Cognitive and psychosocial impairment in remitted bipolar patients

Flávia Moreira Lima; Letícia S. Czepielewski; Clarissa S. Gama; Flávio Kapczinski; Adriane R. Rosa

doi:10.18682/pd.v14i2.354

Flávia Moreira Lima Laboratory of Molecular Psychiatry, INCT for Translational Medicine—CNPq, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Letícia S. Czepielewski Laboratory of Molecular Psychiatry, INCT for Translational Medicine—CNPq, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Clarissa S. Gama Laboratory of Molecular Psychiatry, INCT for Translational Medicine—CNPq, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Flávio Kapczinski Laboratory of Molecular Psychiatry, INCT for Translational Medicine—CNPq, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Adriane R. Rosa Department of Pharmacology, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil Centro de Investigación Biomédica en Red de Salud Mental, (CIBERSAM), Madrid

DOI: https://doi.org/10.18682/pd.v14i2.354

Palabras clave: Euthymic bipolar disorder, Cognition, Psychosocial functioning

Resumen

There is growing evidence showing that bipolar disorder is associated with persistent cognitive deficits. However, the exact meaning and impact of cognitive deficits in bipolar disorder is still not entirely known, even though they have been associated with poor psychosocial functioning. This study aims to summarize cognitive and psychosocial functioning findings of remitted bipolar patients. We conducted an extensive Medline search of the published English literature for the period January 2000– March 2014 using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further analysed for publications of interest. Our results showed that: (1) all mood states of bipolar disorder are associated with cognitive impairment. However, the euthymic state is associated with less impairment than the other states; (2) there is a strong association between clinical factors (i.e, duration of illness, number of episodes, residual mood symptoms, comorbidities) and cognitive impairment in euthymic bipolar patients, although these factors do not account fully for these deficits; (3) cognitive deficits, in particular, verbal learning and executive dysfunctions may contribute to poor functioning. In conclusion, our review suggests that cognitive deficits are strongly associated with mood episodes; such deficits persist, in lower degree, during remission. Impairment on cognitive performance may explain, in part, poor long–term functioning in remitted bipolar patients. It highlights that psychosocial interventions in combination with pharmacotherapy should be considered to improve cognition and enhance the level of functioning. Therefore, studies assessing the efficacy of novel strategies focused on cognitive and functional status are an important area of future investigation in bipolar disorder.

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Arts, B., Jabben, N., Krabbendam, L. & van Os, J. (2008). Meta–analyses of cognitive functioning in euthymic bipolar patients and their ﬁrst–degree relatives. Psychological Medicine, 38, 771–785.

Balanza–Martinez, V., Selva, G., Martinez–Aran, A., Prickaerts, J., Salazar, J., Gonzalez–Pinto, A., … Tabares–Seisdedos, R. (2009). Neurocognition in bipolar disorders a closer look at comorbidities and medications. European Journal of Pharmacology, 626, 87–96.

Bonnín, C. M., Martinez–Aran, A., Torrent, C., Pacchiarotti, I., Rosa, A. R., Franco, C., … Vieta, E. (2010). Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: a long–term, follow–up study. Journal of Affective Disorders, 121,156–160.

Bonnín, C. M., Sanchez–Moreno, J., Martinez–Aran, A., Sole, B., Reinares, M., Rosa, A. R., … Torrent, C. (2012). Subthreshold symptoms in bipolar disorder: impact on neurocognition, quality of life and disability. Journal of Affective Disorders, 136, 650–659.

Bora, E., Yucel, M. & Pantelis, C. (2009). Cognitive endophenotypes of bipolar disorder: a meta–analysis of neuropsychological deﬁcits in euthymic patients and their ﬁrst–degree relatives. Journal of Affective Disorders, 113, 1–20.

Bourne, C., Aydemir, O, Balanza–Martinez, V., Bora, E., Brissos, S., Cavanagh, J. T., … Goodwin, G. M. (2013). Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta–analysis. Acta Psychiatrica Scandinavica, 128(3),149–62.

Burdick, K. E., Goldberg, J. F. & Harrow, M. (2010). Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15–year follow–up. Acta Psychiatrica Scandinavica, 122, 499–506.

Goodwin, G. M., Martinez–Aran, A., Glahn, D. C. & Vieta, E. (2008). Cognitive impairment in bipolar disorder: Neurodevelopment or neurodegeneration? An ECNP expert meeting report. European Neuropsychopharmacology, 18, 787–793.

Goswami, U., Sharma, A., Khastigir, U., Ferrier, I.N., Young, A.H., Gallagher, P., … Moore, P.B. (2006). Neuropsychological dysfunction, soft neurological signs and social disability in euthymic patients with bipolar disorder. British Journal of Psychiatry, 188, 366–373.

Huxley, N. & Baldessarini, R. J. (2007). Disability and its treatment in bipolar disorder patients. Bipolar Disorders, 9, 183–196.

Kurtz, M. M. & Gerraty, R. T. (2009). A meta–analytic investigation of neurocognitive deﬁcits in bipolar illness: proﬁle and eﬀects of clinical state. Neuropsychology, 23, 551–562.

Levy, B. & Weiss, R.D. (2010). Neurocognitive impairment and psychosis in bipolar I disorder during early remission from an acute episode of mood disturbance. The Journal of Clinical Psychiatry, 71(2), 201–206.

Lezak, M. D. (1995). Neuropsychological Assessment. New York: Oxford University Press.

Lopez–Jaramillo, C., Lopera–Vasquez, J., Ospina–Duque, J., Garcıa, J., Gallo, A., Cortez, V., … Vieta, E. (2010). Lithium treatment eﬀects on the neuropsychological functioning of patients with bipolar I disorder. The Journal of Clinical Psychiatry, 71, 1055–1060.

Malhi, G. S., Ivanovski, B., Hadzi–Pavlovic, D., Mitchell, P. B., Vieta, E. & Sachdev, P. (2007). Neuropsychological deﬁcits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disorders, 9, 114–125.

Mann–Wrobel, M. C., Carreno, J. T. & Dickinson, D. (2011). Meta–analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disorders, 13, 334–342.

Martinez–Aran, A., Torrent, C., Sole, B., Bonnin, C. M., Rosa, A. R., Sanchez–Moreno, J., & Vieta, E. (2011). Functional remediation for bipolar disorder. Clinical Practice and Epidemiology in Mental Health, 7, 112–116.

Martínez–Aran, A., Vieta, E., Colom, F., Torrent, C., Sanchez–Moreno, J., Reinares, M., … Salamero, M. (2004a). Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disorders, 6, 224–232.

Martínez–Aran, A., Vieta, E., Reinares, M., Colom, F., Torrent, C., Sanchez–Moreno, J., … Salamero, M. (2004b). Cognitive function across manic, hypomanic, depressed, and euthymic states in bipolar disorder. American Journal of Psychiatry, 161, 262–270.

Martinez–Aran, A., Vieta, E., Torrent, C., Sanchez–Moreno, J., Goikolea, J. M., Salamero, M., … Ayuso–Mateos, J. L. (2007). Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disorders, 9, 103–113.

Martino, D. J., Marengo, E., Igoa, A., Scapola, M., Ais, E. D., Perinot, L. & Strejilevich, S. A. (2009). Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: a prospective 1 year follow–up study. Journal of Aﬀective Disorders, 116, 37–42.

Merikangas, K. R., Akiskal, H. S., Angst, J., Greenberg, P. E., Hirschfeld, R. M., Petukhova. M. & Kessler, R. C. (2007). Lifetime and 12–month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Archives of General Psychiatry, 64, 543–552.

Mora, E., Portella, M. J., Forcada, I., Vieta, E. & Mur, M. (2013). Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium–treated, euthymic bipolar patients: a 6–year follow–up study. Psychological Medicine, 43(6),1187–96.

Mur, M., Portella, M. J., Martinez–Aran, A., Pifarre, J. & Vieta, E. (2008). Long–term stability of cognitive impairment in bipolar disorder: a 2–year follow–up study of lithium–treated euthymic bipolar patients. The Journal of Clinical Psychiatry, 69, 712–719.

Murray, C. J. & Lopez, A. D. (1997). Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet, 349, 1498–1504.

Quraishi, S. & Frangou, S. (2002). Neuropsychology of bipolar disorder: a review. Journal of Affective Disorders, 72, 209–226.

Robb, J. C., Cooke, R. G., Devins, G. M., Young, L. T. & Joffe, R. T. (1997) Quality of life and lifestyle disruption in euthymic bipolar disorder. Journal of Psychiatric Research, 31, 509–517.

Robinson, L. J. & Ferrier, I. N. (2006). Evolution of cognitive impairment in bipolar disorder: a systematic review of cross–sectional evidence. Bipolar Disorders, 8, 103–116.

Robinson, L. J., Thompson, J. M., Gallagher, P., Goswami, U., Young, A. H., Ferrier, I. N. & Moore, P. B. (2006). A meta–analysis of cognitive deﬁcits in euthymic patients with bipolar disorder. Journal of Affective Disorders, 93, 105–115.

Rosa, A. R., Bonnin, C. M., Vazquez, G. H., Reinares, M., Sole, B., Tabares–Seisdedos, R., … Vieta, E. (2010a) Functional impairment in bipolar II disorder: is it as disabling as bipolar I? Journal of Affective Disorders,127, 71–76.

Rosa, A. R., Gonzalez–Ortega, I., Gonzalez–Pinto, A., Echeburua, E., Comes, M., Martinez–Aran, A., … Vieta, E. (2012). One–year psychosocial functioning in patients in the early vs. late stage of bipolar disorder. Acta Psychiatrica Scandinavica,125(4), 335–341.

Rosa, A. R., Magalhães, P. V. S., Czepielewski, L., Sulzbach, M. V., Goi, P. D., Vieta, E., … Kapczinski, F. (2014). Clinical Staging in Bipolar Disorder: Focus on Cognition and Functioning. Journal of Clinical Psychiatry, 75(5), e450–456. doi: 10.4088/JCP.13m08625.

Rosa, A. R., Reinares, M., Amann, B., Popovic, D., Franco, C., Comes, M., … Vieta, E. (2011). Six–month functional outcome of a bipolar disorder cohort in the context of a specialized–care program. Bipolar Disorders, 13, 679–686.

Rosa, A. R., Reinares, M., Franco, C., Comes, M., Torrent, C., Sanchez–Moreno, J., … Vieta, E. (2009). Clinical predictors of functional outcome of bipolar patients in remission. Bipolar Disorders, 11, 401–409.

Rosa, A. R., Reinares, M., Michalak, E. E., Bonnin, C. M., Sole, B., Franco, C., … Vieta, E. (2010b). Functional impairment and disability across mood states in bipolar disorder. Value in health, 13(8), 984–988.

Sanchez–Moreno, J., Martinez–Aran, A., Tabares–Seisdedos, R., Torrent, C., Vieta, E. & Ayuso–Mateos, J. L. (2009). Functioning and disability in bipolar disorder: an extensive review. Psychotherapy and Psychosomatics, 78, 285–297.

Sanchez–Morla, E. M., Barabash, A., Martinez–Vizcaino, V., Tabares–Seisdedos, R., Balanza–Martinez, V., Cabranes–Diaz, J. A., … Gomez, J. L. (2009). Comparative study of neurocognitive function in euthymic bipolar patients and stabilized schizophrenic patients. Psychiatry Research, 169(3), 220–228.

Simon, G. E., Bauer, M. S., Ludman, E. J., Operskalski, B. H. & Unutzer, J. (2007). Mood symptoms, functional impairment, and disability in people with bipolar disorder: specific effects of mania and depression. The Journal of Clinical Psychiatry, 68,1237–1245.

Tabares–Seisdedos, R., Balanza–Martınez, V., Sanchez– Moreno, J., Martinez–Aran, A., Salazar–Fraile, J., Selva–Vera, G., … Vieta, E. (2008). Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one–year follow–up. The Journal of Clinical Psychiatry, 109, 286–299.

Torrent, C., Martinez–Aran, A., Bonnin, C. M., Reinares, M., Daban, C., Sole, B., … Vieta, E. (2012). Long–term outcome of cognitive impairment in bipolar disorder. The Journal of Clinical Psychiatry, 73, 899–905.

Torres, I. J., Boudreau, V. G., & Yatham, L. N. (2007). Neuropsychological functioning in euthymic bipolar disorder: a meta–analysis. Acta Psychiatrica Scandinavica Supplementum, 434, 17–26.

Vieta, E. (2009). The inﬂuence of medications on neurocognition in bipolar disorder. Acta Psychiatrica Scandinavica, 120, 414–415.

Wingo, A. P., Harvey, P. D. & Baldessarini, R. J. (2009). Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disorders, 11, 113–125.

World Health Organization. (2008). The global burden of disease: 2004 update. Geneva: WHO Press.

Yatham, L. N., Torres, I. J., Malhi, G. S., Frangou, S., Glahn, D. C., Bearden, C. E., … Chengappa, K. N. (2010). The International Society for Bipolar Disorders – Battery for Assessment of Neurocognition (ISBD–BANC). Bipolar Disorders, 12, 351–363.

Zubieta, J. K., Huguelet, P., O’Neil, R. L., & Giordani, B. J. (2001). Cognitive function in euthymic bipolar I disorder. Psychiatry Research, 102, 9–20.