Cognitive behavioral rehabilitation for bipolar disorder patients: A randomized controlled trial (original) (raw)
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Trials, 2017
Background: Bipolar disorder (BD) is commonly associated with cognitive and functional impairments even during remission periods, and although a growing number of studies have demonstrated the benefits of psychotherapy as an add-on to pharmacological treatment, its effectiveness appears to be less compelling in severe presentations of the disorder. New interventions have attempted to improve cognitive functioning in BD patients, but results have been mixed. Methods: The study consists of a clinical trial comparing a new structured group intervention, called "Cognitive-Behavioral Rehabilitation," with treatment as usual (TAU) for bipolar patients. The new approach is a combination of cognitive behavioral strategies and cognitive remediation exercises, consisting of 12 weekly group sessions of 90 min each. To be included in the study, patients must be diagnosed with BD type I or II, aged 18-55 years, in full or partial remission, and have an IQ of at least 80. A comprehensive neuropsychological battery, followed by mood, social functioning, and quality of life assessments will occur in three moments: pre and post intervention and 12 months later. The primary outcome of the study is to compare the time, in weeks, that the first full mood episode appears in patients who participated in either group of the study. Secondary outcome will include improvement in cognitive functions. Discussion: This is the first controlled trial assessing the validity and effectiveness of the new "Cognitive-Behavioral Rehabilitation" intervention in preventing new mood episodes and improving cognitive and functional impairments. Trial registration: Clinicaltrial.gov, NCT02766361. Registered on 2 May 2016.
Neuropsychological rehabilitation for bipolar disorder
Background: The cognitive functions that are most impaired by mood disorders are memory, attention, and executive functions that are intrinsically related to functional performance. Cognitive impairment is linked to lower quality of life, and also has a negative impact on functional skills. For these reasons, it is relevant to propose interventions in neuropsychological rehabilitation (NR). Aim: To investigate the efficacy of NR techniques for attention, memory, and executive function impairments in a person with bipolar disorder (BD) type 1. Methods: The NR protocol consisted of fourteen weekly individual sessions divided into three modules. The first was directed toward mood monitoring, the following focused on executive functions, and the third addressed attention and memory rehabilitation. Comparisons were made between the patient's scores in pre-intervention, post-intervention, and follow-up phase. Statistical analysis was conducted using Singlims_ES.exe program. The significance level was set at p<.05. Results: The patient's scores for all functional demands were significantly higher than those of the controls at the baseline (p<.05 for all comparisons). At the post-intervention phase, the effect sizes were lower than the baseline, and the patient demonstrated a level of performance similar to the control sample in two of five functional demands (p>.05). At the follow-up phase, the patient exhibited similar performance to the controls (p>.05 for all comparisons). Conclusion: This is a preliminary study in NR applied to BD, and fourteen weeks of the NR program appeared to be successful in improving the patient`s functional ability toward the level of performance shown by six matched controls.
Associations between cognitive impairment and quality of life in euthymic bipolar patients
Psychiatry Research
During the euthymic state in bipolar disorder, cognitive functions often remain affected. Specifically, subjective and objective cognitive impairment might distinctly affect patients' quality of life (QoL); however, this question had not been examined previously in Japanese patients. Therefore, the current study investigated the associations between cognitive complaints, QoL, and objective cognitive functions. Forty patients in remission were recruited from the Hokkaido University Hospital, Sapporo, Japan and assessed with the translated version of the cognitive complaints in bipolar disorder rating assessment (COBRA), medical outcomes study 36-item short-form health survey version 2 (SF-36v2), and Sheehan disability scale (SDS). The Japanese adult reading scale, Wisconsin card sorting test, word fluency, continuous performance test, trail making test (TMT), auditory verbal learning, and Stroop test evaluated objective cognitive functions. Significant correlations were observed between the COBRA, SF-36v2, and SDS results, as well as the TMT scores. Overall, euthymic patients were aware of their cognitive dysfunction, which could be understood in relation to the decrease in satisfaction in their daily life. Therefore, even mild cognitive impairments can have ramifications for patients in the euthymic state of bipolar disorder.
Psychiatry Investigation, 2017
tive to household/work and low quality of familial/social relationships is commonly reported in these populations, with a decline of their subjective quality of life. 2-4 The daily life functioning of subjects with MDD or BD after symptom remission often remains impaired, suggesting that other determinants, such as neuropsychological deficits, may contribute to their functional decline. 5,6 An impairment on a range of cognitive domains is well-documented in patients with MDD or BD, both in acute phases and euthymia. 5,7,8 In these patients, long-lasting difficulties in daily life functioning has been associated with their long-lasting cognitive impairment, 6,9 and neuropsychological functioning was the single best predictor of later socio-occupational outcome among young patients suffering from MDD or BD. 10 Considering the relevance of functional impairment in these populations, a variety of psychosocial interventions in the framework of the PsyR has been applied as adjunctive treatments to pharmacological therapies. Most of them usually lasts
Neuropsychological rehabilitation for bipolar disorder — A single case design
Translational Neuroscience, 2013
Background: The cognitive functions that are most impaired by mood disorders are memory, attention, and executive functions that are intrinsically related to functional performance. Cognitive impairment is linked to lower quality of life, and also has a negative impact on functional skills. For these reasons, it is relevant to propose interventions in neuropsychological rehabilitation (NR). Aim: To investigate the efficacy of NR techniques for attention, memory, and executive function impairments in a person with bipolar disorder (BD) type 1. Methods: The NR protocol consisted of fourteen weekly individual sessions divided into three modules. The first was directed toward mood monitoring, the following focused on executive functions, and the third addressed attention and memory rehabilitation. Comparisons were made between the patient's scores in pre-intervention, post-intervention, and follow-up phase. Statistical analysis was conducted using Singlims_ES.exe program. The significance level was set at p<.05. Results: The patient's scores for all functional demands were significantly higher than those of the controls at the baseline (p<.05 for all comparisons). At the post-intervention phase, the effect sizes were lower than the baseline, and the patient demonstrated a level of performance similar to the control sample in two of five functional demands (p>.05). At the follow-up phase, the patient exhibited similar performance to the controls (p>.05 for all comparisons). Conclusion: This is a preliminary study in NR applied to BD, and fourteen weeks of the NR program appeared to be successful in improving the patient`s functional ability toward the level of performance shown by six matched controls.
CNS Neuroscience & Therapeutics, 2010
Disorder is characterized by recurrent episodes of depression and/or mania along with interepisodic mood symptoms that interfere with psychosocial functioning. Despite periods of symptomatic recovery, individuals with bipolar disorder often continue to experience impairments in psychosocial functioning, particularly occupational functioning. Two determinants of psychosocial functioning of euthymic (neither fully depressed nor manic) individuals with bipolar disorder are residual depressive symptoms and cognitive impairment (i.e. difficulties with executive functioning, attention and memory).
Cognitive Performance and Quality of Life in Bipolar Disorder
The Canadian Journal of Psychiatry, 2008
Objective: In patients with bipolar disorder (BD), quality of life (QOL) scores have been largely attributed to mood symptoms. However, impairments in QOL may occur even in euthymia, and differential factors have been put forward as important determinants of QOL. Our study was designed to assess the role of cognitive performance in self-reported QOL in patients with BD. Method: In this cross-sectional study, we examined the relation between cognitive variables and self-reported QOL in 55 bipolar I euthymic patients and 50 healthy subjects. Participants were administered the World Health Organization Quality of Life Assessment—Abbreviated version and a battery of neuropsychological tests. Results: BD patients showed lower scores in all QOL domains as compared with control subjects. Poorer self-reported QOL correlated significantly with worse cognitive performance, especially on tests of executive functioning and verbal abstraction. A linear regression model revealed that all QOL doma...
Trials, 2016
Background: People with bipolar disorder often show difficulties with cognitive functioning, and though these difficulties are identified as important targets for intervention, few treatment options are available. Preliminary evidence suggests that cognitive remediation therapy (a psychological treatment proven beneficial for people diagnosed as having schizophrenia) is helpful for people with bipolar disorders. We are conducting a pilot trial to determine whether individual, computerised, cognitive remediation therapy (CRT) for people with bipolar disorder 1) increases cognitive function; 2) improves global functioning, goal attainment and mood symptoms; 3) is acceptable and feasible for participants; and 4) can be addressed in a comprehensive, larger, randomised, controlled trial. Methods/design: The study is designed as a two-arm, randomised, controlled trial comparing cognitive remediation therapy with treatment-as-usual (TAU) for euthymic bipolar patients. Participants are eligible to take part if aged between 18 and 65 with a diagnosis of bipolar disorder (type I) and currently in euthymic state, and no neurological, substance or personality disorder diagnoses. Sixty participants will be recruited (mainly through secondary and tertiary care) and will be block-randomised to receive either treatment-as-usual alone or in addition to a 12-week course of cognitive remediation therapy totalling 20-40 therapy hours. The intervention will comprise regular sessions with a therapist and computer-based training. Research assessments will take place before and after the intervention period and at a 12-week follow-up, and will include evaluation of neuropsychological, symptom-related, demographic and social factors, as well as collecting qualitative data regarding CRT expectations and satisfaction. Intention-to-treat analyses will examine the efficacy of cognitive remediation therapy primarily on cognition and additionally on functioning, quality of life and mood symptoms. Furthermore, we will examine the acceptability of CRT and undertake a preliminary health economics analysis to ascertain the cost of delivering the intervention. Discussion: The results of this trial will provide valuable information about whether cognitive remediation therapy may be beneficial for people diagnosed with bipolar disorder in a euthymic state.