Objective
We discuss the rationale behind staging systems described specifically for bipolar disorders. Current applications, future directions and research gaps in clinical staging models for ...bipolar disorders are outlined.
Method
We reviewed the literature pertaining to bipolar disorders, focusing on the first episode onwards. We systematically searched data on staging models for bipolar disorders and allied studies that could inform the concept of staging.
Results
We report on several dimensions that are relevant to staging concepts in bipolar disorder. We consider whether staging offers a refinement to current diagnoses by reviewing clinical studies of treatment and functioning and the potential utility of neurocognitive, neuroimaging and peripheral biomarkers.
Conclusion
Most studies to date indicate that globally defined late‐stage patients have a worse overall prognosis and poorer response to standard treatment, consistent with patterns for end‐stage medical disorders. We believe it is possible at this juncture to speak broadly of ‘early’‐ and ‘late’‐stage bipolar disorder. Next steps require further collaborative efforts to consider the details of preillness onset and intermediary stages, and how many additional stages are optimal.
Dias VV, Balanzá‐Martinez V, Soeiro‐de‐Souza MG, Moreno RA, Figueira ML, Machado‐Vieira R, Vieta E. Pharmacological approaches in bipolar disorders and the impact on cognition: a critical overview.
...Objective: Historically, pharmacological treatments for bipolar disorders (BD) have been associated with neurocognitive side‐effects. We reviewed studies which assessed the impact of several psychopharmacological drugs on the neurocognitive function of BD patients.
Method: The PubMed database was searched for studies published between January 1980 and February 2011, using the following terms: bipolar, bipolar disorder, mania, manic episode, or bipolar depression, cross‐referenced with cognitive, neurocognitive, or neuropsychological, cross‐referenced with treatment.
Results: Despite methodological flaws in the older studies and insufficient research concerning the newer agents, some consistent findings emerged from the review; lithium appears to have definite, yet subtle, negative effects on psychomotor speed and verbal memory. Among the newer anticonvulsants, lamotrigine appears to have a better cognitive profile than carbamazepine, valproate, topiramate, and zonisamide. More long‐term studies are needed to better understand the impact of atypical antipsychotics on BD patients’ neurocognitive functioning, both in monotherapy and in association with other drugs. Other agents, like antidepressants and cognitive enhancers, have not been adequately studied in BD so far.
Conclusion: Pharmacotherapies for BD should be chosen to minimize neurocognitive side‐effects, which may already be compromised by the disease process itself. Neurocognitive evaluation should be considered in BD patients to better evaluate treatment impact on neurocognition. A comprehensive neuropsychological evaluation also addressing potential variables and key aspects such as more severe cognitive deficits, comorbidities, differential diagnosis, and evaluation of multiple cognitive domains in longitudinal follow‐up studies are warranted.
Solé B, Bonnin CM, Torrent C, Balanzá‐Martínez V, Tabarés‐Seisdedos R, Popovic D, Martínez‐Arán A, Vieta E. Neurocognitive impairment and psychosocial functioning in bipolar II disorder.
Objective: ...There is a growing body of evidence on neurocognitive impairment in euthymic bipolar patients, but this issue has been studied mostly in bipolar I disorder, data on bipolar II (BD‐II) are scant and discrepant. The two aims of this study were to ascertain whether strictly defined euthymic BD‐II patients would present neurocognitive disturbances and to evaluate their impact on functional outcome.
Method: Forty‐three BD‐II patients and 42 demographically and educationally matched healthy subjects were assessed with a comprehensive neuropsychological test battery and with the Social and Occupational Functioning Assessment Scale (SOFAS). The euthymia criteria were reduced (Hamilton Rating Scale for Depression score ≤6 and a Young Mania Rating Scale score ≤6) to minimize the influence of subdepressive symptomatology on cognition and functioning.
Results: BD‐II patients showed a significantly lower performance on several measures of attention, learning and verbal memory, and executive function compared with healthy controls. The presence of subthreshold depressive symptomatology and one measure related to executive function (Trail Making Test, part B) was the variables that best predicted psychosocial functioning measured with the SOFAS.
Conclusion: This report provides further evidence that euthymic BD‐II patients present cognitive impairment which may impact psychosocial functioning.
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.
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.
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.
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.
Background
The general medical impacts of coronavirus (COVID‐19) are increasingly appreciated. However, its impact on neurocognitive, psychiatric health and quality of life (QoL) in survivors after ...the acute phase is poorly understood. We aimed to evaluate neurocognitive function, psychiatric symptoms and QoL in COVID‐19 survivors shortly after hospital discharge.
Methods
This was a cross‐sectional analysis of a prospective study of hospitalized COVID‐19 survivors followed up for 2 months after discharge. A battery of standardized instruments evaluating neurocognitive function, psychiatric morbidity and QoL (mental and physical components) was administered by telephone.
Results
Of the 229 screened patients, 179 were included in the final analysis. Amongst survivors, the prevalence of moderately impaired immediate verbal memory and learning was 38%, delayed verbal memory (11.8%), verbal fluency (34.6%) and working memory (executive function) (6.1%), respectively. Moreover, 58.7% of patients had neurocognitive impairment in at least one function. Rates of positive screening for anxiety, depression and post‐traumatic stress disorder were 29.6%, 26.8% and 25.1%, respectively. In addition, 39.1% of the patients had psychiatric morbidity. Low QoL for physical and mental components was detected in 44.1% and 39.1% of patients respectively. Delirium and psychiatric morbidity were associated with neurocognitive impairment, and female gender was related with psychiatric morbidity.
Conclusion
Hospitalized COVID‐19 survivors showed a considerable prevalence of neurocognitive impairment, psychiatric morbidity and poor QoL in the short term. It is uncertain if these impacts persist over the long term.
This study aimed to determine the prevalence of substance consumption and mental health problems among Spanish medical students, and their association with sociodemographic factors.
A multicentre ...cross-sectional study was conducted. Self-reported data on sociodemographic and clinical characteristics were collected, including BDI-II, PHQ-9, brief STAI, and single-item academic burnout (IUBA).
Overall, 1265 students (74.2% female) completed the survey. Of them, 37.4% scored positive for depressive symptoms, as measured by the BDI-II, and more than half (53%) by the PHQ-9. Suicidal ideation was reported by about 12% whilst high levels of state and trait anxiety were informed by 28.8% and 29.4% of the students. The prevalence of burnout was 40.2%. Female and pre-clinical students reported significantly (p < 0.01) higher rates of depressive, anxiety, and burnout symptoms. Alcohol, energy drinks, and tobacco were the most frequently used substances. Total scores of self-reported mental health problems negatively correlated (p < 0.001) with objective academic results and positively correlated (p < 0.02) with the number of substances consumed in the last 30 days.
Research-based on self-reported data could favour information bias due to the social desirability effect and memory error.
A high prevalence of substance consumption and several mental health problems was found among medical students, especially females. The relevant influence of academic-related factors on students' well-being may be a call for medical schools to implement initiatives aimed to improve students' ability to detect, address, and seek help for their mental health issues.
•Rates of depressive, anxiety and burnout symptoms were higher among female and pre-clinical medical students.•Lower degree of satisfaction with the previous semester´s academic results associated with higher scores of depressive and burnout symptoms.•The most frequently used substances among medical students were alcohol, energy drinks and tobacco.•A positive correlation was found between self-reported mental health scores and substance consumption.
Objective
The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar ...disorder(BD) presenting moderate‐severe levels of functional impairment.
Methods
Two‐hundred and thirty‐nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run.
Results
The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM‐D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance.
Conclusions
Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.
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.
Abstract Background Cognitive reserve (CR) reflects the capacity of the brain to endure neuropathology, minimize clinical manifestations and successfully complete cognitive tasks. The present study ...aims to determine whether high CR may constitute a moderator of cognitive functioning in bipolar disorder (BD). Methods 102 patients with BD and 32 healthy controls were enrolled. All patients met DSM-IV criteria for I or II BD and were euthymic (YMRS≤6 and HDRS≤8) during a 6-month period. All participants were tested with a comprehensive neuropsychological battery, and a Cerebral Reserve Score (CRS) was estimated. Subjects with a CRS below the group median were classified as having low CR, whereas participants with a CRS above the median value were considered to have high CR. Results Participants with BD with high CR displayed a better performance in measures of attention (digits forward: F=4.554, p=0.039); phonemic and semantic verbal fluency (FAS: F=9.328, p=0.004; and Animal Naming: F=8.532, p=0.006); and verbal memory (short cued recall of California Verbal Learning Test: F=4.236, p=0.046), after multivariable adjustment for potential confounders, including number of admissions and prior psychotic symptoms. Limitations The cross-sectional design of the study does not allow the establishment of causal inferences. Additionally, the small size of the sample may have limited some results. Conclusions High cognitive reserve may therefore be a valuable construct to explore for predicting neurocognitive performance in patients with BD regarding premorbid status.
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