Concordance and Discrepancy Between Subjective and Objective Cognitive Assessment in Bipolar Disorder: What is Influencing this Discrepancy?

IntroductionEvidence has shown that some patients with bipolar disorder have a relatively accurate sense of their cognitive abilities, whereas others may overreported or underreported cognitive difficulties, which causes a discrepancy in this measures.ObjectivesTo investigate concordance and discrepancy between subjective and objective cognitive measures, as well as to identify factors that could influence this discrepancy.MethodsPatients who met DSM IV-TR criteria for bipolar disorder in partial or full remission (HDRS-17 score ≤ 12; YMRS score ≤ 7) were recruited from outpatient clinic at Barcelona and Porto Alegre. Objective cognitive assessment was performed by the Letter-Number Sequencing (LNS-WAIS III). Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA) was used as a subjective cognitive measure.ResultsWere included 179 patients. We found a concordance between COBRA and LNS in 62 cases, and discrepancy in 117 cases (Fig. 1). The incongruent group (COBRA–and LNS + ) have less years of study (8.10 ± 4.01) than the incongruent group (COBRA+ and LNS–) (13.44 ± 4.05, P = 0.001), and than congruent group (COBRA–and NLS–) (13.75 ± 4.04, P = 0.003). Finally, the congruent group (COBRA+ and LNS + ) was the group with higher functioning impairment.ConclusionsA few number of false-negative cases were detected, suggesting that COBRA can be used as a screening instrument. A special attention should be provided for subjects with a few years of study, because possibly these subjects presents more difficulty in express its cognitive difficulties.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Patterns of Impairment in Executive Functions within Unipolar and Bipolar Depression

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2182 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S212-S212

Author(s):

B. Suciu ◽

R. Paunescu ◽

I. Miclutia

Keyword(s):

Bipolar Disorder ◽

Executive Functions ◽

Cognitive Deficits ◽

Cognitive Abilities ◽

Bipolar Depression ◽

Cognitive Effort ◽

Unipolar Disorder ◽

Depressed Patients ◽

Competing Interest ◽

Executive Impairment

IntroductionThe majority of studies revealed that cognitive deficits are an important aspect in many psychiatric illnesses, such as bipolar disorder and major depressive disorder. In the past, cognitive impairment was considered part of depression and it was expected to diminish as other mood symptoms improved with treatment.MethodThis study is based on the review of recent literature, performed in order to understand the dimension of executive impairment in unipolar and bipolar depression.ResultsBoth unipolar and bipolar depressed patients display cognitive deficits in several cognitive domains within executive functions. Different subcomponents of executive functions are altered in both types of patients, but impairments in sustained attention appear specific in bipolar depression while dysfunctional divided attention is reported in unipolar disorder. Studies describe deficits in planning strategies and monitoring processes that are characteristically impaired in unipolar depressed patients. Also these subjects tend to make more perseverative responses suggesting set shifting deficits and moreover they require longer time and more cognitive effort in order to accomplish tasks involving inhibitory control or cognitive flexibility. Other findings suggest that bipolar I depressed patients perform worse than bipolar II depressed patients and unipolar depressed patients across all executive functions especially in the decision making process that is considered to be a trait marker for bipolar disorder with no differences between the two types of bipolar subjects.ConclusionsExecutive functions represent a term that includes a higher order of cognitive abilities with deficits that are present in both disorders but display slightly different patterns of impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Psychosocial functioning impairment in euthymic patients with bipolar disorder II: The role of clinical factors

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1164 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S333-S333

Author(s):

R.S. Ilhan ◽

V. Senturk-Cankorur

Keyword(s):

Bipolar Disorder ◽

Psychosocial Functioning ◽

Rating Scale ◽

Healthy Individuals ◽

Young Mania ◽

Clinical Variables ◽

Hamilton Anxiety Rating Scale ◽

Short Test ◽

Competing Interest ◽

Bipolar Patients

IntroductionGrowing body of evidence have showed that euthymic bipolar patients have poor psychosocial functioning. Most of the studies have focused on the psychosocial functioning in euthymic bipolar disorder (BD)-I patients. On the contrary, there have been limited researches investigating psychosocial functioning in euthymic BD-II patients. Moreover, the factors associated with psychosocial functioning in euthymic patients with BD II have been also understudied.Objectives/aimsAim of our study was to investigate the association between clinical variables and poor psychosocial functioning in euthymic BD-II patients. Hypothesis of this study was that euthymic BD-II patients would have low level of psychosocial functioning compared with healthy individuals.MethodsBD-II (n = 37) and healthy subjects (n = 35) were compared in terms of their psychosocial functioning which were assessed by Functional Assessment Short Test (FAST). The euthymic state was confirmed by low scores both on the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). Anxiety symptoms were also assessed by Hamilton Anxiety Rating Scale (HARS) in both groups. Clinical variables were taken as independent variables and FAST scores were taken as dependent variable in order to run correlation analysis in BD-II group.ResultsNo socio-demographic differences were found between two groups. Euthymic BD-II patients had significantly higher FAST, HARS, HDRS YMRS scores compared with healthy individuals. Only HDRS scores correlated with FAST scores of BD-II patients.ConclusionsThis study indicated that euthymic BD-II patients had poorer psychosocial functioning. And subclinical depressive symptoms were associated with poor psychosocial functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Predictors of functioning in major depression

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.255 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S325-S325

Author(s):

M. Serra-Blasco ◽

E. Aguilar ◽

M. Vicent ◽

G. Navarra ◽

M.J. Portella ◽

...

Keyword(s):

Depressive Symptoms ◽

Major Depression ◽

Statistical Power ◽

Rating Scale ◽

Cognitive Domain ◽

Neuropsychological Battery ◽

Cognitive Difficulties ◽

Mood Symptoms ◽

Life Functioning ◽

Competing Interest

IntroductionLife functioning difficulties are a relevant but undervalued consequence of major depression. Mood symptoms and cognitive deficits have a significant, and somehow independent, impact on them. Therefore, cognitive difficulties should be considered a potential target to improve patients’ functioning.AimsTo examine the degree in which objective and subjective cognition explain functional outcome.ObjectivesTo assess objective cognitive function (CF) with a neuropsychological battery and to measure subjective CF using measures of cognitive perception.MethodsNinety-nine patients with depression were assessed by age, sex and level of schooling. Depressive symptoms severity was measured by Hamilton Depression Rating Scale (HDRS-17). Objective CF consisted in the following cognitive domains: memory, attention, executive functioning and processing speed. Subjective CF was assessed with Perceived Deficit Questionnaire-Depression (PDQ-D). Functioning Assessment Short Test (FAST) was used to evaluate life functioning, excluding the cognitive domain. All the listed measures were included in a multiple regression analysis with FAST scores as dependent variable.ResultsThe regression model was significant (F1,98 = 67.484, P < 0.001) with an R of 0.825. The variables showing statistical power included (from higher to lower β-coefficient) HDRS-17 (β = 0.545, t = 8.453, P < 0.001), PDQ-D (β = 0.383, t = 6.047, P < 0.001) and DSST (β = −0.123, t = −1.998, P = 0.049).ConclusionsThe severity of depressive symptoms is the variable that best explains life functioning. Surprisingly, the second factor hindering it is the patients’ perception of their cognition. Current findings highlight the importance of correcting cognitive bias in order to improve functionality. However, results have to be taken cautiously as mood symptoms could partly explain the bias.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Emotional Schemas: A New Cognitive Perspective for the Distinction Between Unipolar Depression and Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.016 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S243-S243 ◽

Cited By ~ 1

Author(s):

O. Onur

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Depression Scale ◽

Unipolar Depression ◽

Group Differences ◽

Young Mania ◽

Exploratory Investigation ◽

General Activation ◽

Dsm Iv ◽

Competing Interest

IntroductionClinicians need to make the differential diagnosis between unipolar depression and bipolar disorder to guide their treatment choices. Looking at the differences observed in the emotional schemas might help with this differentiation. This study is an exploratory investigation of schema theory's Leahy's emotional schemas among individuals diagnosed with bipolar disorder and unipolar depression.MethodsThree groups of subjects 56 unipolar depression in the remission period, 70 bipolar eutimic and 58 healthy controls were asked to fill out the Leahy Emotional Schema Scale (LESS). The clinicians diagnosed the participants according to the criteria of DSM-IV-TR with SCID-I, and rated the moods of the subjects with the Beck Depression Scale, and the Young Mania Rating Scale (YMRS). Statistical analyses were undertaken to identify the group differences on LESS.ResultsThe bipolar eutimic and unipolar depression patients’ scores on the LESS dimensions were significantly different from the healthy participants in the areas of control, consensus, acceptance of feelings, dissimilarity and simplistic view of emotions.ConclusionsThese results suggest that the metacognitive model of unipolar depression might be extrapolated for patients with bipolar disorder. Bipolar disorder may be associated with a general activation of the emotional schemas.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Download Full-text

Assessment of psychotic symptoms in bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.376 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S419-S419

Author(s):

F. Cazan ◽

R. Paunescu ◽

A. Tamas

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Psychotic Symptoms ◽

Young Mania ◽

Affective Symptoms ◽

Number Of Patients ◽

General Functioning ◽

Competing Interest ◽

Bipolar Patients ◽

Manic Patients

IntroductionBipolar disorder is a disabling condition characterized by the presence of manic, depressive, hypomanic or mixed episodes, affective symptoms that may coexist with several types of psychotic features.ObjectivesThe purpose is to evaluate the frequency of psychotic symptoms among bipolar disorder.MethodThe study included 55 bipolar patients admitted in the Psychiatry Clinical Hospital from January 2012 until May 2013. Inclusion criteria were represented by diagnosis of bipolar disorder, manic or depressive episode, according to DSM-IV-TR and ICD 10 criteria. Clinical instruments used to assess the severity of the current affective episode were Young Mania Rating Scale (YMRS) for manic patients and Hamilton Depression Rating Scale-17 items – (HDRS) for the depressive ones. Psychotic symptoms were evaluated with the Brief Psychiatric Rating Scale-18 items – (BPRS).ResultsOut of the 55 patients, 32 had psychotic symptoms upon admission to the hospital. BPRS results showed delusions of guilt, inutility, hypochondriac and nihilistic delusions for the depressed patients. Delusions of grandiosity and megalomania accounted for most of psychotic symptoms in manic patients. A smaller number of patients showed delusions of invention and reform. Perception disturbances such as auditory hallucinations were present in both diagnosis categories but in a higher percentage in depressive bipolar patients.ConclusionsEven if less frequently than in schizophrenia or schizoaffective disorder, psychotic symptoms are present in bipolar disorder. They influence the general functioning and the outcome of patients diagnosed with this illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

The functional impairment of different subtypes and occupational states in euthymic patients with bipolar disorder

BMC Psychiatry ◽

10.1186/s12888-021-03242-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinyu Liu ◽

Xiaojuan Ma ◽

Wenchen Wang ◽

Jian Zhang ◽

Xia Sun ◽

...

Keyword(s):

Bipolar Disorder ◽

Social Functioning ◽

Rating Scale ◽

Verbal Learning ◽

Occupational Status ◽

Learning Performance ◽

Neurocognitive Functioning ◽

Type I ◽

Speed Of Processing ◽

Occupational Functioning

Abstract Background The aim was to explore the associations between clinical symptoms, demographic variables, social and neurocognitive functioning in euthymic patients with bipolar disorder (BD) stratified by subgroups of DSM-IV BD (type I (BD-I) and type II (BD-II)) and occupational status (employed/unemployed), and to highlight the significance of occupational status when assessing social and neurocognitive functioning in euthymic BD patients. Methods A total of 81 euthymic BD patients were participated in the study. The severity of the depressive and manic/hypomanic symptoms was measured using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Social functioning and neurocognitive functioning were evaluated by the Functioning Assessment Short Test (FAST) and neurocognitive measures, respectively. Results Employed BD patients displayed greater social functioning (autonomy, occupational functioning, interpersonal relationship domain) and better verbal learning performance and speed of processing than unemployed BD patients. The correlation between neurocognitive functioning and social functioning was stronger in the employed group than in the unemployed group. There were no significant differences in neurocognitive and social functioning between the BD-I and BD-II groups, and the correlation between neurocognitive functioning and social functioning was similar between the BD-I and BD-II groups. Conclusion Employed BD patients may present greater occupational functioning and interpersonal relationships, as well as better verbal learning performance and speed of processing.

Download Full-text

Treatment of bipolar depression with supraphysiologic doses of levothyroxine: a randomized, placebo-controlled study of comorbid anxiety symptoms

International Journal of Bipolar Disorders ◽

10.1186/s40345-019-0155-y ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Maximilian Pilhatsch ◽

Thomas J Stamm ◽

Petra Stahl ◽

Ute Lewitzka ◽

Anne Berghöfer ◽

...

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Bipolar Depression ◽

Phenotypic Expression ◽

Anxiety Symptoms ◽

Controlled Study ◽

Double Blind ◽

Comorbid Anxiety ◽

Depressed Patients ◽

Depressive Episodes

Abstract Background Symptoms of anxiety co-occur in a variety of disorders including in depressive episodes of bipolar disorder and in patients with thyrotoxicosis. Treatment of refractory bipolar disorder with supraphysiologic doses of levothyroxine (L-T4) has been shown to improve the phenotypic expression of the disorder and is associated with an increase of circulating thyroid hormones. However, it might be associated with somatic and mental adverse effects. Here we report the investigation of the influence of treatment with supraphysiologic doses of L-T4 on symptoms of anxiety in patients with refractory bipolar depression. Methods Post-hoc analysis from a 6-week, multi-center, randomized, double-blind, placebo-controlled study of the effects of supraphysiologic L-T4 treatment on anxiety symptoms in bipolar depression. Anxiety symptoms were measured weekly with the Hamilton anxiety/somatization factor (HASF) score of the Hamilton Depression Rating Scale (HAMD) and the State- and Trait Anxiety Inventory (STAI). Results Treatment of both groups was associated with a significant reduction in anxiety symptoms (p < 0.001) with no statistical difference between groups (LT-4: from 5.9 (SD = 2.0) at baseline to 3.7 (SD = 2.4) at study end; placebo: from 6.1 (SD = 2.4) at baseline to 4.4 (SD = 2.8) at study end; p = 0.717). Severity of anxiety at baseline did not show a statistically significant correlation to the antidepressive effect of treatment with supraphysiologic doses of L-T4 (p = 0.811). Gender did not show an influence on the reduction of anxiety symptoms (females: from 5.6 (SD = 1.7) at baseline to 3.5 (SD = 2.4) at study end; males: from 6.1 (SD = 2.3) at baseline to 4.0 (SD = 2.4) at study end; p = 0.877). Conclusions This study failed to detect a difference in change of anxiety between bipolar depressed patients treated with supraphysiologic doses of L-T4 or placebo. Comorbid anxiety symptoms should not be considered a limitation for the administration of supraphysiologic doses of L-T4 refractory bipolar depressed patients. Trial registration ClinicalTrials, ClinicalTrials.gov identifier: NCT01528839. Registered 2 June 2012—Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT01528839

Download Full-text

Correlates of the discrepancy between objective and subjective cognitive functioning in non-demented patients with Parkinson’s disease

Journal of Neurology ◽

10.1007/s00415-021-10519-4 ◽

2021 ◽

Author(s):

Mattia Siciliano ◽

Lugi Trojano ◽

Rosa De Micco ◽

Valeria Sant’Elia ◽

Alfonso Giordano ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Linear Regression ◽

Cognitive Functioning ◽

Rating Scale ◽

Regression Analyses ◽

Chi Square ◽

Cognitive Measure ◽

Objective Evidence ◽

Cognitive Discrepancy

Abstract Background Subjective complaints of cognitive deficits are not necessarily consistent with objective evidence of cognitive impairment in Parkinson’s disease (PD). Here we examined the factors associated with the objective-subjective cognitive discrepancy. Methods We consecutively enrolled 90 non-demented patients with PD who completed the Parkinson’s Disease Cognitive Functional Rating Scale (subjective cognitive measure) and the Montreal Cognitive Assessment (MoCA; objective cognitive measure). The patients were classified as “Overestimators”, “Accurate estimators”, and “Underestimators” on the basis of the discrepancy between the objective vs. subjective cognitive measures. To identify the factors distinguishing these groups from each other, we used chi-square tests or one-way analyses of variance, completed by logistic and linear regression analyses. Results Forty-nine patients (54.45%) were classified as “Accurate estimators”, 29 (32.22%) as “Underestimators”, and 12 (13.33%) as “Overestimators”. Relative to the other groups, the “Underestimators” scored higher on the Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), and Parkinson Anxiety Scale (p < 0.01). Logistic regression confirmed that FSS and BDI scores distinguished the “Underestimators” group from the others (p < 0.05). Linear regression analyses also indicated that FSS and BDI scores positively related to objective-subjective cognitive discrepancy (p < 0.01). “Overestimators” scored lower than other groups on the MoCA’s total score and attention and working memory subscores (p < 0.01). Conclusion In more than 45% of consecutive non-demented patients with PD, we found a ‘mismatch’ between objective and subjective measures of cognitive functioning. Such discrepancy, which was related to the presence of fatigue and depressive symptoms and frontal executive impairments, should be carefully evaluated in clinical setting.

Download Full-text

Antipsychotic Medication Adherence Scale (AMAS): Development and preliminary psychometric properties

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.658 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s258-s259

Author(s):

M.J. Martins ◽

A.T. Pereira ◽

C.B. Carvalho ◽

P. Castilho ◽

A.C. Lopes ◽

...

Keyword(s):

Medication Adherence ◽

Psychometric Properties ◽

Antipsychotic Medication ◽

Convergent Validity ◽

Rating Scale ◽

Statistical Analysis Plan ◽

Different Types ◽

Adherence Scale ◽

Relevant Variables ◽

Competing Interest

IntroductionAlthough being highly consensual that antipsychotic adherence is an important outcome predictor in psychosis, existing reviews have found mean rates of adherence around 40–60%. Several aspects, such as patient-related, medication-related, environmental-related variables have been described as important predictors.AimsThis study aim is to develop, administer and present preliminary psychometric properties of a new scale for antipsychotic medication adherence that includes different types of predictors (clinical, psychosocial, and practical among others).MethodsThe “AMAS” was developed by a multidisciplinary team and was based on recent research on factors influencing antipsychotic adherence. The scale evolved from multiple drafts and experts were contacted in order to improve the final version. Over 50 patients with a diagnosis of a psychotic-spectrum disorder taking antipsychotic medication will be assessed with the “AMAS” and the Medication Adherence Rating Scale. Additionally, each patient's psychiatrist will fill in a form with demographic and clinical variables (such as type of symptoms, previous adherence problems, current adherence, insight and other relevant variables).ResultsThis is an ongoing study and the sample is still being collected (scheduled finish date: February/2016). Our statistical analysis’ plan includes: reliability analysis (Chronbach's alpha, alpha if item deleted, inter item correlations and covariances and item-total correlations); validity (convergent validity); factorial analysis.ConclusionsIt is hypothesized that the “AMAS” will be a practical, reliable and valid unidimentional instrument with clinical utility assessing adherence to antipsychotics. The “AMAS” can be also useful in assessing intervention targets (e.g. psychoterapeutical, psychoeducational) to enhance adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Comparisons of Narrative Psychotherapy to Conventional CBT for the Psychotherapy of Psychosis and Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1480 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s779-s779

Author(s):

L. Mehl-Madrona ◽

B. Mainguy

Keyword(s):

Bipolar Disorder ◽

Narrative Therapy ◽

Rating Scales ◽

Psychotic Disorders ◽

Rating Scale ◽

Therapy Group ◽

Well Being ◽

Outcome Data ◽

Symptom Scale ◽

Young Mania

IntroductionThere is ongoing debate about about both the value of psychotherapy in psychotic disorders and the best type of psychotherapy to use if necessary.MethodsWe conducted narrative psychotherapy with 18 adults, all diagnosed as having bipolar disorder with psychotic features and/or schizo-affective disorder. Outcome data consisted of the Positive and Negative Symptom Scale, the Clinical Global Impressions Scale, the Young Mania Rating Scale, the Hamilton Anxiety and Depression Scales, the My Medical Outcome Profile, Version 2(MYMOP2), and the Outcome Rating Scales of Duncan and Miller. We compare the outcomes of our patients to those of a matched comparison group receiving conventional psycho-education and cognitive behavioural therapy. Patients were seen for a minimum of 16 weeks over an average of 22 weeks. Average age was 31.5 years with a standard deviation of 8.1 years.ResultsThe narrative therapy group showed statistically significant reductions in all outcome measures compared to the conventional treatment group. They continued treatment significantly longer and had fewer re-hospitalizations. They were less distressed by voices.ConclusionsA narrative psychotherapy approach using dialogical theory and therapy ideas is a reasonable approach for the psychotherapy of psychosis. Review of psychotherapy notes showed that narrative approaches allowed the therapist to align with the patient as collaborator in considering the story presented and was therefore less productive of defensiveness and self-criticism than conventional approaches. The therapy included techniques for negotiating changes in illness narratives, identity narratives, and treatment narratives that were more conducive of well-being and recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text