Cognitive Processes and Legal Capacity in Patients With Bipolar Disorder: A Brief Research Report (original) (raw)
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Patients with bipolar disorder show differential executive dysfunctions: A case-control study
Psychiatry Research, 2016
Executive deficits in euthymic bipolar I disorder were examined in a fractionated manner based on the "Supervisory Attentional System" (SAS) model, and the relationship between the degree of executive impairment and the demographic and clinical characteristics of bipolar I participants was explored. A battery of neurocognitive tests capturing specific components of executive function was administered on 30 patients with bipolar I disorder in euthymic state, and compared with 30 healthy controls who were matched by age, gender and IQ. A differential impairment in executive function was demonstrated in euthymic bipolar I participants by using a fractionated approach of the SAS. Euthymic bipolar I patients were found to have significantly poorer performance in immediate and delayed visual memory; and in the executive domains of "initiation", "sustained attention", and "attention allocation and planning". Those with a greater number of executive impairments had lower IQ and higher negative sub-scores on PANSS. These findings might provide a the basis for further studies on identifying the executive components that are associated with particular disease characteristics of bipolar disorder, and those with poorer functional outcome, so that rehabilitation can be focused on the selective domains concerned.
Psicothema, 2014
There is a debate about the influence of executive functioning impairment in the functionality of Bipolar Disorder Type I, even when euthymic (EutBDI). The aim of this study was to explore this relationship, taking functional outcome from a multidimensional point of view. An extended neuropsychological battery of executive tests and measures of social functioning were administered to 31 EutBDI and 25 non-psychiatric patients. Percentage of patients scoring lower than -1.64 SD was calculated for each executive measure. This was compared in terms of clinical features to those with normal performance. Partial correlations and ANCOVA were applied between psychosocial and executive variables within the EutBDI-group. Patients reached poorer scores in mental flexibility, plan implementing, set-shifting, and fluency (p<0.05). 76% of patients performed poorly on some of the executive tests, although only around 1/3 reached a clinical deficit (<-1.64SD). Executive functioning was relate...
Cognitive and Behavioral Neurology, 2020
Background: Cognitive impairment is often identified in individuals with bipolar disorder and is associated with their functional impairment. However, there is controversy surrounding potential classification methods for impairment in cognitive measures. Objective: To examine the proportion of cognitive measures indicating impairment of attention, processing speed, memory, visuoconstructional abilities, and executive functions in individuals with bipolar disorder type I (euthymic) and healthy controls, using a strict criterion for defining impairment. Methods: We gave 43 individuals with bipolar disorder type I and 17 healthy controls a comprehensive clinical and neuropsychological assessment. All scores were standardized using means and standard deviations according to age. Impaired performance in all cognitive measures was determined using a distribution-based threshold of z = ± 1645. The effects of the sociodemographic and clinical variables on cognitive performance were examined using multiple stepwise backward regression analyses. Results: Clinically significant cognitive impairment was observed more frequently in the bipolar disorder group, compared to controls, on all measures. From participant factors, we found that level of education and number of manic episodes predicted variation in more cognitive measure scores. Discussion: The use of population-based norms to standardize cognitive measures, and a strict criterion to define cognitive impairment, in individuals with bipolar disorder type 1 and healthy controls resulted in a prevalence of impairment in cognitive domains' frequencies of deficits that fell within the ranges previously reported in meta-analyses. Conclusions: Clinically introducing population norms and a stringent cognitive impairment criterion can facilitate more accurate measures of cognitive impairment in individuals with bipolar disorder.
Cognitive functions in bipolar affective disorder and schizophrenia: comparison
Psychiatry and Clinical Neurosciences 2008; 62: 515-525., 2008
Aims: Earlier comparisons of cognitive impairment among patients with bipolar disorder and schizophrenia have found a largely similar profile of deficits, but results have varied between studies. This prompted the current attempt at another such comparison. Methods: Executive functions, memory, IQ, attention–concentration and perceptuomotor function were assessed in 48 bipolar disorder patients with operationally defined euthymia, and compared with 32 schizophrenia patients in remission, and 23 normal controls. Comparisons were re-attempted after controlling for years of schooling and residual affective symptoms. Results: Uncontrolled comparisons indicated that, compared to controls, both bipolar disorder and schizophrenia patients were significantly impaired on different tests of executive function, memory, IQ and perceptuomotor functions. Controlling for years of schooling and residual affective symptoms, however, served to remove most of the differences between patients and controls, apart from some aspects of executive function in schizophrenia and memory impairment in both schizophrenia and bipolar disorder. Patients with schizophrenia consistently performed worse than patients with bipolar disorder, but none of the differences between schizophrenia and bipolar disorder were significant. Conclusions: Patients with bipolar disorder exhibit cognitive difficulties that are very similar to schizophrenia in terms of their profile, although patients with schizophrenia may have more severe and widespread impairments. The resemblance in cognitive profiles has important implications for the etiology and treatment of both disorders.
Cognitive abilities and clinical variables in bipolar I depressed and euthymic patients and controls
Journal of Psychiatric Research, 2011
While studies demonstrated that bipolar patients (BP) display cognitive deficits during mood episodes and remission, little is known about the clinical influences underlying these deficits. The aim of this study was to compare the performance of euthymic and depressed BPs and non-affective/psychotic disorder controls at several cognitive tasks, exploring which clinical variables influenced the performance of these subtests. It is hypothesized that the cognitive deficits in rank order are: depressed BPs > euthymic BPs > controls.Sixty-five bipolar-I outpatients and thirty-four controls were assessed by the Brazilian version of the Wechsler Adult Intelligence Scale, Third Edition (WAIS-III). BPs were divided into depressed and euthymics, and these two groups were then compared to non-affective/psychotic disorder controls.For 12 of 14 subtest scores, comparisons yielded statistically significant (p < 0.05) between-group differences, including three subtests of attention and working memory (Digit Span and its two subtests) with both depressed and euthymic BPs, compared to controls, displaying significantly worse performance, and six subtests of visual and working memory with depressed (but not euthymic) BPs performing worse than controls. For all subtests, comparisons of depressed and euthymic patients’ scores were non-significant. Performance on several subtests was negatively predicted by the severity of the disorder in both patient groups.The cross-sectional design of the study, as well as confounding effects of medications and co-morbidities.The fact that the impairment of cognitive performance of both groups of patients is influenced by the severity of the illness is consistent with the literature.
Correlates of real world executive dysfunction in bipolar I disorder
Journal of psychiatric research, 2014
Bipolar disorder is characterized by impairments in cognitive functioning, both during acute mood episodes and periods of euthymia, which interfere with functioning. Cognitive functioning is typically assessed using laboratory-based tests, which may not capture how cognitive dysfunction is experienced in real-life settings. Little is known about the specific illness characteristics of bipolar disorder that contribute to cognitive dysfunction in everyday life. Participants met DSM-IV criteria for bipolar I disorder (n = 68) in a depressed or euthymic state. Everyday executive functioning was evaluated using the Behavior Rating Inventory of Executive Functioning (BRIEF) and the Frontal Systems Behavior Rating Scale (FrSBe). Participants completed clinician rated measures of mood state (Hamilton Depression Rating Scale, Young Mania Rating Scale), prior illness course and co-morbidities (Mini International Neuropsychiatric Interview), as well as self-report measures of psychotropic medi...
Cognitive function in euthymic Bipolar I Disorder.pdf
Recent reports have suggested the presence of persistent cognitive impairments in patients diagnosed with Bipolar Disorder even after prolonged euthymic phases. In this work, various domains of cognitive function were examined in Ž . asymptomatic patients diagnosed with Bipolar I Disorder BDI in comparison with healthy subjects. Fifteen otherwise healthy BDI patients with a prior history of psychosis during mania completed a neuropsychological testing battery after a prolonged asymptomatic remission. Their scores were compared to those of individually matched healthy subjects with unpaired two-tailed t-tests at P-0.01. Relationships between cognitive performance measures and clinical variables related to illness severity were also examined with Pearson correlations, P -0.05. We detected poorer performance on measures of verbal learning, executive functioning and motor coordination in BDI patients compared to control volunteers. Scores on tests of executive functioning were negatively correlated with the number of episodes of mania and depression. Social and occupational scores were also associated with a poorer performance on measures of verbal learning and executive function. Euthymic BDI patients, therefore, demonstrate reductions in specific cognitive domains even after prolonged asymptomatic phases. Some of these deficits appear to be associated with a more severe course of illness and poorer social and occupational functioning. ᮊ
Effect of symptoms on executive function in bipolar illness
Psychological Medicine, 2004
Background. The relationship between cognitive function and symptomatology in bipolar disorder is unclear. This study assessed executive function during the manic, depressed and remitted stages of bipolar I disorder.Method. Tasks assessing phonological and semantic verbal fluency, the Hayling Sentence Completion Test, the Stroop Neuropsychological Screening Test and the Cognitive Estimates Test were administered to manic (n=15), depressed (n=15), and remitted (n=15) bipolar I patients, and to healthy controls (n=30). Multiple regression analyses and analyses of covariance were used to identify potential determinants of executive dysfunction in the three bipolar groups.Results. Executive function deficits were particularly associated with the manic state. In general, manic patients performed less accurately than the remitted and depressed groups, and their performance deficit was related to the severity of positive thought disorder. The depressed and remitted bipolar groups showed a ...
FACTORS AFFECTING COGNITIVE FUNCTIONING IN INDIVIDUALS WITH BIPOLAR DISORDER IN EUTHYMIC PHASE
Kerala Journal of Psychiatry, 2022
Background: Neurocognitive studies during the euthymic phase of bipolar disorder have shown persistent cognitive deficits in 32% of patients. There is limited evidence in the Indian literature regarding this area. Neurocognitive impairment can significantly affect the overall functional recovery of these individuals. Understanding potential factors contributing to neurocognitive impairment in bipolar disorder is essential to develop prevention strategies and effective treatments. Methods: A total of 50 patients with bipolar disorder currently in euthymic phase for the last three months with a minimum duration of illness of two years and current Young Mania Rating Scale<11 and Hamilton Depression Rating Scale <8 currently on medications were administered various cognitive tests namely digit span test forward and backward, digit symbol substitution test and Trail making test A and B. The study was completed within a period of 6 months after getting approval from the institutional ethics committee. Results: Patients with bipolar disorder, in remission, have cognitive impairment in attention, memory and executive functioning. More than 50% of the patients could perform digit span test forward more than five digits, and in the case of the digit span test backwards, more than 50% of patients could perform only less than or equal to three digits. In the Trail Making tests A and B, 66% of the patients could perform within </=78seconds, and 62% could perform within </=273 seconds, respectively. Only 4% of the patients could complete 49 squares in the Digit symbol substitution test. Conclusion: Findings of the current study shows evidence of cognitive impairment in euthymic bipolar patients.
Cognitive Deficits in Euthymic Patients with Bipolar Disorder: State or Trait Marker?
Journal of Nervous and Mental Disease, 2019
Cognitive deficits have been demonstrated in people in the euthymic phase of bipolar disorder. This cross-sectional study compared euthymic bipolar disorder patients (N=30) with never psychiatrically ill controls (N=30) on a neuropsychological test battery containing tasks of executive function, the Wisconsin Card Sorting Test (WCST), attention and working memory, Digits Forward and Backward, and speed of information processing, Digit Symbol. Scores on the Mini Mental State Examination (MMSE) and Vocabulary Test did not differ between the groups. The bipolar group were significantly impaired compared to controls on various indices of executive function on the Wisconsin Card Sort Test and on the Digit tests. The impaired performance on the Digit tests, but not the WCST, was significantly associated with medication status, notably prescribed benzodiazepines. There was no significant effect of severity or course of illness on performance. The findings support the hypothesis that impairments in executive function are present between illness episodes in bipolar disorder, and so are not simply state markers.