Abstract
BackgroundThe relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD.MethodsAfter short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects.ResultsFeasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity.LimitationsThe sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored.ConclusionWith minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.
Highlights
The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry
Cognitive deficits in bipolar disorders are relevant to cerebral pathogenesis and prognosis, but they are often neglected in routine clinical practice
The cognitive deficits in bipolar disorder are directly related to functional status or psychosocial outcomes [6,7], and the severity of the cognitive impairment at initiation of therapeutic intervention can be a powerful predictor of functional recovery one year later [8]
Summary
The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Similar observations in schizophrenia [9] prompted the National Institutes of Health initiative for Measurement and Treatment of Cognitive Impairment in Schizophrenia [10], and a parallel initiative for bipolar disorder may be in order This would be facilitated by a more wide spread incorporation of cognitive assessments into the routine clinical examinations of bipolar patients. The MMSE is sensitive to the severity of dementia in geriatric samples, it has proven to be unstable and unreliable in psychotic or affective disorders where it underestimates the cognitive disturbance in younger samples and overestimates pathology in older, less educated, or less intelligent samples [14,15,16,17]
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