Neuropsychological profile of patients with bipolar depression in remission

Aim. To determine if the patients with bipolar affective disorder, after the depressive phase, would exhibit cognitive impairment in remission. Methods. Twenty three euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty-one healthy subjects in the control group, for the presence of the symptoms of depression. The patients and the control group were tested with a battery of neuropsychological tests. Results. Impairments were found in the patients compared with the control group in tests of verbal learning and memory and in tests of executive function. Verbal learning and memory, as well as executive functions, did not correlate either with the clinical indices of patients, or with the demographic and baseline clinical measures of depression. Conclusion. Impaired verbal learning and memory and executive functions may represent a trait rather than the state variables in bipolar disorder.

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Neurocognitive functioning in bipolar depression: a component structure analysis

Psychological Medicine ◽

10.1017/s0033291713001487 ◽

2013 ◽

Vol 44 (5) ◽

pp. 961-974 ◽

Cited By ~ 23

Author(s):

P. Gallagher ◽

J. M. Gray ◽

S. Watson ◽

A. H. Young ◽

I. N. Ferrier

Keyword(s):

Working Memory ◽

Learning And Memory ◽

Test Performance ◽

Bipolar Depression ◽

Statistical Significance ◽

Verbal Learning ◽

Future Research ◽

Control Group ◽

Healthy Controls ◽

Component Structure

BackgroundPrevious studies of neurocognitive performance in bipolar disorder (BD) have focused predominantly on euthymia. In this study we aimed to compare the neurocognitive profile of BD patients when depressed with healthy controls and explore the component structure of neurocognitive processes in these populations.MethodCognitive tests of attention and executive function, immediate memory, verbal and visuospatial learning and memory and psychomotor speed were administered to 53 patients with a SCID-verified diagnosis of BD depression and 47 healthy controls. Test performance was assessed in terms of statistical significance, effect size and percentile standing. Principal component analysis (PCA) was used to explore underlying cognitive factor structure.ResultsMultivariate analysis revealed an overall group effect, depressed BD patients performing significantly worse than controls. Patients performed significantly worse on 18/26 measures examined, with large effect sizes (d > 0.8) on tests of speed of processing, verbal learning and specific executive/working memory processes. Almost all tests produced at least one outcome measure on which ∼25–50% of the BD sample performed at more than 1 standard deviation (s.d.) below the control mean. Between 20% and 34% of patients performed at or below the fifth percentile of the control group in working memory, verbal learning and memory, and psychomotor/processing speed. PCA highlighted overall differences between groups, with fewer extracted components and less specificity in patients.ConclusionsOverall, neurocognitive test performance is significantly reduced in BD patients when depressed. The use of different methods of analysing cognitive performance is highlighted, along with the relationship between processes, indicating important directions for future research.

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Case–control study of neurocognitive function in euthymic patients with bipolar disorder: An association with mania

The British Journal of Psychiatry ◽

10.1192/bjp.180.4.320 ◽

2002 ◽

Vol 180 (4) ◽

pp. 320-326 ◽

Cited By ~ 165

Author(s):

J. T. O. Cavanagh ◽

M. Van Beck ◽

W Muir ◽

D. H. R. Blackwood

Keyword(s):

Bipolar Disorder ◽

Learning And Memory ◽

Verbal Learning ◽

Disease Process ◽

First Episode ◽

State Variables ◽

Neurocognitive Impairments ◽

Adherence To Medication ◽

Process Effects ◽

Healthy Community

BackgroundNeurocognitive impairments in euthymic patients with bipolar disorder may represent trait rather than state variables.AimsTo test the hypothesis that euthymic patients with bipolar disorder would exhibit impairment in verbal learning and memory and executive function compared with healthy controls matched for age, gender and premorbid IQ.MethodTwenty euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty healthy community controls. Cases and controls were tested with a battery of neuropsychological tests.ResultsImpairments were found in cases compared with controls in tests of verbal learning and memory. Verbal learning and memory correlated negatively with the number of manic episodes.ConclusionsImpaired verbal learning and memory may be a trait variable in bipolar disease. There are implications for adherence to medication and relapse and for the role of early treatment interventions. Prospective designs and targeting first-episode groups may help to differentiate trait v. disease process effects.

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Executive functions and insight in OCD: a comparative study

BMC Psychiatry ◽

10.1186/s12888-021-03227-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lucas Manarte ◽

António R. Andrade ◽

Linete do Rosário ◽

Daniel Sampaio ◽

Maria Luísa Figueira ◽

...

Keyword(s):

Executive Functions ◽

Verbal Learning ◽

Wisconsin Card Sorting Test ◽

Control Group ◽

Card Sorting ◽

Obsessive Compulsive ◽

Significance Level ◽

Good Insight ◽

Compulsive Disorder ◽

Neuropsychological Profile

Abstract Background Around 25 to 30% of patients with obsessive-compulsive disorder (OCD) do not respond to treatment. These patients have the longest duration of disease and the worst prognosis. Following years of research on this topic, insight has emerged as a potential explanation for this therapeutic resistance. Therefore, it has become important to characterize OCD patients with poor insight. Few studies have focused on the neuropsychological and cognitive characteristics of these patients. Methods To help fill this gap, we divided 57 patients into two groups, one with good insight and the other with poor insight, assessed their neuropsychological functions—through a Rey’s figure test, a California verbal learning test, a Toulouse–Piéron test and a Wisconsin Card Sorting Test (WCST)—and compared the results with those of a paired control group. Results The statistical analysis, with a significance level of 95%, revealed differences in the executive function tests, and particularly in the WCST (p ≤ 0.001) and trail-making-test (TMT A/B) (p = 0.002). Conclusions These differences suggest that the neuropsychological profile of poor-insight patients is different from their good-insight counterparts, emphasize the role played by the executive functions in insight and highlights the need for more accurate neurocognitive research and treatment.

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Bipolar Affective Disorder and Migraine

Case Reports in Medicine ◽

10.1155/2012/389851 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Birk Engmann

Keyword(s):

Bipolar Disorder ◽

Bipolar Depression ◽

Treatment Options ◽

Bipolar Affective Disorder ◽

Mood Stabilizer ◽

High Rate ◽

First Choice ◽

Bipolar Ii ◽

Behavioural Factors ◽

The Relationship

This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet.

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Temporal Effects of Acute Walking Exercise on Learning and Memory Function

American Journal of Health Promotion ◽

10.1177/0890117117749476 ◽

2017 ◽

Vol 32 (7) ◽

pp. 1518-1525 ◽

Cited By ~ 53

Author(s):

Eveleen Sng ◽

Emily Frith ◽

Paul D. Loprinzi

Keyword(s):

Episodic Memory ◽

Learning And Memory ◽

Acute Exercise ◽

Verbal Learning ◽

Moderate Intensity ◽

Control Group ◽

Memory Encoding ◽

Temporal Effects ◽

Better Than

Purpose: To evaluate the temporal effects of acute exercise on episodic memory. Design: A quasi-experimental study. Sample: Eighty-eight college students (N = 22 per group). Measures: Four experimental groups were evaluated, including a control group, exercising prior to memory encoding, exercising during encoding, and exercising during memory consolidation. The exercise stimulus consisted of a 15-minute moderate-intensity walk on a treadmill. Participants completed the Rey Auditory Verbal Learning Test (RAVLT) to assess learning and memory. Prospective memory was assessed via a Red Pen Task. Long-term memory (recognition and attribution) of the RAVLT was assessed 20 minutes and 24 hours after exercise. Analysis: Repeated-measures analysis of variance (ANOVA) assessed the performance of RAVLT scores of trials 1 to 5 across groups. One-way ANOVA assessed the performance of individual trials across groups, whereas χ2 assessed the performance of the Red Pen Task across groups. Results: Regarding learning, the interaction of groups × trial was marginally statistically significant ( F12,332 = 1.773, P = .05), indicating that the group which exercised before encoding did better than the group that exercised during encoding and consolidation. For both 24-hour recognition and attribution performance, the group that exercised before memory encoding performed significantly better than the group that exercised during consolidation ( P = .05 recognition, P = .006 attribution). Discussion: Engaging in a 15-minute bout of moderate-intensity walking before a learning task was effective in influencing long-term episodic memory.

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A comparison of neurocognitive impairment in younger and older adults with major depression

Psychological Medicine ◽

10.1017/s0033291708004042 ◽

2008 ◽

Vol 39 (5) ◽

pp. 725-733 ◽

Cited By ~ 65

Author(s):

A. J. Thomas ◽

P. Gallagher ◽

L. J. Robinson ◽

R. J. Porter ◽

A. H. Young ◽

...

Keyword(s):

Older Adults ◽

Executive Function ◽

Learning And Memory ◽

Verbal Learning ◽

Late Life ◽

Neurocognitive Impairment ◽

Control Group ◽

Motor Speed ◽

Late Life Depression ◽

Depression Group

BackgroundNeurocognitive impairment is a well-recognized feature of depression that has been reported in younger and older adults. Similar deficits occur with ageing and it is unclear whether the greater deficits in late-life depression are an ageing-related phenomenon or due to a difference in the nature of late-life depression itself. We hypothesized that ageing alone would not fully explain the increased neurocognitive impairment in late-life depression but that differences in the illness explain the greater decrements in memory and executive function.MethodComparison of the neuropsychological performance of younger (<60 years) and older (⩾60 years) adults with major depressive disorder (MDD) and healthy comparison subjects. Scores for each depression group were normalized against their respective age-matched control group and the primary comparisons were on four neurocognitive domains: (i) attention and executive function; (ii) verbal learning and memory; (iii) visuospatial learning and memory; and (iv) motor speed.ResultsWe recruited 75 subjects with MDD [<60 years (n=44), ⩾60 years (n=31)] and 82 psychiatrically healthy comparison subjects [<60 years (n=42), ⩾60 years (n=40)]. The late-life depression group had greater impairment in verbal learning and memory and motor speed but not in executive function. The two depressed groups did not differ in depression severity, global cognitive function, intelligence or education.ConclusionsLate-life depression is associated with more severe impairment in verbal learning and memory and motor speed than depression in earlier adult life and this is not due to ageing alone.

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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.

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Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review

Therapeutic Advances in Psychopharmacology ◽

10.1177/20451253211045870 ◽

2021 ◽

Vol 11 ◽

pp. 204512532110458

Author(s):

Frank M.C. Besag ◽

Michael J. Vasey ◽

Aditya N. Sharma ◽

Ivan C.H. Lam

Keyword(s):

Bipolar Disorder ◽

Bipolar Depression ◽

Controlled Trial ◽

Symptom Control ◽

Bipolar Affective Disorder ◽

Randomised Trial ◽

Controlled Trials ◽

Efficacy And Safety ◽

Mesh Terms ◽

Bipolar Ii

Background: Bipolar disorder (BD) is a cyclic mood disorder characterised by alternating episodes of mania/hypomania and depression interspersed with euthymic periods. Lamotrigine (LTG) demonstrated some mood improvement in patients treated for epilepsy, leading to clinical studies in patients with BD and its eventual introduction as maintenance therapy for the prevention of depressive relapse in euthymic patients. Most current clinical guidelines include LTG as a recommended treatment option for the maintenance phase in adult BD, consistent with its global licencing status. Aims: To review the evidence for the efficacy and safety of LTG in the treatment of all phases of BD. Methods: PubMed was searched for double-blind, randomised, placebo-controlled trials using the keywords: LTG, Lamictal, ‘bipolar disorder’, ‘bipolar affective disorder’, ‘bipolar I’, ‘bipolar II’, cyclothymia, mania, manic, depression, depressive, ‘randomised controlled trial’, ‘randomised trial’, RCT and ‘placebo-controlled’ and corresponding MeSH terms. Eligible articles published in English were reviewed. Results: Thirteen studies were identified. The strongest evidence supports utility in the prevention of recurrence and relapse, particularly depressive relapse, in stabilised patients. Some evidence suggests efficacy in acute bipolar depression, but findings are inconsistent. There is little or no strong evidence in support of efficacy in acute mania, unipolar depression, or rapid-cycling BD. Few controlled trials have evaluated LTG in bipolar II or in paediatric patients. Indications for safety, tolerability and patient acceptability are relatively favourable, provided there is slow dose escalation to reduce the probability of skin rash. Conclusion: On the balance of efficacy and tolerability, LTG might be considered a first-line drug for BD, except for acute manic episodes or where rapid symptom control is required. In terms of efficacy alone, however, the evidence favours other medications.

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Bipolar Affective Disorder and Parkinson's Disease

Case Reports in Medicine ◽

10.1155/2011/154165 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Birk Engmann

Keyword(s):

Parkinson’S Disease ◽

Bipolar Disorder ◽

Parkinson's Disease ◽

Bipolar Depression ◽

Treatment Options ◽

Bipolar Affective Disorder ◽

Mood Stabilizer ◽

Rapid Cycling ◽

Underlying Mechanisms ◽

Few Data

Little is known about comorbidities of bipolar disorder such as Parkinson's disease. A case history and a literature survey indicate that bipolar disorder is linked with or influences Parkinson's disease and vice versa. Underlying mechanisms are poorly understood, and, more importantly, no treatment options are established in such double diagnoses. The few data in comorbid Parkinson cases seem to point to a rapid cycling pattern of bipolar symptoms. With regard to therapeutic intervention, the literature supports pramipexole for treatment of both Parkinson and depressive symptoms in bipolar depression. Lithium, the mood stabilizer of choice for treating manic states, is problematical for use in Parkinson patients because of its side effects. Valproate might be an alternative, especially for treatment of rapid cycling.

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Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees

The British Journal of Psychiatry ◽

10.1192/bjp.bp.110.088823 ◽

2011 ◽

Vol 199 (4) ◽

pp. 303-309 ◽

Cited By ~ 52

Author(s):

Philip B. Mitchell ◽

Andrew Frankland ◽

Dusan Hadzi-Pavlovic ◽

Gloria Roberts ◽

Justine Corry ◽

...

Keyword(s):

Bipolar Disorder ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Clinical Features ◽

Bipolar Depression ◽

Bipolar Affective Disorder ◽

Probabilistic Approach ◽

Psychomotor Retardation ◽

Major Depressive ◽

Depressive Episodes

BackgroundAlthough genetic epidemiological studies have confirmed increased rates of major depressive disorder among the relatives of people with bipolar affective disorder, no report has compared the clinical characteristics of depression between these two groups.AimsTo compare clinical features of depressive episodes across participants with major depressive disorder and bipolar disorder from within bipolar disorder pedigrees, and assess the utility of a recently proposed probabilistic approach to distinguishing bipolar from unipolar depression. A secondary aim was to identify subgroups within the relatives with major depression potentially indicative of ‘genetic’ and ‘sporadic’ subgroups.MethodPatients with bipolar disorder types 1 and 2 (n = 246) and patients with major depressive disorder from bipolar pedigrees (n = 120) were assessed using the Diagnostic Interview for Genetic Studies. Logistic regression was used to identify distinguishing clinical features and assess the utility of the probabilistic approach. Hierarchical cluster analysis was used to identify subgroups within the major depressive disorder sample.ResultsBipolar depression was characterised by significantly higher rates of psychomotor retardation, difficulty thinking, early morning awakening, morning worsening and psychotic features. Depending on the threshold employed, the probabilistic approach yielded a positive predictive value ranging from 74% to 82%. Two clusters within the major depressive disorder sample were found, one of which demonstrated features characteristic of bipolar depression, suggesting a possible ‘genetic’ subgroup.ConclusionsA number of previously identified clinical differences between unipolar and bipolar depression were confirmed among participants from within bipolar disorder pedigrees. Preliminary validation of the probabilistic approach in differentiating between unipolar and bipolar depression is consistent with dimensional distinctions between the two disorders and offers clinical utility in identifying patients who may warrant further assessment for bipolarity. The major depressive disorder clusters potentially reflect genetic and sporadic subgroups which, if replicated independently, might enable an improved phenotypic definition of underlying bipolarity in genetic analyses.

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