa Le
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
| | - Dylan E Kirsch
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States.,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States.,Institute for Neuroscience, University of Texas, Austin, TX, United States
| | - Valeria Tretyak
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States.,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States.,Department of Psychology, University of Texas, Austin, TX, United States
| | - Wade Weber
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States
| | - Stephen M Strakowski
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States.,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States.,Institute for Neuroscience, University of Texas, Austin, TX, United States.,Department of Psychology, University of Texas, Austin, TX, United States
| | - Elizabeth T C Lippard
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, United States.,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, United States.,Institute for Neuroscience, University of Texas, Austin, TX, United States.,Department of Psychology, University of Texas, Austin, TX, United States.,Institute of Early Life Adversity Research, University of Texas, Austin, TX, United States
| |
Collapse
|
10
|
Li C, Palka JM, Brown ES. Cognitive impairment in individuals with bipolar disorder with and without comorbid alcohol and/or cocaine use disorders. J Affect Disord 2020; 272:355-362. [PMID: 32553378 PMCID: PMC7305419 DOI: 10.1016/j.jad.2020.03.179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bipolar disorder (BD) frequently co-occurs with substance use disorders (SUDs), and both are associated with cognitive impairment. This study compares cognition between individuals with BD with and without current alcohol use disorder (AUD), cocaine use disorder (CUD), or both, as these disorders may be linked with additive cognitive impairment. METHODS Baseline data were analyzed from five clinical studies of individuals with the aforementioned disorders (N = 373). Participants were grouped as follows: BD-only, BD + AUD, BD + CUD, or BD + AUD + CUD. Cognition was assessed with the Rey Auditory Verbal Learning Test (RAVLT) (verbal learning and memory) and Stroop Color Word Test (executive function). Multiple linear regression models determined if SUD diagnosis, among other demographic and clinical variables, predicted each cognitive test's T-score. Regression equations were used to compute each group's mean T-scores. RESULTS All groups demonstrated below-average mean T-scores on all tests, with no significant between-group score differences. RAVLT total T-scores were lower than Stroop color-word T-scores within all groups (non-overlapping 95% confidence intervals). Higher daily cocaine use predicted higher Stroop T-scores (p < 0.01) and RAVLT delayed recall T-scores (p < 0.05). No other non-demographic variable, including AUD/CUD group status, predicted cognitive performance. LIMITATIONS A full cognitive battery and some relevant variables (e.g. BD lifetime illness course) were not available. Many participants (42.1%) had additional SUDs. CONCLUSIONS BD with and without AUD/CUD was found to be associated with greater deficits in verbal learning and memory than in executive function. Addressing these impaired domains in dually-diagnosed patients may improve treatment and functional outcomes.
Collapse
Affiliation(s)
- Chengxi Li
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Jayme M. Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
| | - E. Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX,Corresponding author: E. Sherwood Brown, M.D., Ph.D., Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 8849, Dallas, TX 75390-8849, Tel: 214-645-6950; Fax: 214-645-6951,
| |
Collapse
|
11
|
Busk J, Faurholt-Jepsen M, Frost M, Bardram JE, Kessing LV, Winther O. Daily estimates of clinical severity of symptoms in bipolar disorder from smartphone-based self-assessments. Transl Psychiatry 2020; 10:194. [PMID: 32555144 PMCID: PMC7303106 DOI: 10.1038/s41398-020-00867-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 12/22/2022] Open
Abstract
Currently, the golden standard for assessing the severity of depressive and manic symptoms in patients with bipolar disorder (BD) is clinical evaluations using validated rating scales such as the Hamilton Depression Rating Scale 17-items (HDRS) and the Young Mania Rating Scale (YMRS). Frequent automatic estimation of symptom severity could potentially help support monitoring of illness activity and allow for early treatment intervention between outpatient visits. The present study aimed (1) to assess the feasibility of producing daily estimates of clinical rating scores based on smartphone-based self-assessments of symptoms collected from a group of patients with BD; (2) to demonstrate how these estimates can be utilized to compute individual daily risk of relapse scores. Based on a total of 280 clinical ratings collected from 84 patients with BD along with daily smartphone-based self-assessments, we applied a hierarchical Bayesian modelling approach capable of providing individual estimates while learning characteristics of the patient population. The proposed method was compared to common baseline methods. The model concerning depression severity achieved a mean predicted R2 of 0.57 (SD = 0.10) and RMSE of 3.85 (SD = 0.47) on the HDRS, while the model concerning mania severity achieved a mean predicted R2 of 0.16 (SD = 0.25) and RMSE of 3.68 (SD = 0.54) on the YMRS. In both cases, smartphone-based self-reported mood was the most important predictor variable. The present study shows that daily smartphone-based self-assessments can be utilized to automatically estimate clinical ratings of severity of depression and mania in patients with BD and assist in identifying individuals with high risk of relapse.
Collapse
Affiliation(s)
- Jonas Busk
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark.
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark.
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Jakob E Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Winther
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Bioinformatics Centre, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Busk J, Faurholt-Jepsen M, Frost M, Bardram JE, Vedel Kessing L, Winther O. Forecasting Mood in Bipolar Disorder From Smartphone Self-assessments: Hierarchical Bayesian Approach. JMIR Mhealth Uhealth 2020; 8:e15028. [PMID: 32234702 PMCID: PMC7367518 DOI: 10.2196/15028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/25/2019] [Accepted: 12/17/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Bipolar disorder is a prevalent mental health condition that is imposing significant burden on society. Accurate forecasting of symptom scores can be used to improve disease monitoring, enable early intervention, and eventually help prevent costly hospitalizations. Although several studies have examined the use of smartphone data to detect mood, only few studies deal with forecasting mood for one or more days. OBJECTIVE This study aimed to examine the feasibility of forecasting daily subjective mood scores based on daily self-assessments collected from patients with bipolar disorder via a smartphone-based system in a randomized clinical trial. METHODS We applied hierarchical Bayesian regression models, a multi-task learning method, to account for individual differences and forecast mood for up to seven days based on 15,975 smartphone self-assessments from 84 patients with bipolar disorder participating in a randomized clinical trial. We reported the results of two time-series cross-validation 1-day forecast experiments corresponding to two different real-world scenarios and compared the outcomes with commonly used baseline methods. We then applied the best model to evaluate a 7-day forecast. RESULTS The best performing model used a history of 4 days of self-assessment to predict future mood scores with historical mood being the most important predictor variable. The proposed hierarchical Bayesian regression model outperformed pooled and separate models in a 1-day forecast time-series cross-validation experiment and achieved the predicted metrics, R2=0.51 and root mean squared error of 0.32, for mood scores on a scale of -3 to 3. When increasing the forecast horizon, forecast errors also increased and the forecast regressed toward the mean of data distribution. CONCLUSIONS Our proposed method can forecast mood for several days with low error compared with common baseline methods. The applicability of a mood forecast in the clinical treatment of bipolar disorder has also been discussed.
Collapse
Affiliation(s)
- Jonas Busk
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Jakob E Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Winther
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark.,Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Bioinformatics Centre, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
13
|
Torres IJ, Qian H, Basivireddy J, Chakrabarty T, Wong H, Lam RW, Yatham LN. Three-year longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Acta Psychiatr Scand 2020; 141:98-109. [PMID: 31840225 DOI: 10.1111/acps.13141] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The longitudinal course of neuropsychological functioning after the first manic episode in bipolar disorder is unknown. The present study evaluated cognitive change in bipolar disorder in the first 3 years after the initial manic episode. METHODS Ninety-one newly diagnosed patients with bipolar disorder and 61 demographically similar healthy participants received a neuropsychological evaluation assessing multiple cognitive domains at baseline, 1-year, and 3-year time points. Patients also received clinical assessments including mood ratings at all time points. RESULTS Patients showed deficits in all domains at baseline, but similar longitudinal trajectories across time relative to healthy participants in most cognitive domains. For processing speed, patients showed more gains than controls from baseline to 1 year, but these gains stabilized thereafter. Patients with alcohol/substance abuse showed an initial delay but subsequent recovery in executive functioning. Patients who discontinued antipsychotic treatment showed better cognitive outcomes in verbal memory. CONCLUSION Appropriately treated patients with bipolar disorder showed favorable cognitive outcome in the first 3 years after experiencing an initial manic episode, arguing against cognitive neuroprogression at this stage of the illness. Discontinuation of antipsychotic treatment may be associated with better cognitive outcomes, but clarification of the role of antipsychotics on cognitive functioning requires further investigation.
Collapse
Affiliation(s)
- I J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - H Qian
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - J Basivireddy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - T Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - H Wong
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - R W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - L N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
14
|
Zhang X, Cheng X, Chen J, Zhang B, Wu Q, Deng W, Li X, Lin Y, Yang C, Cao L. Association of subthreshold manic symptoms and cognitive impairments in euthymic patients with bipolar disorder I. Psychiatry Res 2019; 278:303-308. [PMID: 31255953 DOI: 10.1016/j.psychres.2019.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Cognitive impairments exist during the euthymic period of bipolar disorder (BD). However, the impact of clinical factors (e.g., subthreshold symptoms and body mass index) on cognitive function in euthymic patients with bipolar disorder I is inconsistent. This cross-sectional study included 83 patients with euthymic BD I and 115 healthy controls. The Repeatable Battery for the Assessment of Neuropsychological Status indices were used to assess cognitive function. We assessed the relationship between cognitive function and clinical impact factors. Performance in language abilities, attention, and immediate memory was worse in euthymic BD I. Spearman's correlation revealed that indices for immediate memory and attention were negatively correlated with subthreshold manic symptoms, and indices for delayed memory were positively correlated with years of education. Linear regressions indicated that subthreshold manic symptoms were the best predictors of immediate memory and attention. Years of education predicted performance in most cognitive domains, except immediate memory. Individuals with euthymic BD I exhibited cognitive deficits in language learning, attention, and immediate memory. Our study highlights the importance of the effect of subthreshold manic symptoms on cognitive function in remitted BD; these symptoms should receive more attention and be targeted in personalized clinical therapeutic interventions.
Collapse
Affiliation(s)
- Xiaofei Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Xiongchao Cheng
- Department of Medical Psychology, Guilin Mental Health Center, Fuli Road 4, Guilin, Guangxi Zhuang Autonomous Region, 541000, China.
| | - Jianshan Chen
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Bin Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Qiuxia Wu
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Wenhao Deng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Xuan Li
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Yin Lin
- Department of Psychology, Shenzhen Children's Hospital, Yitian Road 7019, Futian district, Shenzhen, 518000, China.
| | - Chanjuan Yang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| | - Liping Cao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital). Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, 510370, China.
| |
Collapse
|
15
|
Bonnín CDM, Reinares M, Martínez-Arán A, Jiménez E, Sánchez-Moreno J, Solé B, Montejo L, Vieta E. Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. Int J Neuropsychopharmacol 2019; 22:467-477. [PMID: 31093646 PMCID: PMC6672628 DOI: 10.1093/ijnp/pyz018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022] Open
Abstract
People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described.
Collapse
Affiliation(s)
- Caterina del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,Correspondence: Anabel Martínez-Arán, PhD, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Catalonia ()
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Sánchez-Moreno
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| |
Collapse
|
16
|
Yoldi-Negrete M, Fresán-Orellana A, Martínez-Camarillo S, Ortega-Ortiz H, Juárez García FL, Castañeda-Franco M, Tirado-Durán E, Becerra-Palars C. Psychometric properties and cross-cultural comparison of the cognitive complaints in bipolar disorder rating assessment (COBRA) in Mexican patients with bipolar disorder. Psychiatry Res 2018; 269:536-541. [PMID: 30199694 DOI: 10.1016/j.psychres.2018.08.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 01/03/2023]
Abstract
Bipolar Disorder (BD) is a serious and frequent mental health condition that is sometimes fatal. Several longitudinal studies have found an important correlation between cognition and functionality in BD. Despite the known importance of cognitive symptoms in BD, evaluation of cognitive deficits is not routinely done in clinical settings, as assessment is time-consuming and requires neuropsychological testing. The aim was to evaluate the psychometric properties of the subjective cognitive deficits in bipolar disorder (COBRA) rating scale in a Mexican sample of patients with BD and perform a cross-cultural comparison with the results obtained in other cultures. Ninety-two Healthy Subjects and 80 euthymic patients with BD were asked to complete the COBRA rating scale. The psychometric properties found in Mexican population show a good internal consistency and good discriminant validity with control subjects. Adequate congruence coefficients were obtained between the COBRA analyses in Mexican population and Spanish population and acceptable when compared to Japanese population. The COBRA scale is a brief and valid measure of cognitive complaints in BD for use in Mexican population.
Collapse
Affiliation(s)
- María Yoldi-Negrete
- National Council of Science and Technology, Mexico City, Mexico; Affective Disorders' Clinic, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico.
| | - Ana Fresán-Orellana
- Laboratory of Clinical Epidemiology, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Sara Martínez-Camarillo
- Affective Disorders' Clinic, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Hiram Ortega-Ortiz
- Affective Disorders' Clinic, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico.
| | - Francisco Lorenzo Juárez García
- Epidemiologic and Psychosocial Research Department, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Marisol Castañeda-Franco
- Department of Neuropsychology, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Elsa Tirado-Durán
- Department of Neuropsychology, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Claudia Becerra-Palars
- Affective Disorders' Clinic, National Institute of Psychiatry "Ramón de la Fuente Muñíz", Mexico City, Mexico
| |
Collapse
|
17
|
Martino DJ, Igoa A, Marengo E, Scápola M, Strejilevich SA. Longitudinal relationship between clinical course and neurocognitive impairments in bipolar disorder. J Affect Disord 2018; 225:250-255. [PMID: 28841488 DOI: 10.1016/j.jad.2017.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/23/2017] [Accepted: 08/10/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to estimate the relationship between clinical course and trajectory of neurocognitive functioning during a follow-up period in a sample of euthymic bipolar patients. METHODS Fifty-one patients with BD performed two-neurocognitive assessment separated by a period of at least 48 months. The clinical course during the follow-up period was documented by: three measures 1) number of affective episodes, 2) time spent ill, and 3) mood instability. RESULTS Patients were followed-up for a mean period of 73.21 months. Neurocognitive performance tended to be stable throughout the follow-up. Performance in verbal memory and executive functions at the end of study were related with the number of hypo/manic episodes and time spent with hypo/manic symptoms during the follow-up. None of the clinical measures considered were related to changes in neurocognitive performance over the follow-up period. LIMITATIONS The relatively small sample size limits the value of subgroup analysis. The study design does not rule out some risk of selection bias. CONCLUSIONS Although there may be a positive relationship between number of episodes and neurocognitive deficits in patients with bipolar disorder, successive episodes do not seem to modify the trajectory of neurocognitive functioning over time. Theoretical implications of these findings are discussed.
Collapse
Affiliation(s)
- Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.
| | - Ana Igoa
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Eliana Marengo
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - María Scápola
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| |
Collapse
|
18
|
Solé B, Jiménez E, Torrent C, Reinares M, Bonnin CDM, Torres I, Varo C, Grande I, Valls E, Salagre E, Sanchez-Moreno J, Martinez-Aran A, Carvalho AF, Vieta E. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies. Int J Neuropsychopharmacol 2017; 20:670-680. [PMID: 28498954 PMCID: PMC5570032 DOI: 10.1093/ijnp/pyx032] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/08/2017] [Indexed: 12/21/2022] Open
Abstract
Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients' psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients.
Collapse
Affiliation(s)
- Brisa Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Esther Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Carla Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Maria Reinares
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Caterina del Mar Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Imma Torres
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Cristina Varo
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Iria Grande
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Elia Valls
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Estela Salagre
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Jose Sanchez-Moreno
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Anabel Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - André F Carvalho
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain (Drs Sole, Jimenez, Torrent, Reinares, del Mar Bonnin, Torres, Varo, Grande, Valls, Salagre, Sanchez-Moreno, Martinez-Aran, and Vieta); Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil (Dr Carvalho)
| |
Collapse
|
19
|
Papazacharias A, Lozupone M, Barulli MR, Capozzo R, Imbimbo BP, Veneziani F, De Blasi R, Nardini M, Seripa D, Panza F, Logroscino G. Bipolar Disorder and Frontotemporal Dementia: An Intriguing Association. J Alzheimers Dis 2016; 55:973-979. [DOI: 10.3233/jad-160860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Apostolos Papazacharias
- Department of Basic Medical Science, Neuroscience and Sense Organs, Psychiatric Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Madia Lozupone
- Department of Basic Medical Science, Neuroscience and Sense Organs, Neurodegenerative Disease Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Rosaria Barulli
- Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Rosa Capozzo
- Department of Research & Development, Chiesi Farmaceutici, Parma, Italy
| | - Bruno P. Imbimbo
- Department of Research & Development, Chiesi Farmaceutici, Parma, Italy
| | - Federica Veneziani
- Department of Basic Medical Science, Neuroscience and Sense Organs, Psychiatric Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Roberto De Blasi
- U.O.C. Radiology, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Marcello Nardini
- Department of Basic Medical Science, Neuroscience and Sense Organs, Psychiatric Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit & Laboratory of Gerontology and Geriatrics, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Panza
- Department of Basic Medical Science, Neuroscience and Sense Organs, Neurodegenerative Disease Unit, University of Bari “Aldo Moro”, Bari, Italy
- Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
- Department of Medical Sciences, Geriatric Unit & Laboratory of Gerontology and Geriatrics, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
| | - Giancarlo Logroscino
- Department of Basic Medical Science, Neuroscience and Sense Organs, Neurodegenerative Disease Unit, University of Bari “Aldo Moro”, Bari, Italy
- Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| |
Collapse
|
20
|
Cardoso TDA, Bauer IE, Jansen K, Suchting R, Zunta-Soares G, Quevedo J, Glahn DC, Soares JC. Effect of alcohol and illicit substance use on verbal memory among individuals with bipolar disorder. Psychiatry Res 2016; 243:225-231. [PMID: 27423121 PMCID: PMC5033059 DOI: 10.1016/j.psychres.2016.06.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/16/2016] [Accepted: 06/26/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cognitive impairment is a well-established feature of bipolar disorder (BD). Comorbid BD and substance use leads to poor psychosocial and clinical outcomes. However, knowledge on the neurocognitive functioning of individuals with dual diagnosis is limited. The aim of this study is to assess the cognitive performance of subjects with BD, BD with comorbid alcohol use disorder (AUD), and BD with comorbid illicit substance use disorders (SUD) as compared to healthy individuals. METHODS We included 270 inpatients and outpatients with BD and 211 healthy controls. The diagnostic of BD and substance use disorder was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Axis I. Demographic and clinical information were also collected. The cognitive assessment included the Wechsler Test of Adult Reading (WTAR), and a revised version of the California Verbal Learning Test (CVLT) as part of the South Texas Assessment of Neurocognition (STAN). RESULTS The STAN was administered to 134 BD patients (100 female, M±SD: 37.37±12.74 years), 72 BD patients with AUD (40 female, M±SD: 38.42±11.82), 64 BD patients with SUD (39 female, M±SD: 34.50±10.57), and 211 healthy controls with no lifetime history of mental illness and substance use (127 female, M±SD: 34.80±12.57 years). In terms of clinical characteristics, BD+SUD showed a marginally earlier onset of illness compared to BD. Compared to HC, BD performed poorly in the immediate recall and short-delay free tests of the CVLT, while BD patients with AUD and SUD showed significant memory deficits in both the immediate recall and recognition components of the CVLT. There were no differences in memory performance between BD and BD with either AUD or SUD. CONCLUSIONS A history of substance use disorders is associated with an earlier onset of BD. BD has marked effects on processes underlying the encoding of new information, while comorbid substance use in BD impairs more specifically the recognition of previously presented information. Future longitudinal studies should evaluate the effects of AUD and SUD on illness progression and therapeutic outcomes.
Collapse
Affiliation(s)
- Taiane de A. Cardoso
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas (UCPEL), Pelotas, RS, Brazil
| | - Isabelle E. Bauer
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Corresponding author. University of Texas Health Science Center at Houston. Department of Psychiatry and Behavioral Science. 1941 East Road. 77054 Houston, TX, USA. Tel.: +713 486 2624.
| | - Karen Jansen
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas (UCPEL), Pelotas, RS, Brazil
| | - Robert Suchting
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Giovana Zunta-Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - João Quevedo
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
- Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - David C. Glahn
- The Olin Neuropsychiatry Research Center, Institute of Living, and Department of Psychiatry, Yale University School of Medicine, CT, United States
| | - Jair C. Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Beblo T. Die Bedeutung kognitiver Beeinträchtigungen bei depressiven Patienten. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2016. [DOI: 10.1024/1016-264x/a000174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Beeinträchtigungen der Exekutivfunktionen, der Aufmerksamkeit und des Gedächtnisses sind einige der häufigsten und hartnäckigsten Symptome depressiver Störungen. Bisher konnte allerdings kein eindeutiges Profil dieser Defizite identifiziert werden, wahrscheinlich auch deshalb, weil die Defizite von verschiedenen klinischen und demografischen Faktoren, wie dem Depressionssubtypus, Grübeln, Komorbiditäten und Alter beeinflusst werden. Die kognitiven Beeinträchtigungen verbessern sich mit der Remission der Störung, häufig findet jedoch keine vollständige Rückbildung statt. Sie sind klinisch sehr relevant und gehen einher mit Suizidalität, reduzierten Therapieeffekten und negativen Auswirkungen auf Alltagsaktivitäten. Aus diesen Gründen ergibt sich für betroffene Patienten die Notwendigkeit einer neuropsychologischen Behandlung. Erste Ergebnisse lassen hoffen, dass die kognitiven Beeinträchtigungen mithilfe neuropsychologischer Therapie, Achtsamkeitstraining, psychopharmakologischer Therapie und weiteren neurobiologischen Behandlungen, wie z. B. der repetitiven transkraniellen Magnetstimulation, erfolgreich behandelt werden können.
Collapse
Affiliation(s)
- Thomas Beblo
- Klinik für Psychiatrie und Psychotherapie Bethel, Evangelisches Krankenhaus Bielefeld, Bielefeld
| |
Collapse
|
23
|
Forlenza OV, Aprahamian I, Radanovic M, Talib LL, Camargo MZ, Stella F, Machado-Vieira R, Gattaz WF. Cognitive impairment in late-life bipolar disorder is not associated with Alzheimer's disease pathological signature in the cerebrospinal fluid. Bipolar Disord 2016; 18:63-70. [PMID: 26876913 DOI: 10.1111/bdi.12360] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/01/2015] [Accepted: 11/06/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Cognitive impairment is a common feature of late-life bipolar disorder (BD). Yet, there is limited information on the biological mechanisms associated with this process. It is uncertain whether cognitively impaired patients with BD may present the Alzheimer's disease (AD) bio-signature in the cerebrospinal fluid (CSF), defined as a combination of low concentrations of the amyloid-beta peptide (Aβ1-42 ) and high concentrations of total tau (T-tau) and tau phosphorylated at threonine 181 (P-tau). In this study, we sought to determine whether cognitive impairment in elderly patients with BD is associated with the AD CSF bio-signature. METHODS Seventy-two participants were enrolled in the study. The test group comprised older adults with BD and mild cognitive impairment (BD-MCI; n = 16) and the comparison groups comprised patients with dementia due to AD (n = 17), patients with amnestic MCI (aMCI; n = 14), and cognitively healthy older adults (control group; n = 25). CSF samples were obtained by lumbar puncture and concentrations of Aβ1-42 , T-tau and P-tau were determined. RESULTS CSF concentrations of all biomarkers were significantly different in the AD group compared to all other groups, but did not differentiate BD-MCI subjects from aMCI subjects and controls. BD-MCI patients had a non-significant reduction in CSF Aβ1-42 compared to controls, but this was still higher than in the AD group. Concentrations of T-tau and P-tau in BD-MCI patients were similar to those in controls, and significantly lower than those in AD. CONCLUSIONS Cognitively impaired patients with BD do not display the so-called AD bio-signature in the CSF. We therefore hypothesize that cognitive deterioration in BD is not associated with the classical pathophysiological mechanisms observed in AD, i.e., amyloid deposition and hyperphosphorylation of microtubule-associated tau protein.
Collapse
Affiliation(s)
- Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo
| | - Ivan Aprahamian
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo.,Internal Medicine Department, Jundiaí Medical School
| | - Márcia Radanovic
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo
| | - Leda L Talib
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo
| | - Marina Za Camargo
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo
| | - Florindo Stella
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo.,Biosciences Institute, Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil
| | - Rodrigo Machado-Vieira
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo.,Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
| | - Wagner F Gattaz
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo
| |
Collapse
|
24
|
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]
|
25
|
Martino DJ, Strejilevich SA, Marengo E, Ibañez A, Scápola M, Igoa A. Toward the identification of neurocognitive subtypes in euthymic patients with bipolar disorder. J Affect Disord 2015; 167:118-24. [PMID: 24955563 DOI: 10.1016/j.jad.2014.05.059] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/18/2014] [Accepted: 05/29/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cross-sectional and meta-analytic studies showed that patients with bipolar disorder (BD) had neurocognitive impairments even during periods of euthymia. The aim of this study was to estimate the prevalence of BD patients with and without clinically significant cognitive impairments, as well as to analyze clinical and functional variables in these subgroups. METHODS Hundred patients with BD and 40 healthy controls were assessed with an extensive neurocognitive assessment. Soft (some cognitive domain with a performance below 1.5 SD of the mean) and hard (at least two domains with values below 2 SD of the mean) criteria were utilized to define clinically significant cognitive impairments. RESULTS Using both soft and hard criteria, the prevalence of clinically significant cognitive impairments was higher in people with BD than in healthy controls. 70% of patients only showed failures of small effect (d=0.21-0.35) in 2 measures of executive functions. Moreover, 30% of patients were indistinguishable from healthy subjects in terms of both neurocognitive and psychosocial functioning. On the contrary, 30% of the sample showed more severe cognitive deficits than those usually reported in literature and had the worst psychosocial functioning. CONCLUSIONS The fact that cognitive impairments are very heterogeneous among euthymic patients with BD could contribute to understanding differences in functional outcome. Theoretical and practical implications of these findings are discussed.
Collapse
Affiliation(s)
- Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Gurruchaga 2463, 1°"C", 1425 Ciudad Autónoma de Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina.
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Gurruchaga 2463, 1°"C", 1425 Ciudad Autónoma de Buenos Aires, Argentina; Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
| | - Eliana Marengo
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Gurruchaga 2463, 1°"C", 1425 Ciudad Autónoma de Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | - Agustín Ibañez
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Gurruchaga 2463, 1°"C", 1425 Ciudad Autónoma de Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina; Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina; UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), New South Wales, Australia
| | - María Scápola
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Gurruchaga 2463, 1°"C", 1425 Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Igoa
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Gurruchaga 2463, 1°"C", 1425 Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Koenders MA, Spijker AT, Hoencamp E, Haffmans JPM, Zitman FG, Giltay EJ. Effects of mood state on divided attention in patients with bipolar disorder: evidence for beneficial effects of subclinical manic symptoms. Psychiatry Res 2014; 220:302-8. [PMID: 25129563 DOI: 10.1016/j.psychres.2014.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/19/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Abstract
A relatively small number of studies have been dedicated to the differential effects of the current mood state on cognition in patients with a bipolar disorder (BD). The aim of the current study was to investigate the effect of current mood state on divided attention (DA) performance, and specifically examine possible beneficial effects of the (hypo-) manic state. Over a maximum period of 24 months, medication use, divided attention test (a subtest of the Test for Attentional Performance (TAP)) was assessed every 6 months in 189 outpatients with BD. Data were analyzed with multilevel regression analysis (i.e. linear mixed models). DA performance varied considerable over time within patients. Corrected for psychotropic medication a significant quadratic relationship between manic symptoms and DA performance was found, with mild hypomanic symptoms having a positive influence on divided attention scores and moderate to severe manic symptoms having a negative influence. No association between depressive symptoms and DA performance was found. In future research on mania and cognition as well as in the clinical practice both the beneficial and negative effects of mania should be taken into account.
Collapse
Affiliation(s)
- Manja A Koenders
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands.
| | - Annet T Spijker
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands
| | - Erik Hoencamp
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Judith P M Haffmans
- PsyQ The Hague, Department of Mood Disorders, The Hague, The Netherlands; Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Frans G Zitman
- Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| | - Erik J Giltay
- Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| |
Collapse
|
28
|
Benzerouk F, Dereux A, Gorsane MA, Lançon C. L’addictologie est-elle une spécialisation de la psychiatrie ? ANNALES MEDICO-PSYCHOLOGIQUES 2014. [DOI: 10.1016/j.amp.2014.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Jakobsson J, Bjerke M, Ekman CJ, Sellgren C, Johansson AGM, Zetterberg H, Blennow K, Landén M. Elevated concentrations of neurofilament light chain in the cerebrospinal fluid of bipolar disorder patients. Neuropsychopharmacology 2014; 39:2349-56. [PMID: 24694925 PMCID: PMC4138743 DOI: 10.1038/npp.2014.81] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/07/2014] [Accepted: 03/17/2014] [Indexed: 12/24/2022]
Abstract
Bipolar disorder (BD) is characterized by mood swings between manic and depressive states. The etiology and pathogenesis of BD is unclear, but many of the affected cognitive domains, as well as neuroanatomical abnormalities, resemble symptoms and signs of small vessel disease. In small vessel disease, cerebrospinal fluid (CSF) markers reflecting damages in different cell types and subcellular structures of the brain have been established. Hence, we hypothesized that CSF markers related to small vessel disease may also be applicable as biomarkers for BD. To investigate this hypothesis, we sampled CSF from 133 patients with BD and 86 healthy controls. The concentrations of neurofilament light chain (NF-L), myelin basic protein (MBP), S100B, and heart-type fatty acid binding protein (H-FABP) were measured in CSF and analyzed in relation to diagnosis, clinical characteristics, and ongoing medications. Hereby we found an elevation of the marker of subcortical axonal damage, NF-L, in bipolar subjects. We also identified positive associations between NF-L and treatment with atypical antipsychotics, MBP and lamotrigine, and H-FABP and lithium. These findings indicate axonal damage as an underlying neuropathological component of bipolar disorder, although the clinical value of elevated NF-L remains to be validated in follow-up studies. The associations between current medications and CSF brain injury markers might aid in the understanding of both therapeutic and adverse effects of these drugs.
Collapse
Affiliation(s)
- Joel Jakobsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, Floor 3, Gothenburg SE-413 45, Sweden, Tel: +46 31 342 4522, Fax: +46 31 342 1533, E-mail:
| | - Maria Bjerke
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Johan Ekman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Carl Sellgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anette GM Johansson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,UCL Institute of Neurology, London, UK
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
30
|
Wilcox CE, Dekonenko CJ, Mayer AR, Bogenschutz MP, Turner JA. Cognitive control in alcohol use disorder: deficits and clinical relevance. Rev Neurosci 2014; 25:1-24. [PMID: 24361772 DOI: 10.1515/revneuro-2013-0054] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 11/27/2013] [Indexed: 01/25/2023]
Abstract
Cognitive control refers to the internal representation, maintenance, and updating of context information in the service of exerting control over thoughts and behavior. Deficits in cognitive control likely contribute to difficulty in maintaining abstinence in individuals with alcohol use disorders (AUD). In this article, we define three cognitive control processes in detail (response inhibition, distractor interference control, and working memory), review the tasks measuring performance in these areas, and summarize the brain networks involved in carrying out these processes. Next, we review evidence of deficits in these processes in AUD, including both metrics of task performance and functional neuroimaging. Finally, we explore the clinical relevance of these deficits by identifying predictors of clinical outcome and markers that appear to change (improve) with treatment. We observe that individuals with AUD experience deficits in some, but not all, metrics of cognitive control. Deficits in cognitive control may predict clinical outcome in AUD, but more work is necessary to replicate findings. It is likely that performance on tasks requiring cognitive control improves with abstinence, and with some psychosocial and medication treatments. Future work should clarify which aspects of cognitive control are most important to target during treatment of AUD.
Collapse
|
31
|
Affiliation(s)
- E Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| |
Collapse
|
32
|
Samalin L, Llorca PM, Giordana B, Milhiet V, Yon L, El-Hage W, Courtet P, Hacques E, Bedira N, Filipovics A, Arnaud R, Dillenschneider A, Bellivier F. Residual symptoms and functional performance in a large sample of euthymic bipolar patients in France (the OPTHYMUM study). J Affect Disord 2014; 159:94-102. [PMID: 24679396 DOI: 10.1016/j.jad.2014.02.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Some residual symptoms were found to be associated with impaired functioning in euthymic bipolar patients, but their impact and relevance are unclear in clinical practice. We re-examined the functional influence of a large set of residual symptoms in 525 euthymic bipolar outpatients using self- and clinician-rated questionnaires (OPTHYMUM study). METHODS This was a multi-centre, cross-sectional, non-interventional study of adult bipolar outpatients. All patients were euthymic at the time of assessment (YMRS score <8 and BDRS ≤8). Patients with low functioning (GAF score <60) were compared with the rest of the sample. Patients filled in specific questionnaires concerning their perceptions of different residual and subsyndromal symptoms. RESULTS Ninety-seven (97) psychiatrists included 525 patients. Of them, 35 patients had a GAF score <60. These "low functioning patients" were more frequently unemployed, had presented more manic episodes and psychotic symptoms, used more atypical antipsychotics or benzodiazepines and received less adjunctive psychotherapy. Concerning residual symptoms, they had more frequent emotional subsyndromal symptoms, disruption of circadian rhythms and sexual disorders. They perceived some cognitive deficits and suffered more social and family stigma. LIMITATIONS Our study used an arbitrary GAF cut-off score (60) to separate bipolar patients in two groups (low and satisfactory functioning). CONCLUSIONS Residual symptoms are associated with functional impairment and may represent specific treatment targets. A personalized approach through specific psychotherapeutic programs may lead to more efficient support by the clinician.
Collapse
Affiliation(s)
- Ludovic Samalin
- CHU Clermont-Ferrand, EA7280, Auvergne University, Clermont-Ferrand, France.
| | - Pierre Michel Llorca
- CHU Clermont-Ferrand, EA7280, Auvergne University, Clermont-Ferrand, France; Fondation FondaMental, Créteil, France
| | | | | | | | - Wissam El-Hage
- CRHU Tours, INSERM U930, François Rabelais University, Tours, France
| | - Philippe Courtet
- CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France; Fondation FondaMental, Créteil, France
| | | | | | | | | | | | - Frank Bellivier
- AP-HP, CHU Saint-Louis Lariboisière, F. Widal, Paris, France; INSERM UMRS 1144, Universités Paris Diderot et Paris Descartes, Paris, France; Fondation FondaMental, Créteil, France
| |
Collapse
|
33
|
Torres IJ, Kozicky J, Popuri S, Bond DJ, Honer WG, Lam RW, Yatham LN. 12-month longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disord 2014; 16:159-71. [PMID: 24636366 DOI: 10.1111/bdi.12154] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although cognitive deficits are observed in the early stages of bipolar disorder, the longitudinal course of neuropsychological functioning during this period is unknown. Such knowledge could provide etiologic clues into the cognitive deficits associated with the illness, and could inform early treatment interventions. The purpose of the present study was to evaluate cognitive change in bipolar disorder in the first year after the initial manic episode. METHODS From an initial pool of 65 newly diagnosed patients with bipolar disorder (within three months of the end of the first manic or mixed episode) and 36 demographically similar healthy participants, 42 patients [mean age 22.9 years, standard deviation (SD) = 4.0] and 23 healthy participants [mean age 22.9 years (SD = 4.9)] completed baseline, six-month, and one-year neuropsychological assessments of multiple domains including processing speed, attention, verbal and nonverbal memory, working memory, and executive function. Patients also received clinical assessments, including mood ratings. RESULTS Although patients showed consistently poorer cognitive performance than healthy individuals in most cognitive domains, patients showed a linear improvement over time in processing speed (p = 0.008) and executive function (p = 0.004) relative to the comparison group. Among patients, those without a history of alcohol/substance abuse or who were taken off an antipsychotic treatment during the study showed better improvement. CONCLUSIONS The early course of cognitive functioning in bipolar disorder is likely influenced by multiple factors. Nevertheless, patients with bipolar disorder showed select cognitive improvements in the first year after resolution of their initial manic episode. Several clinical variables were associated with better recovery, including absence of substance abuse and discontinuation of antipsychotic treatment during the study. These and other factors require further investigation to better understand their contributions to longitudinal cognitive functioning in early bipolar disorder.
Collapse
Affiliation(s)
- Ivan J Torres
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
- British Columbia Mental Health and Addictions Services; Vancouver BC Canada
| | - Jan Kozicky
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - Swetha Popuri
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - David J Bond
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - William G Honer
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
- British Columbia Mental Health and Addictions Services; Vancouver BC Canada
| | - Raymond W Lam
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - Lakshmi N Yatham
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| |
Collapse
|
34
|
Fineberg NA, Hengartner MP, Bergbaum C, Gale T, Rössler W, Angst J. Lifetime comorbidity of obsessive-compulsive disorder and sub-threshold obsessive-compulsive symptomatology in the community: impact, prevalence, socio-demographic and clinical characteristics. Int J Psychiatry Clin Pract 2013; 17:188-96. [PMID: 23428236 DOI: 10.3109/13651501.2013.777745] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aims to expand the available knowledge on Obsessive Compulsive Disorder (OCD)-comorbidity by investigating the prevalence and clinical impact on a group of individuals with OCD or subthreshold OC syndrome (OCS), prospectively followed-up over an extended period. METHODS A stratified sample of the general population of the canton of Zurich, Switzerland (n = 591), participated in a series of seven interviews over a 30-year period. Clinically significant comorbid subgroups of OCD/OCS were compared to cases of OCD/OCS without respective comorbidity, in order to determine differences in socio-demographic and other clinical characteristics. RESULTS Lifetime rates of psychiatric comorbidity were high and increased in prevalence across the OC severity spectrum. Bipolar affective disorder was significantly associated with OCD whereas unipolar major depression and both alcohol and drug misuse disorders were not. Most forms of comorbidity increased distress and impacted negatively on family and work relationships, though disorder-specific effects were observed. Thus, agoraphobia and GAD were associated with increased OCD-severity; bipolar disorder was associated with suicidal acts and panic disorder increased treatment-seeking behaviour. CONCLUSIONS Despite the statistical limitations imposed by the small sample-size, our findings highlight the negative impact of psychiatric comorbidity on health and psychosocial function.
Collapse
Affiliation(s)
- Naomi A Fineberg
- National Obsessive Compulsive Disorders Specialist Service, Hertfordshire Partnership NHS Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire, UK
| | | | | | | | | | | |
Collapse
|
35
|
Relationship between neurocognitive functioning and episode recurrences in bipolar disorder. J Affect Disord 2013; 147:345-51. [PMID: 23232419 DOI: 10.1016/j.jad.2012.11.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 11/20/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND The relationship between neurocognitive impairment and clinical course in bipolar disorder (BD) is inconclusive. The aim of this study was to compare time to recurrence between patients with and without clinically significant cognitive impairment. METHODS Seventy euthymic patients with BD were included. Based on baseline neurocognitive performance, patients were divided into those with (n=49) and those without (n=21) clinically significant cognitive impairment. Both groups of patients were prospectivelly assessed by a modified life chart method during a mean of 16.3 months. RESULTS Patients with some cognitive domain compromised had an increased risk of suffering any recurrence (HR: 3.13; CI 95%: 1.64-5.96), hypo/manic episodes (HR: 2.42; CI 95%: 1.13-5.19), or depressive episodes (HR: 3.84, CI 95%: 1.66-8.84) compared with those patients without clinically significant cognitive impairment. These associations remained significant after adjusting for several potential counfounders such as number of previous episodes, time since last episode, clinical subtype of BD, exposure to antipsychotics, and subclinical symptoms. LIMITATIONS We classified patients as with or without clinically significant cognitive impairment, although deficits in different cognitive domains may not be equivalent in terms of risk of recurrence. CONCLUSIONS The results did not support the hypothesis that the experience of successive episodes is related to a progressive neurocognitive decline. On the contrary, cognitive impairment could be the cause more than the consequence of poorer clinical course. Alternatively, a specific subgroup of patients with clinically significant cognitive impairment and a progressive illness in terms of counts of recurrence and shortening of wellness intervals might explain the association showed in this study.
Collapse
|
36
|
Jakobsson J, Zetterberg H, Blennow K, Johan Ekman C, Johansson AGM, Landén M. Altered concentrations of amyloid precursor protein metabolites in the cerebrospinal fluid of patients with bipolar disorder. Neuropsychopharmacology 2013; 38:664-72. [PMID: 23212456 PMCID: PMC3572463 DOI: 10.1038/npp.2012.231] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Bipolar disorder is a psychiatric disorder characterized by recurrent episodes of mania/hypomania and depression. Progressive cognitive dysfunction such as impairments in executive function and verbal memory is common in euthymic bipolar patients. The cerebrospinal fluid has previously been used to study neurodegenerative processes in Alzheimer's disease, from which changes in three core biomarkers have emerged as indicative of degeneration: amyloid β, total tau, and hyperphosphorylated tau. Here, neurodegeneration in bipolar disorder was investigated by assessing the association between bipolar disorder and cerebrospinal fluid biomarkers for neurodegenerative processes. Cerebrospinal fluid was obtained from 139 bipolar disorder patients and 71 healthy controls. Concentrations of total and phosphorylated tau, amyloid β1-42, amyloid β38/β40/β42, and the soluble forms of amyloid precursor protein were measured in patients vs controls. The concentrations of the soluble forms of amyloid precursor protein were significantly lower in bipolar patients compared with controls. The amyloid β42/amyloid β38 and the amyloid β42/amyloid β40 ratios were higher in bipolar patients than controls. There were no discernible differences in the concentrations of total/phosphorylated tau, amyloid β1-42, or amyloid β38/β40/β42. The concentrations of the biomarkers within the bipolar patient group were further associated with different ongoing medical treatments and diagnostic subgroups. The findings suggest that the amyloid precursor protein metabolism is altered in bipolar disorder. The results may have implications for the understanding of the pathophysiology of bipolar disorder and for the development of treatment strategies. Importantly, there were no signs of an Alzheimer-like neurodegenerative process among bipolar patients.
Collapse
Affiliation(s)
- Joel Jakobsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Mölndal, Gothenburg, Sweden.
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Mölndal, Gothenburg, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Mölndal, Gothenburg, Sweden
| | - Carl Johan Ekman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Mikael Landén
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy, University of Gothenburg, Mölndal, Gothenburg, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
37
|
Lagopoulos J, Hermens DF, Tobias-Webb J, Duffy S, Naismith SL, White D, Scott E, Hickie IB. In vivo glutathione levels in young persons with bipolar disorder: a magnetic resonance spectroscopy study. J Psychiatr Res 2013; 47:412-7. [PMID: 23312884 DOI: 10.1016/j.jpsychires.2012.12.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 01/23/2023]
Abstract
Oxidative stress has recently been reported to assume a significant role in the pathophysiology of bipolar disorder. Several studies have demonstrated the replenishment of glutathione (GSH) diminishes oxidative cellular damage and ameliorates depressive symptoms in this disorder. Whilst the mechanism by which GSH exerts any clinical effect is unknown it has been proposed that it involves the bolstering of antioxidant defences by increasing the bioavailability of GSH, which in turn reverses clinical symptoms of depression. Such a proposal is predicated on the implicit assumption that GSH is diminished in these patients prior to GSH supplementation. However hitherto no study has reported in vivo measures of GSH in patients with bipolar disorder. Using magnetic resonance spectroscopy we obtained in vivo measures of GSH in young people with bipolar disorder and contrasted these with matched healthy controls. Young people with bipolar disorder were found to have no diminution in baseline GSH concentration and, furthermore, no significant correlations were found between GSH and clinical scores of depression or mania. The results do not support the hypothesis that oxidative stress is involved in the primary pathophysiology of bipolar disorder.
Collapse
Affiliation(s)
- J Lagopoulos
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Nery FG, Hatch JP, Monkul ES, Matsuo K, Zunta-Soares GB, Bowden CL, Soares JC. Trait impulsivity is increased in bipolar disorder patients with comorbid alcohol use disorders. Psychopathology 2013; 46:145-52. [PMID: 23007160 DOI: 10.1159/000336730] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 01/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Up to 60% of bipolar disorder (BD) patients develop alcohol use disorders (AUD) at some point in their lives. The causes of this highly prevalent comorbidity are unknown. High trait impulsivity characterizes both isolated BD and AUD and may be a link to explain the association between BD and AUD. In this study, our aims were to investigate whether BD patients with comorbid AUD would present higher trait impulsivity levels compared to BD patients without comorbid AUD, and whether trait impulsivity levels differ within subgroups of BD according to the subcategory of AUD (abuse vs. dependence, alcoholism alone vs. alcoholism plus drug use disorders). SAMPLING AND METHODS Forty-seven outpatients with BD with comorbid AUD (alcoholic BD group) were compared to 66 outpatients with BD alone (nonalcoholic BD group) and to 90 healthy controls (HC). BD and AUD diagnoses were obtained using the Structured Clinical Interview for DSM-IV diagnoses. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11), a self-report instrument that measures trait impulsivity in three domains: nonplanning, attentional and motor. RESULTS Alcoholic BD patients scored significantly higher than nonalcoholic BD and HC on the total and on each subscale BIS scores. Within the alcoholic BD patients, alcohol abusers and alcohol dependents did not statistically differ from each other on the BIS-11 scores. BD patients with AUD plus drug use disorders presented statistically higher nonplanning impulsivity than BD patients with AUD alone. CONCLUSIONS This was a cross-sectional study and causal inferences about the relationship between impulsivity and the comorbidity phenomenon cannot be made. Increased impulsivity may be a trait marker for the co-occurrence between BD and AUD, and mediate some severe manifestations of this comorbidity.
Collapse
Affiliation(s)
- Fabiano G Nery
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | | | | | | | |
Collapse
|
39
|
Greater executive and visual memory dysfunction in comorbid bipolar disorder and substance use disorder. Psychiatry Res 2012; 200:252-7. [PMID: 22769049 PMCID: PMC3650480 DOI: 10.1016/j.psychres.2012.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/31/2012] [Accepted: 06/11/2012] [Indexed: 11/22/2022]
Abstract
Measures of cognitive dysfunction in Bipolar Disorder (BD) have identified state and trait dependent metrics. An influence of substance abuse (SUD) on BD has been suggested. This study investigates potential differential, additive, or interactive cognitive dysfunction in bipolar patients with or without a history of SUD. Two hundred fifty-six individuals with BD, 98 without SUD and 158 with SUD, and 97 Healthy Controls (HC) completed diagnostic interviews, neuropsychological testing, and symptom severity scales. The BD groups exhibited poorer performance than the HC group on most cognitive factors. The BD with SUD exhibited significantly poorer performance than BD without SUD in visual memory and conceptual reasoning/set-shifting. In addition, a significant interaction effect between substance use and depressive symptoms was found for auditory memory and emotion processing. BD patients with a history of SUD demonstrated worse visual memory and conceptual reasoning skills above and beyond the dysfunction observed in these domains among individuals with BD without SUD, suggesting greater impact on integrative, gestalt-driven processing domains. Future research might address longitudinal outcome as a function of BD, SUD, and combined BD/SUD to evaluate neural systems involved in risk for, and effects of, these illnesses.
Collapse
|
40
|
Li CT, Hsieh JC, Wang SJ, Yang BH, Bai YM, Lin WC, Lan CC, Su TP. Differential relations between fronto-limbic metabolism and executive function in patients with remitted bipolar I and bipolar II disorder. Bipolar Disord 2012; 14:831-42. [PMID: 23167933 DOI: 10.1111/bdi.12017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between resting brain glucose metabolism and cognitive profiles in patients with remitted bipolar I disorder (BD-I) and bipolar II disorder (BD-II). We hypothesized that BD-I patients (compared to BD-II patients) would perform worse on tests of cognitive function because of abnormal metabolism in the prefrontal cortex and other mood-related brain areas. METHODS Thirty-four patients with remitted bipolar disorder (BD) (BD-I = 17, BD-II = 17) under treatment and 17 well-matched healthy controls received both fluorodeoxyglucose ((18) F-FDG) positron emission tomography (PET) and neuropsychological tests of attention, memory, and executive function. RESULTS Clinical features in patients with BD-I and BD-II were comparable. Executive function, as indicated by performance on the Wisconsin Card Sorting Test, was significantly worse (i.e., higher percentage of errors, lower percentage of conceptual level responses, and fewer categories completed) in BD-I patients than in BD-II patients and healthy subjects. No difference in attention and memory tests was found among these three groups. Brain PET analysis showed that BD-I patients (compared to BD-II patients) had significantly lower glucose uptake in the bilateral anterior cingulum, insula, striatum, and part of the prefrontal cortex, and higher glucose uptake in the left parahippocampus. Further analyses revealed significant correlations between poor executive function and abnormal glucose uptake in other brain areas in BD-I patients. CONCLUSIONS There are neurobiological differences between subtypes of BD. BD-I is associated with more impaired fronto-limbic circuitry, which might account for reduced executive function in BD-I patients during remission.
Collapse
Affiliation(s)
- Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Solé B, Martínez-Arán A, Torrent C, Bonnin CM, Reinares M, Popovic D, Sánchez-Moreno J, Vieta E. Are bipolar II patients cognitively impaired? A systematic review. Psychol Med 2011; 41:1791-1803. [PMID: 21275085 DOI: 10.1017/s0033291711000018] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is evidence that bipolar disorder (BD) is associated with significant neurocognitive deficits and this occurs in individuals with BD type I (BD I) and with BD type II (BD II). Only a few studies have focused on cognitive impairment in BD II. The aim of this study was to describe the pattern of cognitive impairment in patients with BD II, in order to identify specific cognitive deficits that distinguish BD II from BD I patients as well as from healthy subjects. METHOD We performed a systematic review of the literature of neuropsychological studies of BD II published between 1980 and July 2009. Fourteen articles fulfilled the inclusion criteria and were included in this review. RESULTS Main cognitive deficits found in BD II include working memory and some measures of executive functions (inhibitory control) and approximately half of the studies also detected verbal memory impairment. CONCLUSIONS There are subtle differences between the two subtypes regarding cognition. This may suggest neurobiological differences between the two subgroups which will be helpful in order to determine cognitive endophenotypes in BD subtypes.
Collapse
Affiliation(s)
- B Solé
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Beblo T, Sinnamon G, Baune BT. Specifying the Neuropsychology of Affective Disorders: Clinical, Demographic and Neurobiological Factors. Neuropsychol Rev 2011; 21:337-59. [PMID: 21660503 DOI: 10.1007/s11065-011-9171-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 05/24/2011] [Indexed: 12/30/2022]
|
43
|
Chang JS, Choi S, Ha K, Ha TH, Cho HS, Choi JE, Cha B, Moon E. Differential pattern of semantic memory organization between bipolar I and II disorders. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1053-8. [PMID: 21371517 DOI: 10.1016/j.pnpbp.2011.02.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 11/25/2022]
Abstract
Semantic cognition is one of the key factors in psychosocial functioning. The aim of this study was to explore the differences in pattern of semantic memory organization between euthymic patients with bipolar I and II disorders using the category fluency task. Study participants included 23 euthymic subjects with bipolar I disorder, 23 matched euthymic subjects with bipolar II disorder and 23 matched control subjects. All participants were assessed for verbal learning, recall, learning strategies, and fluency. The combined methods of hierarchical clustering and multidimensional scaling were used to compare the pattern of semantic memory organization among the three groups. Quantitative measures of verbal learning, recall, learning strategies, and fluency did not differ between the three groups. A two-cluster structure of semantic memory organization was identified for the three groups. Semantic structure was more disorganized in the bipolar I disorder group compared to the bipolar II disorder. In addition, patients with bipolar II disorder used less elaborate strategies of semantic memory organization than those of controls. Compared to healthy controls, strategies for categorization in semantic memory appear to be less knowledge-based in patients with bipolar disorders. A differential pattern of semantic memory organization between bipolar I and II disorders indicates a higher risk of cognitive abnormalities in patients with bipolar I disorder compared to patients with bipolar II disorder. Exploring qualitative nature of neuropsychological domains may provide an explanatory insight into the characteristic behaviors of patients with bipolar disorders.
Collapse
Affiliation(s)
- Jae Seung Chang
- Bipolar Disorder Translational Research Center & Department of Neuropsychiatry, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-Gu, Seongnam, Gyeonggi 463-707, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Grande I, Kunz M, Potter W, Balanzá-Martínez V, Vieta E, Kapczinski F. Should bipolar disorder be considered a systemic illness? ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.10.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
45
|
Shan C, Lee SY, Chang YH, Wu JYW, Chen SL, Chen SH, Hsiao YL, Yang HF, Lee IH, Chen PS, Yeh TL, Yang YK, Lu RB. Neuropsychological functions in Han Chinese patients in Taiwan with bipolar II disorder comorbid and not comorbid with alcohol abuse/alcohol dependence disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:131-6. [PMID: 20951757 DOI: 10.1016/j.pnpbp.2010.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 08/30/2010] [Accepted: 10/08/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Studies exploring neuropsychological functions of bipolar disorder (BP) specifically include patients comorbid with alcohol abuse (AB), alcohol dependence (AD), or both (AB/AD). Contradictory assessments of neuropsychological impairment may be caused by not excluding the confounding effects of comorbid AB/AD. Most of the literature discusses BP without subtyping, which overlooks that BP-II may be a valid diagnosis different from BP-I. Because neuropsychological functions are involved in overall BP-II outcomes, we hypothesized that the neuropsychological functions of patients with BP-II comorbid with AD (BP(+AD)) are significantly different from and more impaired than those of patients with BP-II not comorbid with AD (BP(-AD)). METHODS Using DSM-IV criteria, the study included 69 patients with BP-II (19 with BP(+AD); 28 with BP(-AD)) and 22 healthy controls compared using a battery of neuropsychological tests that assessed memory, psychomotor speed, and certain aspects of frontal executive function. All BP-II patients were in an inter-episode period (a period of remission between states of mania, hypomania, and depression). RESULTS BP(+AD) patients had lower scores than did BP(-AD) patients and controls in verbal memory, visual memory, attention, psychomotor speed, and executive function. Working memory was poorer for BP(+AD) than BP(-AD) patients and for both BP groups than for controls. CONCLUSIONS BP(+AD) patients manifested wide neuropsychological dysfunctions, and BP(-AD) patients showed a reduction in working memory, which suggested that working memory might be related to a history of BP-II. Neuropsychological dysfunctions seemed more strongly associated with AB/AD than with BP-II in inter-episode periods.
Collapse
Affiliation(s)
- Cindy Shan
- Institute of Behavioral Medicine, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Lopera-Vasquez J, Bell V, López-Jaramillo C. What is the Contribution of Executive Dysfunction to the Cognitive Profile of Bipolar Disorder? A Well-Controlled Direct Comparison Study. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s0034-7450(14)60194-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Terciarismo en psiquiatría: el Programa de Trastornos Bipolares del Clínic de Barcelona. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:1-4. [DOI: 10.1016/j.rpsm.2011.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 01/31/2011] [Indexed: 02/04/2023]
|
48
|
van der Werf-Eldering MJ, Burger H, Holthausen EAE, Aleman A, Nolen WA. Cognitive functioning in patients with bipolar disorder: association with depressive symptoms and alcohol use. PLoS One 2010; 5:e13032. [PMID: 20927392 PMCID: PMC2946919 DOI: 10.1371/journal.pone.0013032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 09/07/2010] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cognitive dysfunction is clearly recognized in bipolar patients, but the degree of impairment varies due to methodological factors as well as heterogeneity in patient populations. The goal of this study was to evaluate cognitive functioning in bipolar patients and to assess its association with depressive symptoms. Post hoc the relationship with lifetime alcohol use disorder was explored. METHODOLOGY/PRINCIPAL FINDINGS The study included 110 bipolar patients and 75 healthy controls. Patients with severe depressive symptoms, (hypo)manic symptoms and current severe alcohol use disorder were excluded. Diagnoses were evaluated via the Mini-International Neuropsychiatric Interview. Cognitive functioning was measured in domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory, executive functioning and an overall mean score. Severity of depression was assessed by the Inventory of Depressive Symptomatology-self rating. Patients were euthymic (n = 46) or with current mild (n = 38) or moderate (n = 26) depressive symptoms. Cognitive impairment was found in 26% (z-score 2 or more above reference control group for at least one domain) of patients, most prominent in executive functioning (effect size; ES 0.49) and speed of information processing (ES 0.47). Depressive symptoms were associated with dysfunction in psychomotor speed (adjusted beta 0.43; R(2) 7%), speed of information processing (adjusted beta 0.36; R(2) 20%), attentional switching (adjusted beta 0.24; R(2) 16%) and the mean score (adjusted beta 0.23; R(2) 24%), but not with verbal and visual memory and executive functioning. Depressive symptoms explained 24% of the variance in the mean z-score of all 6 cognitive domains. Comorbid lifetime alcohol use (n = 21) was not associated with cognitive dysfunction. CONCLUSIONS/SIGNIFICANCE Cognitive dysfunction in bipolar disorder is more severe in patients with depressive symptoms, especially regarding speed and attention. Therefore, interpretation of cognitive functioning in patients with depressive symptoms should be cautious. No association was found between cognitive functioning and lifetime comorbid alcohol use disorder.
Collapse
|
49
|
Abstract
PURPOSE OF REVIEW Research on the neurocognitive functions of bipolar patients has yielded inconsistent results over recent years. There is a growing need for clarification regarding the magnitude, clinical relevance and confounding variables of cognitive impairment in bipolar patients. RECENT FINDINGS Current findings of studies investigating executive functions, psychomotor speed and memory functions suggest heterogeneous cognitive functioning in patients. A significant amount of variance can be attributed to treatment factors or interactions of those factors with the course of illness and individual characteristics. Furthermore, cognitive domains are presumably inter-related. The impact of bipolar illness on cognition can be influenced by age of onset, pharmaceutical treatment approaches, individual response, familial risk factors, and clinical features. Although brain activation patterns appear to be altered, these alternations do not necessarily correlate with impairment in cognitive performance. Without carefully controlling for confounding variables, the actual effect of bipolar disorder on cognitive performance scores cannot be evaluated. SUMMARY Cognitive deficits of clinical relevance are documented for a substantial proportion, but not the majority, of bipolar patients. Yet, available data are inconclusive with respect to the origin of these deficits. Future studies on cognitive deficits in bipolar patients need to deliver detailed descriptions of drug treatment and clinical features.
Collapse
|
50
|
Neurocognition in bipolar disorders—A closer look at comorbidities and medications. Eur J Pharmacol 2010; 626:87-96. [PMID: 19836378 DOI: 10.1016/j.ejphar.2009.10.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/09/2009] [Indexed: 01/01/2023]
|