Impact of subthreshold symptoms on cognitive performance and psychosocial functioning in patients with bipolar disorder

BackgroundPersistent impairments in neurocognitive function have been described in bipolar disorder.AimsTo compare the cognitive performance of patients with bipolar II disorder with that of patients with bipolar I disorder and a healthy control group.MethodThe study included 71 euthymic patients with bipolar disorder (38 bipolar I, 33 bipolar II), who were compared on clinical and neuropsychological variables (e.g. executive function, attention, verbal and visual memory) and contrasted with 35 healthy controls on cognitive performance.ResultsCompared with controls, both bipolar groups showed significant deficits in most cognitive tasks including working memory (Digit Span Backwards, P=0.002) and attention (Digit Span Forwards, P=0.005; Trail Making Test, P=0.001). Those with type II disorders had an intermediate level of performance between the bipolar I group and the control group in verbal memory (P < 0.005) and executive functions (Stroop interference task, P=0.020).ConclusionsCognitive impairment exists in both subtypes of bipolar disorder, although more so in the bipolar I group. The best predictors of poor psychosocial functioning in bipolar II disorder were subclinical depressive symptoms, early onset of illness and poor performance on a measure related to executive function.

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Determinants of Functioning in Euthymic Patients with Bipolar Disorder: A Structural Equation Modelling Approach

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.246 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S77-S77

Author(s):

L. Samalin ◽

L. Boyer ◽

A. Murru ◽

I. Pacchiarotti ◽

M. Reinares ◽

...

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Cognitive Performance ◽

Psychosocial Functioning ◽

Structural Equation ◽

Sleep Disturbances ◽

Path Coefficient ◽

Residual Symptoms ◽

Equation Modelling

BackgroundEuthymic patients with bipolar disorder (BD) experience residual symptoms. Interestingly, residual symptoms appear to impact the natural course of BD and represent potential predictors of recurrence and functional impairment.ObjectivesThe study aimed to analyse the relationship between residual depressive symptoms, sleep disturbances and cognitive impairment as determinants of psychosocial functioning in a large sample of euthymic BD patients.MethodsWe performed a cross-sectional study of 468 BD outpatients in clinical remission for at least 6 months. Bipolar Depression Rating Scale (BDRS), Pittsburgh Sleep Quality Index (PSQI) scale, Visual Analogic Scales (VAS) evaluated cognitive impairment and functioning assessment short test were used to assess residual symptomatology and functioning of patients. We evaluated functioning with. Structural equation modelling (SEM) was used to describe the relationships among the residual depressive symptoms, sleep disturbances, perceived cognitive performance and functioning.ResultsSEM showed good fit. This model revealed that residual depressive symptoms (path coefficient = 0.37) and perceived cognitive performance (path coefficient = 0.27) were the most important features significantly related to psychosocial functioning. Sleep disturbances were indirectly associated with functioning via residual depressive symptoms and perceived cognitive performance (path coefficient = 0.23).ConclusionsThis study contributes to a better understanding of the determinants of psychosocial functioning during the interepisodic periods of BD patients. These findings should have implications for the improvement of functioning of BD patients in a personalized approach to treatment.Disclosure of interestCOI: Dr. Samalin reports personal fees and nonfinancial support from Astra-Zeneca, Bristol Myers Squibb, Janssen, Lundbeck, and Otsuka.The authors L. Boyer, A. Murru, I. Pacchiarotti, M. Reinares, C.M. Bonnin, C. Torrent, V. Norma, P. Corinna, I. de Chazeron, M. Boucekine, P.A. Geoffroy, F. Bellivier, P.M. Llorca, E. Vieta have have not supplied their declaration of competing interest.

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Longitudinal relationships between cognition and functioning over 2 years in euthymic patients with bipolar disorder: a cross-lagged panel model approach with the FACE-BD cohort

The British Journal of Psychiatry ◽

10.1192/bjp.2019.180 ◽

2019 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Mickael Ehrminger ◽

Eric Brunet-Gouet ◽

Anne-Sophie Cannavo ◽

Bruno Aouizerate ◽

Irena Cussac ◽

...

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Functional Outcome ◽

Cognitive Performance ◽

Psychosocial Functioning ◽

Causal Effect ◽

Causal Structure ◽

Cognitive Remediation ◽

Bipolar Disorders ◽

Causal Link

Background Longitudinal studies of the relationship between cognition and functioning in bipolar disorder are scarce, although cognition is thought to be a key determinant of functioning. The causal structure between cognition and psychosocial functioning in bipolar disorder is unknown. Aims We sought to examine the direction of causality between cognitive performance and functional outcome over 2 years in a large cohort of euthymic patients with bipolar disorder. Method The sample consisted of 272 adults diagnosed with bipolar disorder who were euthymic at baseline, 12 and 24 months. All participants were recruited via the FondaMental Advanced Centers of Expertise in Bipolar Disorders. We used a battery of tests, assessing six domains of cognition at baseline and 24 months. Residual depressive symptoms and psychosocial functioning were measured at baseline and 12 and 24 months. The possible causal structure between cognition and psychosocial functioning was investigated with cross-lagged panel models with residual depressive symptoms as a covariate. Results The analyses support a causal model in which cognition moderately predicts and is causally primary to functional outcome 1 year later, whereas psychosocial functioning does not predict later cognitive performance. Subthreshold depressive symptoms concurrently affected functioning at each time of measure. Conclusions Our results are compatible with an upward causal effect of cognition on functional outcome in euthymic patients with bipolar disorder. Neuropsychological assessment may help specify individual prognoses. Further studies are warranted to confirm this causal link and evaluate cognitive remediation, before or simultaneously with functional remediation, as an intervention to improve functional outcome. Declaration of interest None.

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Psychosocial Functioning in a Prepubertal and Early Adolescent Bipolar Disorder Phenotype

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1097/00004583-200012000-00018 ◽

2000 ◽

Vol 39 (12) ◽

pp. 1543-1548 ◽

Cited By ~ 122

Author(s):

BARBARA GELLER ◽

KRISTINE BOLHOFNER ◽

JAMES L. CRANEY ◽

MARLENE WILLIAMS ◽

MELISSA P. DELBELLO ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychosocial Functioning ◽

Early Adolescent

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Does cognitive performance map to categorical diagnoses of schizophrenia, schizoaffective disorder and bipolar disorder? A discriminant functions analysis

Journal of Affective Disorders ◽

10.1016/j.jad.2015.12.022 ◽

2016 ◽

Vol 192 ◽

pp. 109-115 ◽

Cited By ~ 21

Author(s):

Tamsyn E. Van Rheenen ◽

Shayden Bryce ◽

Eric J. Tan ◽

Erica Neill ◽

Caroline Gurvich ◽

...

Keyword(s):

Bipolar Disorder ◽

Cognitive Performance ◽

Schizoaffective Disorder ◽

Discriminant Functions ◽

Performance Map

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Exercise as an Add-on Strategy for the Treatment of Bipolar Disorder: Systematic Review and Meta-analysis Protocol

10.21203/rs.3.rs-616750/v1 ◽

2021 ◽

Author(s):

Andrey Rocha Rocca ◽

José Celio da Rocha Lima Filho ◽

Rafael Barbosa Roque Pesconi ◽

Déborah Alvim Monteiro Batista Alves ◽

João Victor Coutinho Pereira ◽

...

Keyword(s):

Systematic Review ◽

Bipolar Disorder ◽

Physical Exercise ◽

Psychosocial Functioning ◽

Meta Analysis ◽

Structured Interview ◽

Clinical Expertise ◽

Medical Subject Headings ◽

Prevention Of Relapse

Abstract Background: Bipolar disorder (BD) is a severe, recurrent and chronic disorder associated with cognitive impairment, reduction in quality of life and substantially reduction in psychosocial functioning. It presents high rates of comorbidity with cardiovascular and cerebrovascular diseases, diabetes and metabolic syndrome. Individuals with bipolar disorder need to focus their attention and treatment on mental and physical health. Physical exercise is often recommended in bipolar disorder, based on extrapolation from the major depressive disorder literature, theory and clinical expertise. However, studies tend to exclude individuals with BD or make no distinction between diagnostic groups, which leads to heterogeneity and difficulty in generalizing the results. The aim of this review is to evaluate the role of physical exercise as an intervention in bipolar disorder treatment. Method: The study populations must be humans, aged 18 years or older, with a clinical diagnosis of Bipolar Disorder (BD) according to a recognised widely-used diagnostic classification approach, confirmed with a structured interview. We will evaluate two main outcomes (mood symptoms improvement and functioning) and an additional outcome (prevention of relapse/recurrence). The search strategy will be based on the PICOS framework, using medical subject headings, on the following databases: MEDLINE (via Pubmed), EMBASE, CENTRAL, SPORTDiscus (via EBSCO), PsycINFO (via APA) and OpenGrey Repository. Selection and data collection process will be carried out by two authors, independently. Risk of bias and quality of evidence will be graded acording ROB-2 and GRADE. We will present a narrative and quantitative synthesis of the results from the included studies. Regarding quantitative data, we will extract means (M) and standard deviations (SD), when available, to calculate the standardised mean difference (SMD). Effects size will be calculated using SMD and 95% confidence interval and heterogeneity will be assessed. Subgroup analysis will be conducted to explore heterogeneity across studies depending on quality and quantity of the data extracted.Discussion: To date, there wasn't a systematic review with only randomized controlled trials on effects of physical activity on BD. Because of this, we will conduct this systematic review trying to estabilish the effects of exercise on mood, functionality and prevention of relapse.Registration: submitted

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Long-term trajectory of cognitive performance in people with bipolar disorder and controls: 6-year longitudinal study

BJPsych Open ◽

10.1192/bjo.2021.66 ◽

2021 ◽

Vol 7 (4) ◽

Author(s):

Timea Sparding ◽

Erik Joas ◽

Caitlin Clements ◽

Carl M. Sellgren ◽

Erik Pålsson ◽

...

Keyword(s):

Bipolar Disorder ◽

Cognitive Functioning ◽

Cognitive Performance ◽

Repeated Measures ◽

Cognitive Test ◽

Healthy Controls ◽

Cross Sectional ◽

Time Interaction

Background Cross-sectional studies have found impaired cognitive functioning in patients with bipolar disorder, but long-term longitudinal studies are scarce. Aims The aims of this study were to examine the 6-year longitudinal course of cognitive functioning in patients with bipolar disorder and healthy controls. Subsets of patients were examined to investigate possible differences in cognitive trajectories. Method Patients with bipolar I disorder (n = 44) or bipolar II disorder (n = 28) and healthy controls (n = 59) were tested with a comprehensive cognitive test battery at baseline and retested after 6 years. We conducted repeated measures ANCOVAs with group as a between-subject factor and tested the significance of group and time interaction. Results By and large, the change in cognitive functioning between baseline and follow-up did not differ significantly between participants with bipolar disorder and healthy controls. Comparing subsets of patients, for example those with bipolar I and II disorder and those with and without manic episodes during follow-up, did not reveal subgroups more vulnerable to cognitive decline. Conclusions Cognitive performance remained stable in patients with bipolar disorder over a 6-year period and evolved similarly to healthy controls. These findings argue against the notion of a general progressive decline in cognitive functioning in bipolar disorder.

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