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E Vieta,
D Popovic,
A R Rosa,
B Solé,
I Grande,
B N Frey, A Martinez-Aran,
J Sanchez-Moreno,
V Balanzá-Martínez,
R Tabarés-Seisdedos,
F Kapczinski
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ABSTRACT: BACKGROUND: Allostatic load (AL) relates to the neural and bodily "wear and tear" that emerge in the context of chronic stress. This paper aims to provide clinicians with a comprehensive overview of the role of AL in patophysiology of bipolar disorder (BD) and its practical implications. METHODS: PubMed searches were conducted on English-language articles published from 1970 to June 2011 using the search terms allostatic load, oxidative stress, staging, and bipolar disorder cross-referenced with cognitive impairment, comorbidity, mediators, prevention. RESULTS: Progressive neural and physical dysfunction consequent to mood episodes in BD can be construed as a cumulative state of AL. The concept of AL can help to reconcile cognitive impairment and increased rates of clinical comorbidities that occur over the course of cumulative BD episodes. CONCLUSIONS: Data on transduction of psychosocial stress into the neurobiology of mood episodes converges to the concept of AL. Mood episodes prevention would not only alleviate emotional suffering, but also arrest the cycle of AL, cognitive decline, physical morbidities and, eventually, related mortality. These objectives can be achieved by focusing on effective prophylaxis from the first stages of the disorder, providing mood-stabilizing agents and standardized psychoeducation and, potentially, addressing cognitive deficits by the means of specific medication and neuropsychological interventions.
European Psychiatry 04/2012; · 2.77 Impact Factor
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ABSTRACT: Bipolar disorder is a severe mental illness that affects nearly 4.4% of the general population when bipolar spectrum disorders are taken into account. Neurocognitive impairment is thought to be a core deficit of this illness since it is present during euthymia. In fact, 40-60% of euthymic patients present with neurocognitive disturbances. Not only the clinical factors but also disturbances in neurocognition can influence the functional outcome of BD patients. Hence, further research is needed in order to clarify the relationship between these variables. Despite the growing body of evidence that has emerged during the last decade, no unique neurocognitive profile has been proposed yet for either BD subtype. The majority of the studies recluted heterogeneous samples (including both bipolar I and II) or focused on BD-I patients only. The aim of this review is to give an overall picture of the main neurocognitive disturbances found in the bipolar spectrum and particularly in BD-II, where the findings are more ambiguous. An extensive review of all the literature has been done regarding this subtype (from 1980 until July 2009). Data available until now suggest that deficits are present across the bipolar spectrum (BD-I and BD-II), but they seem slightly more severe in BD-I. The extent to which either subtype share-or not-some similarities is still unknown. More studies are required but it would also be interesting to reach a consensus in the neuropsychological assessment of BD to facilitate comparisons between the different studies.
CNS Neuroscience & Therapeutics 11/2011; 18(3):194-200. · 4.44 Impact Factor
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ABSTRACT: In psychoneuroendocrinology there's a scarcity of knowledge of hypothalamic-pituitary-thyroid axis (HPT) in relation to bipolar disorder (BD) and neuropsychological functions. The aim of this study is to review the current state of the following issues: (1) neuropsychological dysfunctions in BD, as well as their hypothetic aetiology; (2) response of HPT in each phase of BD, and, finally, (3) connection between alterations in HPT and neuropsychological deficits.
Actas espanolas de psiquiatria 07/2010; 38(4):223-8. · 0.59 Impact Factor
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ABSTRACT: Bipolar disorder has generally been regarded as having a better functional outcome than schizophrenia. However, studies have suggested low functioning in bipolar patients even when they are in clinical remission. Our aim was to determine the degree of functioning and disability in bipolar patients. Secondly, we reviewed factors potentially associated with the low functioning of bipolar patients.
The authors conducted an extensive Medline and Pubmed search of the published literature from 1980 up to December 2007, using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further analysed for publications of interest. Articles that reported clinically significant findings on functioning and disability, and research reports were reviewed in detail.
From these articles, we determined that bipolar disorder is associated with significant impairment in work, family and social life, beyond the acute phases of the illness. The aspects that appear to increase the risk of low functioning and disability in bipolar patients are mainly subsyndromal symptoms and neurocognitive impairment, among others.
Suitable pharmacological and psychological interventions may improve the level of functioning and reduce the disability in bipolar patients. Potential targets to be considered for intervention should be residual symptoms, comorbid conditions and neurocognitive deficits. Further research is required to better identify the factors that best predict functioning in bipolar patients.
Psychotherapy and Psychosomatics 08/2009; 78(5):285-97. · 6.28 Impact Factor
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ABSTRACT: This is a report arising from an ECNP expert meeting. Recent studies have focussed on cognitive problems in manic-depressive illness and a few have addressed premorbid neuropsychological functioning. The results are not fully consistent but seem to point to a neurodegenerative model, rather than a neurodevelopmental one, for some cognitive domains. There is agreement that cognitive dysfunction is highly correlated with psychosocial functioning. The neurobiological and clinical implications of recent findings will be discussed. Treatments to reduce subsyndromal symptoms and relapses may indirectly improve neurocognitive deficits and this should be better documented. Moreover, neurocognitive impairment in bipolar disorder should be considered a potential therapeutic target, so that research should focus on new drugs and psychological interventions, including neurocognitive rehabilitation, addressed to improve not only the cognition but also the functional outcome of this population.
European Neuropsychopharmacology 09/2008; 18(11):787-93. · 4.05 Impact Factor
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A Martinez-Aran,
E Vieta,
C Torrent,
J Sanchez-Moreno,
JM Goikolea,
M Salamero,
GS Malhi,
A Gonzalez-Pinto,
C Daban,
S Alvarez-Grandi,
K Fountoulakis,
G Kaprinis,
R Tabares-Seisdedos,
JL Ayuso-Mateos
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ABSTRACT: Introduction: Few studies have examined the clinical, neuropsychological and pharmacological factors involved in the functional outcome of bipolar disorder despite the gap between clinical and functional recovery.Methods: A sample of 77 euthymic bipolar patients were included in the study. Using an a priori definition of low versus good functional outcome, based on the psychosocial items of the Global Assessment of Functioning (GAF, DSM-IV), and taking also into account their occupational adaptation, the patients were divided into two groups: good or low occupational functioning. Patients with high (n = 46) and low (n = 31) functioning were compared on several clinical, neuropsychological and pharmacological variables and the two patient groups were contrasted with healthy controls (n = 35) on cognitive performance.Results: High- and low-functioning groups did not differ with respect to clinical variables. However, bipolar patients in general showed poorer cognitive performance than healthy controls. This was most evident in low-functioning patients and in particular on verbal memory and executive function measures.Conclusions: Low-functioning patients were cognitively more impaired than highly functioning patients on verbal recall and executive functions. The variable that best predicted psychosocial functioning in bipolar patients was verbal memory.
Bipolar Disorders 02/2007; 9(1‐2):103 - 113. · 5.29 Impact Factor
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ABSTRACT: Recent studies have suggested that the presence of persistent cognitive dysfunctions in bipolar patients is not restricted to acute episodes, but they persist even during remission states. Nevertheless, there are several methodological pitfalls in most studies, such as unclear remission criteria, diagnostic heterogeneity or small sample sizes.
Several domains of cognitive function were examined in 30 depressed bipolar patients [DSM-IV criteria for major depression, Hamilton Depression Scale (HDRS) > or =17] and 30 euthymic bipolar patients (at least 6 months of remission, HDRS < or =8 and Young Mania Rating Scale, YMRS < or =6). Psychosocial functioning was assessed through General Assessment of Functioning.
The two groups showed a similar pattern of neuropsychological performance. However, the depressed group was significantly impaired on the Controlled Oral Word Association Test, FAS (COWAT), a measure of verbal fluency, compared with the euthymic group. On the other hand, functional outcome in euthymic patients was related to verbal fluency, even after controlling for residual depressive symptoms.
Neuropsychological performance was similar in both groups, except for verbal fluency, which was lower in the depressed group. Poor verbal fluency was related to a poor social outcome in euthymic patients. Further research including longitudinal designs aimed at evaluating changes in cognition in these patients is warranted.
Neuropsychobiology 01/2002; 46 Suppl 1:16-21. · 2.67 Impact Factor
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ABSTRACT: Introduction: Recent studies have suggested that the presence of persistent cognitive dysfunctions in bipolar patients is not restricted to acute episodes, but they persist even during remission states. Nevertheless, there are several methodological pitfalls in most studies, such as unclear remission criteria, diagnostic heterogeneity or small sample sizes. Patients and Methods: Several domains of cognitive function were examined in 30 depressed bipolar patients [DSM-IV criteria for major depression, Hamilton Depression Scale (HDRS) ≥17] and 30 euthymic bipolar patients (at least 6 months of remission, HDRS ≤8 and Young Mania Rating Scale, YMRS ≤6). Psychosocial functioning was assessed through General Assessment of Functioning. Results: The two groups showed a similar pattern of neuropsychological performance. However, the depressed group was significantly impaired on the Controlled Oral Word Association Test, FAS (COWAT), a measure of verbal fluency, compared with the euthymic group. On the other hand, functional outcome in euthymic patients was related to verbal fluency, even after controlling for residual depressive symptoms. Conclusions: Neuropsychological performance was similar in both groups, except for verbal fluency, which was lower in the depressed group. Poor verbal fluency was related to a poor social outcome in euthymic patients. Further research including longitudinal designs aimed at evaluating changes in cognition in these patients is warranted.
Neuropsychobiology 08/1970; 46(1):16-21. · 2.67 Impact Factor
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A Martinez-Aran,
E Vieta,
C Torrent,
J Sanchez-Moreno,
J M Goikolea,
M Salamero,
G S Malhi,
A Gonzalez-Pinto,
C Daban,
S Alvarez-Grandi,
K Fountoulakis,
G Kaprinis,
R Tabares-Seisdedos,
J L Ayuso-Mateos
[show abstract]
[hide abstract]
ABSTRACT: Few studies have examined the clinical, neuropsychological and pharmacological factors involved in the functional outcome of bipolar disorder despite the gap between clinical and functional recovery.
A sample of 77 euthymic bipolar patients were included in the study. Using an a priori definition of low versus good functional outcome, based on the psychosocial items of the Global Assessment of Functioning (GAF, DSM-IV), and taking also into account their occupational adaptation, the patients were divided into two groups: good or low occupational functioning. Patients with high (n = 46) and low (n = 31) functioning were compared on several clinical, neuropsychological and pharmacological variables and the two patient groups were contrasted with healthy controls (n = 35) on cognitive performance.
High- and low-functioning groups did not differ with respect to clinical variables. However, bipolar patients in general showed poorer cognitive performance than healthy controls. This was most evident in low-functioning patients and in particular on verbal memory and executive function measures.
Low-functioning patients were cognitively more impaired than highly functioning patients on verbal recall and executive functions. The variable that best predicted psychosocial functioning in bipolar patients was verbal memory.
Bipolar Disorders 9(1-2):103-13. · 5.29 Impact Factor
