Patients with bipolar disorder show differential executive dysfunctions: A case-control study (original) (raw)
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Differential deficit in executive control in euthymic bipolar disorder
Journal of Abnormal Psychology, 2009
Patients with remitted bipolar disorder (BD) have persistent cognitive deficits, but the nature and specificity of this deficit remain unclear. The authors evaluated the executive hypothesis of BD by determining whether (a) patients' executive deficits qualify as differential deficits, that is, that these significantly exceed deficits in other cognitive domains; (b) deficits in particular executive functions are evident, and (c) executive difficulties mediate declarative memory deficits in BD. The cognitive performance of 63 prospectively verified euthymic bipolar patients was compared with controls, using J. Baron and R. Trieman's (1980) method of testing for differences in nonindependent correlations. There were no differential deficits within the executive domain. Patients' generic executive performance was differentially impaired relative to primary verbal memory and retention in declarative memory, but not relative to their declarative recall, recognition, or their psychomotor performance. However, patients' executive deficit was not an artifact of their poor psychomotor performance. Executive performance accounted for all but a trivial portion of the between-group variance in declarative memory. Persistent cognitive difficulties in euthymic bipolar disorder (EBD) are thus usefully characterized as a generic dysexecutive syndrome.
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...
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...
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 ...
Neuropsychologia, 2010
Objective: To identify neurocognitive measures that could be used as objective markers of bipolar disorder. Methods: We examined executive function, sustained attention and short-term memory as neurocognitive domains in 18 participants with bipolar disorder in euthymic state (Beuth), 14 in depressed state (Bdep), 20 with unipolar depression (Udep) and 28 healthy control participants (HC). We conducted four-group comparisons followed by relevant post hoc analyses. Results: Udep and Bdep, but not Beuth showed impaired executive function (p = 0.045 and p = 0.046, respectively). Both Bdep and Beuth, but not Udep, showed impaired sustained attention (p = 0.001 and p = 0.045, respectively). The four groups did not differ significantly on short-term memory. Impaired sustained attention and executive dysfunction were not associated with depression severity, duration of illness and age of illness onset. Only a small number of abnormal neurocognitive measures were associated with medication in Bdep and Beuth. Conclusion: Impaired sustained attention appears specific to bipolar disorder and present in both Beuth and Bdep; it may represent an objective marker of bipolar disorder. Executive dysfunction by contrast, appears to be present in Udep and Bdep and likely represents a marker of depression.
Sustained attention and executive functions in euthymic young people with bipolar disorder
British Journal of Psychiatry, 2006
BackgroundPersistent neuropsychological impairments have been reported in the euthymic phase of bipolar affective disorder. However, the findings have been confounded by multiple episodes, chronic illness and residual mood symptoms.AimsTo assess sustained attention and executive functioning in euthymic young people with bipolar I disorder who had had no more than two affective episodes.MethodThirty euthymic patients (with illness duration of less than 5 years and no more than two affective episodes) and 30 matched healthy individuals were assessed for sustained attention and executive functioning.ResultsThe bipolar group (mean age 22.4 years, s.d.=2.52; duration of illness 20.87 months, s.d.=14.72), showed impairment on tasks of attention and executive functioning. Multivariate logistic regression analysis demonstrated that deficits in executive functioning differentiated cases from controls. There was no correlation between residual depressive symptoms and neuropsychological perfor...
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
Development and Psychopathology, 2004
Studies of adults who have been diagnosed with, and treated for, bipolar disorder have shown that these patients exhibit impairment on measures of executive functioning. However, it is unclear whether executive dysfunction precedes the diagnosis of bipolar illness, or develops subsequent to its onset. Moreover, investigators have failed to control for the effects of premorbid attentional problems on cognitive performance in these patients. The present authors explored these questions using data from a longitudinal prospective study of individuals at risk for major mood disorder. Results revealed that 67% of participants who met criteria for bipolar disorder in young adulthood showed impairment on the Wisconsin Card Sorting Test~WCST! when they were assessed during adolescence, as compared with 17% of individuals with no major mood diagnosis, and 19% with unipolar depression. This association between performance on the WCST and bipolar illness was not accounted for by high rates of premorbid attentional disturbance. In fact, among participants with early attentional problems, only those who ultimately developed bipolar disorder exhibited impairment on the WCST. Early attentional problems that preceded unipolar depression or no mood disorder were not associated with executive dysfunction.
Working Memory and Response Inhibition in Patients With Bipolar I Disorder During Euthymic Period
Iranian Journal of Psychiatry and Behavioral Sciences, 2015
Background: Several cognitive domains, including attention, memory, and executive functions are impaired in bipolar disorder. Objectives: This study aimed to investigate two executive functions (working memory and response inhibition) in patients with bipolar I disorder during remission of the symptoms. Patients and Methods: In this case-control design, 30 bipolar I patients (18 to 45 years old) were matched with 30 ones in the control group in terms of age, gender, and education. The patients were selected from Roozbeh Psychiatric Hospital (a hospital affiliated to Tehran University of Medical Sciences) from May to October 2013. They were evaluated and contrasted using working memory (Spatial Span and Spatial Working Memory (SSP and SWM)) and response inhibition (Stop Signal Task (SST)) tests. Results: We used independent t-tests for comparing and contrasting 2 groups on total and sub-scales scores of these 3 tests. In terms of SWM test there was a significant difference in between-group error between the two groups (P = 0.05); there was also a meaningful difference between the strategies used by two groups (P = 0.05). In SSP test, a significant difference appeared between averages of span length of the two groups. In the first and last item delays, there was also a clear difference, but the total error index was not noticeably different. In SST test, the direction error indicator in start-stop trials indicated a major difference, while in successful stops ratio, the case group had a lower ratio. In addition, reaction time to stop signs in bipolar group was meaningfully lower than the control group. Conclusion: In conclusion, even during remission phase, executive dysfunction is detectable at least in some areas in patients with bipolar disorder.