Deficits in tasks of executive functioning that mimic real-life scenarios in bipolar disorder

AbstractExecutive dysfunction causes significant real-life disability for patients with spina bifida (SB). However, no previous research has been directed toward the amelioration of executive functioning deficits amongst persons with SB. Goal Management Training (GMT) is a compensatory cognitive rehabilitation approach, addressing underlying deficits in sustained attention to improve executive function. GMT has received empirical support in studies of other patient groups. The purpose of the present study was to determine the efficacy of GMT in treating subjects with SB, using inpatient intervention periods. We hypothesized post-intervention changes in scores on neuropsychological measures to reflect improved attentional control, including sustained attention and inhibitory control. Thirty-eight adult subjects with SB were included in this randomized controlled trial. Inclusion was based upon the presence of executive functioning complaints. Experimental subjects (n = 24) received 21 hr of GMT, with efficacy of GMT being compared to results of subjects in a wait-list condition (n = 14). All subjects were assessed at baseline, post-intervention, and at 6-month follow-up. Findings indicated superior effects of GMT on domain-specific neuropsychological measures and on a functional “real-life” measure, all lasting at least 6 months post-treatment. These results show that deficits in executive functioning can be ameliorated in patients with congenital brain dysfunction. (JINS, 2013, 19, 1–14)

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Executive functioning deficits among adults with Bipolar Disorder (types I and II): A systematic review and meta-analysis

Journal of Affective Disorders ◽

10.1016/j.jad.2017.04.010 ◽

2017 ◽

Vol 218 ◽

pp. 407-427 ◽

Cited By ~ 35

Author(s):

Tania Dickinson ◽

Rodrigo Becerra ◽

Jacqui Coombes

Keyword(s):

Systematic Review ◽

Bipolar Disorder ◽

Executive Functioning ◽

Meta Analysis ◽

Executive Functioning Deficits

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Executive dysfunction in bipolar disorder and borderline personality disorder

European Psychiatry ◽

10.1016/j.eurpsy.2014.12.009 ◽

2015 ◽

Vol 30 (8) ◽

pp. 959-964 ◽

Cited By ~ 11

Author(s):

H.Z. Gvirts ◽

Y. Braw ◽

H. Harari ◽

M. Lozin ◽

Y. Bloch ◽

...

Keyword(s):

Bipolar Disorder ◽

Borderline Personality Disorder ◽

Problem Solving ◽

Personality Disorder ◽

Executive Functioning ◽

Neuropsychological Test ◽

Executive Dysfunction ◽

Borderline Personality ◽

Healthy Controls ◽

Strategy Formation

AbstractObjectiveThe boundary between bipolar disorder (BD) and borderline personality disorder is a controversial one. Despite the importance of the topic, few studies have directly compared these patient groups. The aim of the study was to compare the executive functioning profile of BD and BPD patients.MethodExecutive functioning (sustained attention, problem-solving, planning, strategy formation, cognitive flexibility and working memory) was assessed in BD (n= 30) and BPD outpatients (n= 32) using a computerized assessment battery (Cambridge Neuropsychological Test Automated Battery, CANTAB). The groups were compared to one another as well as to healthy controls.ResultsBD patients showed deficits in strategy formation and in planning (indicated by longer execution time in the ToL task) in comparison to BPD patients and healthy controls. BPD patients showed deficits in planning (short deliberation time in the ToL task) in comparison to BD patients and in comparison to healthy controls. In comparison to healthy controls, BPD patients displayed deficits in problem-solving.ConclusionsDifferences in executive dysfunction between BD and BPD patients suggest that this cognitive dimension may be relevant for the clarification of the boundary between the disorders.

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Understanding the Impact of Bipolar Disorder Experience from an Insiders' Perspective

Psychological Disorders and Research ◽

10.31487/j.pdr.2020.01.07 ◽

2020 ◽

pp. 1-5

Author(s):

Sophie Favre ◽

Hélène Richard-Lepouriel ◽

Sophie Favre

Keyword(s):

Bipolar Disorder ◽

Clinical Practice ◽

Lived Experience ◽

Life Experience ◽

Single Case ◽

Real Life ◽

Future Research ◽

Type I ◽

Key Informant ◽

The Impact

Introduction: Bipolar disorder is characterized by recurrent episodes of depression and hypomania and is often associated with functional impairment even between mood episodes. A substantial proportion of patients experience inter-episode mood swings, making bipolar disorder a complex psychiatric disorder to manage. Patients’ perspectives can enhance clinical practice and research. The present study aimed to explore the impact of the bipolar disorder experience from a patient’s perspective to facilitate better understanding in clinical practice and future research. Method: We conducted a single case study with a key informant living with bipolar disorder (type I) for more than 20 years. The key informant constructed a chart of his mood disorder experiences. Subsequently, he commented on the chart and these comments were noted down by his therapist. Results: We present a chart of lived experience perception by a person living with bipolar disorder. The main axis was reality perception and it was related with mood, identity, and functioning. The comments on the chart provided a detailed and accurate description of a lived experience of functioning of bipolar disorder and its impact on a person’s life. Discussion: Globally, the experiences described by the key informant are consistent with previous literature. The principal finding was the meaning of the subjective experiences of reality perception, their relation with mood change, and impact on the person’s life. The perception of reality seems to be a key factor in the experience of bipolar mood swings. Not only did the disorder affect the self and the functioning, but at its extreme, reality “either did not matter or did not exist.” This feeling enhanced the sense of being disconnected from the world and the surroundings and led to the experience of extreme loneliness. Conclusion: The description in this study cannot be generalized, since it was conducted with only one subject. However, it provided a better insight into the detailed real-life experience that can be useful for clinicians treating persons living with bipolar disorder. Such descriptions obtained from a qualitative procedure can also be combined with quantitative data in patients' assessments and research. This study suggests that the experience of “disconnection” should be investigated further.

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Chronic stress, executive functioning, and real‐life self‐control: An experience sampling study

Journal of Personality ◽

10.1111/jopy.12587 ◽

2020 ◽

Author(s):

Max Wolff ◽

Sören Enge ◽

Anja Kräplin ◽

Klaus‐Martin Krönke ◽

Gerhard Bühringer ◽

...

Keyword(s):

Executive Functioning ◽

Chronic Stress ◽

Real Life ◽

Experience Sampling ◽

Self Control

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Differential executive functioning performance by phase of bipolar disorder

Bipolar Disorders ◽

10.1111/j.1399-5618.2012.01032.x ◽

2012 ◽

Vol 14 (5) ◽

pp. 527-536 ◽

Cited By ~ 45

Author(s):

Kelly A Ryan ◽

Aaron C Vederman ◽

E Michelle McFadden ◽

Anne L Weldon ◽

Masoud Kamali ◽

...

Keyword(s):

Bipolar Disorder ◽

Executive Functioning

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Bipolar Disorder

Understanding the Mental Health Problems of Children and Adolescents ◽

10.1093/oso/9780190927844.003.0013 ◽

2021 ◽

pp. 191-211

Author(s):

Kirstin Painter ◽

Maria Scannapieco

Keyword(s):

Bipolar Disorder ◽

Real Life ◽

Assessment Tools ◽

Class Discussion ◽

Developmental Level ◽

Bipolar Ii Disorder ◽

Diagnostic And Statistical Manual ◽

Disruptive Mood Dysregulation Disorder ◽

Bipolar Ii ◽

New Diagnosis

Bipolar disorder is a category of mood disorders that result in severe changes in a person’s mood and energy level. This chapter provides an overview of the most current research, causes, signs, symptoms, and diagnostic criteria of bipolar I and bipolar II disorder and cyclothymia. A discussion on the differences in the presentation of symptoms based on child or adolescents developmental level and on differential diagnosis is included. Disruptive mood dysregulation disorder (DMDD) is described in Chapter 5; however, it is revisited in this chapter because it was added as a new diagnosis beginning with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders to capture youth who experience significant difficulties but do not have the classic symptoms of BD. The chapter ends with an overview of common assessment tools, real-life case studies, and questions for class discussion.

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Emotional avoidance process in patients with schizophrenia and bipolar disorder. New module: Emotional body's sensations and meta-cognitive work on the interpretation of delusional thinking

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2083 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S562-S562

Author(s):

A. Suchocka Capuano ◽

A. Karar ◽

A. Ponseti Gaillochon ◽

A. Georgin ◽

C. Bungener ◽

...

Keyword(s):

Bipolar Disorder ◽

Behavioral Therapy ◽

Real Life ◽

Role Playing ◽

Emotional Awareness ◽

Mediating Role ◽

Cognitive Work ◽

Emotional Avoidance ◽

Competing Interest ◽

Emotional Identification

IntroductionPsychological processes play a mediating role in the development of psycho-pathological disorders depending on the Kinderman's model. Excessive use of emotional avoidance becomes, following the model of Barlow and Allen, the booster of emotional distress at long term. Dysfunctional meta-cognitive processes in turn influence the inadequate interpretations of life experiences.ObjectiveTo improve identification, expression and emotional management in patients with schizophrenia (PWS) and patients with bipolar disorder (PWBD).AimsIntroduction of exposition for the emotional body's sensations. This work on emotional awareness by images and sounds prepare to role-playing and to exposure in real life.MethodsGroups of psychotherapy for adults PWS and PWBD was implemented. The techniques used are those of cognitive behavioral therapy CBT (Beck) and emotional therapies (Barlow): columns Beck tailored, role-playing, psycho-emotional and breathing. Four groups of four patients participated in six therapy sessions.ResultsAn increase in emotional flexibility is observed two weeks after the group work (Wilcoxon P = 0.025). Work on emotional identification facilitates the relaxation of the avoidance process while promoting social skills. The new format includes nine sessions three additional sessions on the emotional body sensations. Meta-cognitive work on the interpretation of the delusional thinking has been inserted.ConclusionThe experience of this pilot study provides encouraging results. The transdiagnostic approach referring to the alterations of this common psychological process finds use with PWS and PWBD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Toi Même, a Mobile Health Platform for Measuring Bipolar Illness Activity: Protocol for a Feasibility Study (Preprint)

10.2196/preprints.18818 ◽

2020 ◽

Author(s):

Aroldo A Dargél ◽

Elise Mosconi ◽

Marc Masson ◽

Marion Plaze ◽

Fabien Taieb ◽

...

Keyword(s):

Bipolar Disorder ◽

Real Life ◽

Integrated Approach ◽

Type I ◽

Motion Sensors ◽

Open Label ◽

Self Monitoring ◽

Mood Instability ◽

Mood Symptoms ◽

First Results

BACKGROUND The diagnosis and management of bipolar disorder are limited by the absence of available biomarkers. Patients with bipolar disorder frequently present with mood instability even during remission, which is likely associated with the risk of relapse, impaired functioning, and suicidal behavior, indicating that the illness is active. OBJECTIVE This research protocol aimed to investigate the correlations between clinically rated mood symptoms and mood/behavioral data automatically collected using the Toi Même app in patients with bipolar disorder presenting with different mood episodes. This study also aimed to assess the feasibility of this app for self-monitoring subjective and objective mood/behavior parameters in those patients. METHODS This open-label, nonrandomized trial will enroll 93 (31 depressive, 31 euthymic, and 31 hypomanic) adults diagnosed with bipolar disorder type I/II (Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria) and owning an iPhone. Clinical evaluations will be performed by psychiatrists at the baseline and after 2 weeks, 1 month, 2 months, and 3 months during the follow-up. Rather than only accessing the daily mood symptoms, the Toi Même app also integrates ecological momentary assessments through 2 gamified tests to assess cognition speed (QUiCKBRAIN) and affective responses (PLAYiMOTIONS) in real-life contexts, continuously measures daily motor activities (eg, number of steps, distance) using the smartphone’s motion sensors, and performs a comprehensive weekly assessment. RESULTS Recruitment began in April 2018 and the completion of the study is estimated to be in December 2021. As of April 2019, 25 participants were enrolled in the study. The first results are expected to be submitted for publication in 2020. This project has been funded by the Perception and Memory Unit of the Pasteur Institute (Paris) and it has received the final ethical/research approvals in April 2018 (ID-RCB: 2017-A02450-53). CONCLUSIONS Our results will add to the evidence of exploring other alternatives toward a more integrated approach in the management of bipolar disorder, including digital phenotyping, to develop an ethical and clinically meaningful framework for investigating, diagnosing, and treating individuals at risk of developing bipolar disorder or currently experiencing bipolar disorder. Further prospective studies on the validity of automatically generated smartphone data are needed for better understanding the longitudinal pattern of mood instability in bipolar disorder as well as to establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with bipolar disorder. CLINICALTRIAL ClinicalTrials.gov NCT03508427; https://clinicaltrials.gov/ct2/show/NCT03508427 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18818

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