Objective
An association between bipolar disorder and cognitive impairment has repeatedly been described, even for euthymic patients. Findings are inconsistent both across primary studies and ...previous meta‐analyses. This study reanalysed 31 primary data sets as a single large sample (N = 2876) to provide a more definitive view.
Method
Individual patient and control data were obtained from original authors for 11 measures from four common neuropsychological tests: California or Rey Verbal Learning Task (VLT), Trail Making Test (TMT), Digit Span and/or Wisconsin Card Sorting Task.
Results
Impairments were found for all 11 test‐measures in the bipolar group after controlling for age, IQ and gender (Ps ≤ 0.001, E.S. = 0.26–0.63). Residual mood symptoms confound this result but cannot account for the effect sizes found. Impairments also seem unrelated to drug treatment. Some test‐measures were weakly correlated with illness severity measures suggesting that some impairments may track illness progression.
Conclusion
This reanalysis supports VLT, Digit Span and TMT as robust measures of cognitive impairments in bipolar disorder patients. The heterogeneity of some test results explains previous differences in meta‐analyses. Better controlling for confounds suggests deficits may be smaller than previously reported but should be tracked longitudinally across illness progression and treatment.
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We analyze periods with elevated >40 MeV proton intensities observed near Earth over a time span of 43 years (1973-2016) that coincide with the passage of interplanetary shocks. Typically, elevated ...proton intensities result from large solar energetic particle (SEP) events. The interplanetary shocks observed during these elevated-intensity periods may or may not be related to the origin of the SEP events. By choosing those cases when the shocks can be confidently associated with the solar eruption that generated the SEP event, we analyze the components of these SEP events that are localized in the vicinity of the shock (so-called “energetic storm particles (ESPs)"), focusing on those events where the ESP component exceeds 40 MeV. We examine the interdependence of these high-energy ESPs with (i) the properties of the solar eruptions that generated the shocks and the SEP events, and (ii) the parameters of the shocks at their arrival at 1 au. The solar eruptions at the origin of the shocks producing >40 MeV proton ESP intensity enhancements are within ±50° longitude of central meridian and are associated with fast coronal mass ejections (plane-of-sky speeds ≳1000 km s-1). The ESP events with the largest >40 MeV proton intensity increases tend to occur when there are structures such as intervening interplanetary coronal mass ejections and other unrelated shocks present in the solar wind through which the shock is propagating. Among the various local shock parameters considered, only the shock speed shows a certain degree of correlation with the observed ESP intensity increase.
Objectives
To aid the development of treatment for cognitive impairment in bipolar disorder, the International Society for Bipolar Disorders (ISBD) convened a task force to create a consensus‐based ...guidance paper for the methodology and design of cognition trials in bipolar disorder.
Methods
The task force was launched in September 2016, consisting of 18 international experts from nine countries. A series of methodological issues were identified based on literature review and expert opinion. The issues were discussed and expanded upon in an initial face‐to‐face meeting, telephone conference call and email exchanges. Based upon these exchanges, recommendations were achieved.
Results
Key methodological challenges are: lack of consensus on how to screen for entry into cognitive treatment trials, define cognitive impairment, track efficacy, assess functional implications, and manage mood symptoms and concomitant medication. Task force recommendations are to: (i) enrich trials with objectively measured cognitively impaired patients; (ii) generally select a broad cognitive composite score as the primary outcome and a functional measure as a key secondary outcome; and (iii) include remitted or partly remitted patients. It is strongly encouraged that trials exclude patients with current substance or alcohol use disorders, neurological disease or unstable medical illness, and keep non‐study medications stable. Additional methodological considerations include neuroimaging assessments, targeting of treatments to illness stage and using a multimodal approach.
Conclusions
This ISBD task force guidance paper provides the first consensus‐based recommendations for cognition trials in bipolar disorder. Adherence to these recommendations will likely improve the sensitivity in detecting treatment efficacy in future trials and increase comparability between studies.
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Objective
The aim was to examine the heterogeneity of psychosocial outcomes in euthymic bipolar disorder (BD) patients and analyse the potential influence of distinct variables on functioning.
Method
...Using a hierarchical cluster exploratory analysis, 143 euthymic patients with diagnosis of BD were grouped according to their functional performance based on domains scores of the Functioning Assessment Short Test (FAST). The resulting groups were compared on sociodemographic, clinical and neurocognitive variables to find factors associated with each functional cluster.
Results
Patients were grouped in three functional profiles: patients with good functioning in all the FAST areas, patients with an intermediate profile showing great difficulties in the occupational domain and milder difficulties in most of the rest domains, and a third group with serious difficulties in almost all functional areas. Both functionally impaired groups were characterized by higher subthreshold symptoms (depressive and manic) and higher unemployment rates. The most functionally impaired group also showed lower scores on some measures of processing speed.
Conclusion
Two of three functional profiles showed some kind of impairment which was associated with subsyndromal symptoms and cognitive performance. These patterns should be taken into consideration to develop more individualized interventions to restore, or improve, psychosocial outcomes.
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Objectives
Cognition is a new treatment target to aid functional recovery and enhance quality of life for patients with bipolar disorder. The International Society for Bipolar Disorders (ISBD) ...Targeting Cognition Task Force aimed to develop consensus‐based clinical recommendations on whether, when and how to assess and address cognitive impairment.
Methods
The task force, consisting of 19 international experts from nine countries, discussed the challenges and recommendations in a face‐to‐face meeting, telephone conference call and email exchanges. Consensus‐based recommendations were achieved through these exchanges with no need for formal consensus methods.
Results
The identified questions were: (I) Should cognitive screening assessments be routinely conducted in clinical settings? (II) What are the most feasible screening tools? (III) What are the implications if cognitive impairment is detected? (IV) What are the treatment perspectives? Key recommendations are that clinicians: (I) formally screen cognition in partially or fully remitted patients whenever possible, (II) use brief, easy‐to‐administer tools such as the Screen for Cognitive Impairment in Psychiatry and Cognitive Complaints in Bipolar Disorder Rating Assessment, and (III) evaluate the impact of medication and comorbidity, refer patients for comprehensive neuropsychological evaluation when clinically indicated, and encourage patients to build cognitive reserve. Regarding question (IV), there is limited evidence for current evidence‐based treatments but intense research efforts are underway to identify new pharmacological and/or psychological cognition treatments.
Conclusions
This task force paper provides the first consensus‐based recommendations for clinicians on whether, when, and how to assess and address cognition, which may aid patients’ functional recovery and improve their quality of life.
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Aims. We introduce a new solar energetic particle (SEP) transport code that aims at studying the effects of different background solar wind configurations on SEP events. In this work, we focus on the ...influence of varying solar wind velocities on the adiabatic energy changes of SEPs and study how a non-Parker background solar wind can trap particles temporarily at small heliocentric radial distances (≲1.5 AU) thereby influencing the cross-field diffusion of SEPs in the interplanetary space. Methods. Our particle transport code computes particle distributions in the heliosphere by solving the focused transport equation (FTE) in a stochastic manner. Particles are propagated in a solar wind generated by the newly developed data-driven heliospheric model, EUHFORIA. In this work, we solve the FTE, including all solar wind effects, cross-field diffusion, and magnetic-field gradient and curvature drifts. As initial conditions, we assume a delta injection of 4 MeV protons, spread uniformly over a selected region at the inner boundary of the model. To verify the model, we first propagate particles in nominal undisturbed fast and slow solar winds. Thereafter, we simulate and analyse the propagation of particles in a solar wind containing a corotating interaction region (CIR). We study the particle intensities and anisotropies measured by a fleet of virtual observers located at different positions in the heliosphere, as well as the global distribution of particles in interplanetary space. Results. The differential intensity-time profiles obtained in the simulations using the nominal Parker solar wind solutions illustrate the considerable adiabatic deceleration undergone by SEPs, especially when propagating in a fast solar wind. In the case of the solar wind containing a CIR, we observe that particles adiabatically accelerate when propagating in the compression waves bounding the CIR at small radial distances. In addition, for r ≳ 1.5 AU, there are particles accelerated by the reverse shock as indicated by, for example, the anisotropies and pitch-angle distributions of the particles. Moreover, a decrease in high-energy particles at the stream interface (SI) inside the CIR is observed. The compression/shock waves and the magnetic configuration near the SI may also act as a magnetic mirror, producing long-lasting high intensities at small radial distances. We also illustrate how the efficiency of the cross-field diffusion in spreading particles in the heliosphere is enhanced due to compressed magnetic fields. Finally, the inclusion of cross-field diffusion enables some particles to cross both the forward compression wave at small radial distances and the forward shock at larger radial distances. This results in the formation of an accelerated particle population centred on the forward shock, despite the lack of magnetic connection between the particle injection region and this shock wave. Particles injected in the fast solar wind stream cannot reach the forward shock since the SI acts as a diffusion barrier.
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Objective
To study the prevalence of attention‐deficit and hyperactivity disorder (ADHD) in adult patients with bipolar disorder (BD) and identify differential clinical features for a better ...diagnosis.
Method
A total of 163 euthymic bipolar out‐patients were screened for ADHD with the ASRS.V1 and the WURS at a BD Unit. Patients with a positive screening were assessed with the CAADID, at an ADHD unit. Sociodemographic and clinical features of the groups with and without ADHD were compared.
Results
Lifetime prevalence of comorbid ADHD was 17.9% (10.5% for adult ADHD and 7.4% for childhood ADHD). The BD + ADHD group showed more suicidal behaviour although less severe. Comorbidity was also more common, especially regarding substance use disorders. Nevertheless, these patients did not show more affective episodes or hospitalizations and suffered more atypical but less melancholic depression. However, they required more treatment with psychotherapy and valproate. One‐third of positive screenings at the ASRS were false; a severe course of BD was the hallmark of this subgroup.
Conclusion
Adult patients with BD and ADHD show differential clinical features, but not a more severe course of BD. Comorbidity with substance abuse is a big issue, deserving special clinical attention. Better screening tools are necessary to avoid overdiagnosis of comorbid ADHD in BD.
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Aims.
We study the effect of the magnetic gradient and curvature drifts on the pitch-angle dependent transport of solar energetic particles (SEPs) in the heliosphere, focussing on ∼3–36 MeV protons. ...By considering observers located at different positions in the heliosphere, we investigate how drifts may alter the measured intensity-time profiles and energy spectra. We focus on the decay phase of solar energetic proton events in which a temporal invariant spectrum and disappearing spatial intensity gradients are often observed; a phenomenon known as the “reservoir effect” or the “SEP flood”. We study the effects of drifts by propagating particles both in nominal and non-nominal solar wind conditions.
Methods.
We used a three-dimensional (3D) particle transport model, solving the focused transport equation extended with the effect of particle drifts in the spatial term. Nominal Parker solar wind configurations of different speeds and a magnetohydrodynamic (MHD) generated solar wind containing a corotating interaction region (CIR) were considered. The latter configuration gives rise to a magnetic bottle structure, with one bottleneck at the Sun and the other at the CIR. We inject protons from a fixed source at 0.1 AU, the inner boundary of the MHD model.
Results.
When the drift induced particle net-flux is zero, the modelled intensity-time profiles obtained at different radial distances along an IMF line show the same intensity fall-off after the prompt phase of the particle event, which is in accordance with the SEP flood phenomenon. However, observers magnetically connected close to the edges of the particle injection site can experience, as a result of drifts, a sudden drop in the intensities occurring at different times for different energies such that no SEP flood phenomenon is established. In the magnetic bottle structure, this effect is enhanced due to the presence of magnetic field gradients strengthening the nominal particle drifts. Moreover, anisotropies can be large for observers that only receive particles through drifts, illustrating the importance of pitch-angle dependent 3D particle modelling. We observe that interplanetary cross-field diffusion can mitigate the effects of particle drifts.
Conclusions.
Particle drifts can substantially modify the decay phase of SEP events, especially if the solar wind contains compression regions or shock waves where the drifts are enhanced. This is, for example, the case for our CIR solar wind configuration generated with a 3D MHD model, where the effect of drifts is strong. A similar decay rate in different energy channels and for different observers requires the mitigation of the effect of drifts. One way to accomplish this is through interplanetary cross-field diffusion, suggesting thus a way to determine a minimum value for the cross-field diffusion strength.
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The long-term efficacy of psychological interventions for bipolar disorders has not been tested.
This study assessed the efficacy of group psychoeducation to prevent recurrences and to reduce time ...spent ill for people with bipolar disorders.
A randomised controlled trial with masked outcome assessment comparing group psychoeducation and non-structured group intervention during 5-year follow-up. One hundred and twenty people with bipolar disorders were included in the study and 99 completed 5-year follow-up. Time to any recurrence, number of recurrences, total number of days spent ill, frequency and length of hospitalisations were the main outcome measures.
At the 5-year follow-up, time to any recurrence was longer for the psychoeducation group (log rank=9.953, P<0.002). The psychoeducation group had fewer recurrences (3.86 v. 8.37, F=23.6, P<0.0001) of any type and they spent less time acutely ill (154 v. 586 days, F=31.66, P=0.0001). The median number of days of hospitalisation per hospitalised participant was also lower for the psychoeducation group (45 v. 30, F=4.26, P=0.047).
Six-month group psychoeducation has long-lasting prophylactic effects in individuals with bipolar disorders. Group psychoeducation is the first psychological intervention showing such a long-term maintained efficacy in people with bipolar disorders.
Context. The source of high-energy protons (above ~500 MeV) responsible for ground level enhancements (GLEs) remains an open question in solar physics. One of the candidates is a shock wave driven by ...a coronal mass ejection, which is thought to accelerate particles via diffusive-shock acceleration. Aims. We perform physics-based simulations of proton acceleration using information on the shock and ambient plasma parameters derived from the observation of a real GLE event. We analyse the simulation results to find out which of the parameters are significant in controlling the acceleration efficiency and to get a better understanding of the conditions under which the shock can produce relativistic protons. Methods. We use the results of the recently developed technique to determine the shock and ambient plasma parameters, applied to the 17 May 2012 GLE event, and carry out proton acceleration simulations with the Coronal Shock Acceleration (CSA) model. Results. We performed proton acceleration simulations for nine individual magnetic field lines characterised by various plasma conditions. Analysis of the simulation results shows that the acceleration efficiency of the shock, i.e. its ability to accelerate particles to high energies, tends to be higher for those shock portions that are characterised by higher values of the scattering-centre compression ratio rc and/or the fast-mode Mach number MFM. At the same time, the acceleration efficiency can be strengthened by enhanced plasma density in the corresponding flux tube. The simulations show that protons can be accelerated to GLE energies in the shock portions characterised by the highest values of rc. Analysis of the delays between the flare onset and the production times of protons of 1 GV rigidity for different field lines in our simulations, and a subsequent comparison of those with the observed values indicate a possibility that quasi-perpendicular portions of the shock play the main role in producing relativistic protons.
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