Deficits In Euthymic Patients Research Articles

The relationship between peripheral insulin resistance and social cognitive deficits among euthymic patients with bipolar disorder

BackgroundDespite extensive literature documenting emotion-related social-cognitive deficits in euthymic patients with bipolar disorder (BD), the factors contributing to these deficits have not been definitively established. To address this gap, the present study aimed to examine the association between peripheral insulin resistance (IR) and emotion-related social-cognitive abilities in BD patients and controls. MethodSixty-five BD patients and 38 non-psychiatric controls were recruited, and their social cognitive ability and IR were measured using the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) and the homeostasis model assessment of insulin resistance (HOMA-IR), respectively. ResultsThe study found that the BD patients scored significantly lower than the non-psychiatric controls in the task of emotional management. The BD patients had a higher mean HOMA-IR value as compared with the controls but this result was not statistically significant (p = 0.051). The interaction between BD diagnosis and HOMA-IR value was significant on the MSCEIT Facilitating emotions branch and Facilitation subscale (p = 0.024, p = 0.010), and post-hoc analyses revealed that the BD patients in the higher HOMA-IR group had significantly lower scores than BD patients in the lower HOMA-IR group and the non-psychiatric controls in the higher HOMA-IR group on both the MSCEIT Facilitating emotion branch and Facilitation subscale. LimitationsDue to the cross-sectional nature of the study, causality could not be inferred. The study did not examine potential mediators or moderators between IR and social cognition. ConclusionsThe results suggested that BD patients with IR experience additional impairment in specific domains of social cognition.

Cognitive functions in euthymic patients with bipolar II disorder and their correlation with the clinical profile

Deficits in neurocognitive functions can hinder the functional recovery and the quality of life of psychiatric patients, especially those with bipolar disorder. Numerous reports consistently demonstrated cognitive deficits in euthymic patients with bipolar disorder; however, their relation to the clinical profile remains unclear. The aim of this study was to demonstrate the range of neuropsychological deficits in euthymic patients with bipolar II disorder and to correlate these neuropsychological deficits with their illness characteristics. Thirty bipolar affective disorder type II patients in their euthymic state were assessed by the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression, the Young Mania Rating Scale, the Wechsler Adult Intelligence Scale, the Wechsler Memory Scale, the Continuous Performance Test, and the Wisconsin Card Sorting Test. Patients’ cognitive functions were compared with a matched control group. The performance on most domains of the Wechsler Adult Intelligence Scale was associated with the total number of episodes, the number of depressive episodes, the age of onset, and the average duration of an episode in months. The performance on the Wechsler Memory Scale was significantly associated across most domains with the total number of episodes, the number of depressive episodes, the age in years, the average duration of an episode in months, and the average duration of illness in years. The performance deficits on the Wisconsin Card Sorting Test were significantly associated with the total number of episodes, the number of depressive episodes, family history, and the average duration of illness in years. Bipolar II euthymic patients showed persistent cognitive deficits in some aspects of general intellectual capacity, executive and memory functions, and the ability for sustained attention, which are correlated with some clinical variables. Bipolar II patients should be routinely assessed for deficits in cognitive functions to enable early intervention and rehabilitation.

Cognitive Deficits in Euthymic Patients with Bipolar Disorder

Cross-sectional studies have shown impaired cognitive functioning in individuals with bipolar disorder, during both acute mood episodes and periods of remission. In a recent longitudinal study conducted in Spain, researchers examined cognitive impairment and its effect on psychosocial functioning in euthymic patients with bipolar disorder over 6 years of follow-up. Twenty-eight outpatients with …

Cognitive Deficits in Euthymic Patients With Recurrent Depression

Neurocognitive impairments are found in people recovered from major depression compared with never-depressed controls. A total of 20 patients in recovery from recurrent unipolar depression and 20 healthy controls were tested using a neuropsychological battery containing tasks of executive function (Wisconsin Card Sort Test), attention, visuomotor speed, and working memory. The recovered-depressed group performed poorly in comparison to healthy controls on the planning and problem solving aspects of the Wisconsin Card Sort Test, even after controlling for subclinical depressive symptoms. There was no significant difference between the 2 groups on set-shifting aspects of the task and the other tests. These specific deficits, even after controlling for subclinical depressive symptoms, were correlated with the number of previous episodes of depression. These findings support the hypothesis that impairments in executive function are present in recovery from unipolar depression, and so are not simply state markers. Further longitudinal research on samples free of history of depression is needed to determine whether these impairments are intermediate markers for recurrent unipolar depression, rather than "scars" caused by past episodes.

Neuroanatomical and Neuropsychological Features of Euthymic Patients with Bipolar Disorder

Previous studies reported that the severity of cognitive deficits in euthymic patients with bipolar disorder (BD) increases with the duration of illness and postulated that progressive neuronal loss or shrinkage and white matter changes may be at the origin of this phenomenon. To explore this issue, the authors performed a case-control study including detailed neuropsychological and magnetic resonance imaging analyses in 17 euthymic elderly patients with BD and 17 healthy individuals. Neuropsychological evaluation concerned working memory, episodic memory, processing speed, and executive functions. Volumetric estimates of the amygdala, hippocampus, entorhinal cortex, and anterior cingulate cortex were obtained using both voxel-based and region of interest morphometric methods. Periventricular and deep white matter were assessed semiquantitatively. Differences in cognitive performances and structural data between BD and comparison groups were analyzed using paired t-test or analysis of variance. Wilcoxon test was used in the absence of normal distribution. Compared with healthy individuals, patients with BD obtained significantly lower performances in processing speed, working memory, and episodic memory but not in executive functions. Morphometric analyses did not show significant volumetric or white matter differences between the two groups. Our results revealed impairment in verbal memory, working memory, and processing speed in euthymic older adults with BD. These cognitive deficits are comparable both in terms of affected functions and size effects to those previously reported in younger cohorts with BD. Both this observation and the absence of structural brain abnormalities in our cohort do not support a progressively evolving neurotoxic effect in BD.

The duration of inpatient admission predicts cognitive functioning at discharge in patients with bipolar disorder

Previous studies of cognitive functioning in bipolar disorder generally indicate that a more severe course of illness is associated with greater cognitive impairment. In particular, a history of greater number and longer duration of mood episodes predicts enduring cognitive deficits in euthymic patients. Shifting the focus of this investigation to the cognitive effects of a discrete mood episode, the current study aimed to explore whether patients who require a longer hospitalization to stabilize from an acute episode of mood disturbance present with more compromised cognitive functioning during the phase of early recovery. For this purpose, the study examined the link between the duration of inpatient admission and neuropsychological test scores at the time of discharge in 41 patients with bipolar disorder. Participants were assigned to long (n = 20) and short (n = 21) stay groups using a median split (M = 12). Results indicated that longer admissions were associated with more severe deficits in executive functioning at discharge after controlling for residual mood symptoms and previous number of psychiatric admissions. Findings from the current study may inform discharge planning for patients with bipolar disorder after an extended hospital stay.

Bipolar Disorder Clinical Synthesis: Where Does the Evidence Lead?

Bipolar disorder is a common condition diagnosed by the occurrence of pathological mood elevation but most often dominated by dysphoria states. Over the past 10 years, understanding of bipolar disorder and the number of evidence-based treatments have increased dramatically. This article offers strategies for improving diagnostic confidence and simple benchmarks that facilitate integrating principles of evidence-based medicine into the management of patients with bipolar disorder. Simple systematic assessment techniques such as focusing the evaluation to assess the most extreme episode of mood elevation and longitudinal factors such as age of onset and course of illness can avoid errors of omission and raise diagnostic confidence. An iterative measurement-based treatment model that aims to bring patients and their supports into the collaborative care process for progressively better outcomes is recommended.

A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder

BackgroundA number of studies have reported evidence of cognitive deficits in euthymic bipolar patients. Qualitative reviews of the literature have indicated impairments in executive functions and declarative memory are most consistently reported. However, not all primary studies conducted to date have had sufficient power to detect statistically significant differences and there have been few attempts to quantify the magnitude of impairments. This review aims to combine data from available studies to identify the profile of neuropsychological deficits in euthymic bipolar patients and quantify their magnitude. MethodSystematic literature review and meta-analysis. ResultsLarge effect sizes (d≥0.8) were noted for aspects of executive function (category fluency, mental manipulation) and verbal learning. Medium effect sizes (0.5≤d<0.8) were found for aspects of immediate and delayed verbal memory, abstraction and set-shifting, sustained attention, response inhibition, and psychomotor speed. Small effect sizes (0.2≤d<0.5) were reported for verbal fluency by letter, immediate memory, and sustained attention. LimitationsSufficient data were not available to investigate all domains. For example analyses did not include measures of visuospatial function. ConclusionEuthymic bipolar patients demonstrate relatively marked impairment in aspects of executive function and verbal memory. It is not yet clear whether these are two discrete areas of impairment or are related to one another. Future investigations should clarify the functional significance of deficits and indicate whether patients will benefit from ameliorative interventions.

Executive functioning and theory of mind in euthymic bipolar disorder

To examine the nature of executive deficits in euthymic patients with bipolar disorder (BD). Fifteen euthymic BD patients and 13 controls were administered a battery of executive tasks including verbal fluency, Stroop, Theory of Mind (ToM) tests and selected subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Self-report and clinician ratings of mood and social and occupational functioning were also obtained. There were no significant differences between BD patients and controls on the primary measures of the following executive tasks: verbal fluency, attentional set-shifting, problem solving or planning. On secondary measures of speed, BD patients were slower to complete the first trial of the Stroop task (p = 0.001). Patients with BD committed more errors across all secondary measures. Patients performed poorly when compared with controls on tests of verbal ToM (p = 0.02), and although they performed non-verbal ToM tasks at a level comparable to controls (p = 0.60), they were slower to initiate a response (p = 0.006). ToM was not significantly correlated with any measure of social and occupational functioning; however it correlated with the achievement scores of the CANTAB Stockings of Cambridge task (Pearson's r = 0.68, p < 0.01). Deficits found in euthymic bipolar patients suggest fronto-subcortical pathway dysfunction. This is consistent with other neuropsychological and neuroimaging research that points to a trait deficit in BD. Further investigation is necessary perhaps using more real-world tests.

Evidence for theory of mind deficits in euthymic patients with bipolar disorder

i) To investigate the subtle ToM (theory of mind) deficits in euthymic patients with bipolar disorder. ii) To investigate the impact of non-ToM cognitive deficits on ToM abilities. Forty-three euthymic patients with bipolar disorder and 30 healthy control subjects were involved in this study. ToM was assessed by the Eyes test and the Hinting task. Both groups were also evaluated with a comprehensive neuropsychological battery including tasks for basic emotion and face recognition. The patient group was impaired on both of the ToM tasks. The patient group also showed impairment in many cognitive tasks including tasks related to sustained attention. Even euthymic patients with bipolar disorder may be impaired in advanced ToM tasks. Executive dysfunction and some other cognitives deficits such as basic emotion recognition may be at least partly responsible for this result.