When euthymia is just not good enough: The neuropsychology of bipolar disorder

School of Psychiatry, University of New South Wales and Mood Disorders Unit, Black Dog Institute, Prince of Wales Hospital, Sydney, Australia.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 06/2005; 193(5):323-30. DOI: 10.1097/01.nmd.0000161684.35904.f4
Source: PubMed


Bipolar disorder (BD) is a debilitating psychiatric illness that is uniquely characterized by switching between psychopathologically contrasting phases of mania and depression, often with intervening periods of euthymia. However, these periods of apparent clinical recovery (euthymia) are marked by subtle social, occupational, and cognitive impairments, profiled by recent neuropsychological investigations. Determining the cognitive changes across these three phases may help differentiate the disruptions that are mood state-dependent from those associated with underlying pathology. This article therefore critically reviews the reported neuropsychological impairments in BD and the methodological limitations facing such research. Integration of the available evidence, principally from the field of neuropsychology, when synthesized, implicates the prefrontal cortex in the etiopathogenesis of BD and posits cortical-subcortical-limbic disruption in recovered euthymic patients that manifests as cognitive dysfunction.

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    • "White matter abnormalities have also been found to be predictive of poor outcome (Bearden, Woogen, & Glahn, 2010; Forcada, Papachristou, Mur, Christodoulou, Jogia et al., 2011). In general, different studies have raised the need for formal assessment of cognition in patients with bipolar disorder (Martínez-Arán et al., 2001; Malhi et al., 2004; Savitz et al., 2005; Olley et al., 2005; Robinson et al., 2006). Executive functions include a broad range of mental abilities to respond adaptively to novel situations and are necessary for appropriate, socially responsible and effectively self-serving adult behaviour. "
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    ABSTRACT: Background: 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. Methods: 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. Results: 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 related to some clinical, evolution, and treatment variables. A better use of leisure time, higher competence for independent living and holding a skilled type of profession were significantly associated with a better performance on planning, set-shifting, and fluency tasks. Conclusions: Persistent executive deficits in EutBDI may be related to their frequently reported difficulties in personaland occupational adjustment.
    Psicothema 05/2014; 26(2):166-73. DOI:10.7334/psicothema2013.111 · 0.96 Impact Factor
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    • "Specifically, when the individual is asked to retrieve a specific past personal memory, for example, in response to the question, " Can you remember a specific memory that the word 'joy' evokes to you? " , she/he recovers a past personal fact, called OGM, such as " When I win a football match, " without any contextual details, which is either extended in time or repetitive, instead of recovering a specific personal memory such as " Our team won a football match against opponent team, two months ago, though we had one player less. " A few studies have investigated AM in patients suffering from bipolar disorder (BD) in spite of this disorder being characterised by depressive periods (Delduca et al., 2010; Judd et al., 2003; Olley et al., 2005). Scott et al. (2000) investigated AM in 41 individuals with remitted bipolar I disorder and 20 healthy controls (HCs), using the Autobiographical Memory Test (AMT). "
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    ABSTRACT: This study investigated patients with Bipolar Disorder's abilities to generate specific past and future events in response to positive and negative cues words as well as emotional intensity related to these ones. The relationships between the number of generated specific events cognitive functioning, interpersonal problems and the ability to problem solving were investigated. Nineteen BD and nineteen healthy controls completed a French version of the AMT to evaluate the past and future events recall, in function of their valence, and emotions related. Furthermore, they completed the Optional Thinking Test, the Inventory of Interpersonal Problems and the neuropsychological measures. Compared to healthy controls, BD recollected (1) fewer specific past negative events and (2) fewer future specific positive and negative events furthermore, (3) they felt more emotional intensity related to future events. These results were explained in the light of theoretical models. Finally, specific past memories deficits in BD were linked with issues in problem solving but not with levels of distress arising from interpersonal problems. In view of AM functions in everyday life, all types of deficits should be taken into consideration, and AM remediation envisaged.
    Psychiatry Research 08/2013; 210(3). DOI:10.1016/j.psychres.2013.06.029 · 2.47 Impact Factor
    • "The ACC has also been implicated in the neurological effects of alcohol use (Meyerhoff et al., 2013) as well as in the pathophysiology of BD, with separate neuroimaging investigations involving structural, functional and spectroscopic analyses consistently ACC abnormalities in the disorder (Fornito et al., 2008, 2007; Haldane and Frangou, 2004; Lagopoulos and Malhi, 2007). These neuroimaging findings corroborate an existing neuropsychological literature that has consistently reported frontal lobe-mediated impairments in BD (Olley et al., 2005). Previous 1 H-MRS studies have shown that chronic cigarette smoking compounds regional neurobiological abnormalities in people with alcohol use disorders (Meyerhoff et al., 2013). "
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    ABSTRACT: Alcohol misuse is highly prevalent in bipolar disorder (BD) and has been associated with increased formation of reactive oxygen species in the CNS. Proton magnetic resonance spectroscopy ((1)H-MRS) is an in vivo tissue-based imaging modality that allows the investigation of changes in the brains primary antioxidant, glutathione (GSH), as a result of alcohol use in this population. Thirty-three patients with BD and 17 controls aged 18-30 years were recruited. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and underwent (1)H-MRS. Levels of GSH in the anterior cingulate cortex (ACC) were determined. ANOVA was conducted to determine differences between high and low risk drinking bipolar participants and controls. ANOVA with all groups revealed a significant difference in GSH between bipolar high and low risk drinkers, with those in the high-risk group displaying reduced GSH levels. A significant negative correlation was found between total AUDIT score and GSH in bipolar (R=-0.478, p=0.005) which remained significant when controlling for age and medication status. Our participant sample consisted of a heterogeneous group of patients, most of whom were medicated at time of testing. Young people with emerging BD who drink at risky levels display reduced levels of ACC-GSH. Increased oxidative stress and its resulting neurotoxic effects may be especially detrimental in an emerging bipolar sample where the illness trajectory is unclear and the brain is still undergoing significant development.
    Journal of Affective Disorders 07/2013; 150(3). DOI:10.1016/j.jad.2013.06.003 · 3.38 Impact Factor
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