Functioning In Euthymic Patients Research Articles

The effect of premorbid intelligence on neurocognitive and psychosocial functioning in bipolar disorder

BackgroundThe aim of this study was to assess if premorbid IQ moderates the association between measures of clinical severity and neurocognitive or psychosocial functioning in euthymic patients with bipolar disorder. MethodsOne hundred and nineteen outpatients and forty healthy controls were included. The length of illness, number of previous hypo/manic and depressive episodes, episode density, and history of psychosis assessed clinical severity. Performances in verbal memory, attention, and executive functions, as well as level of psychosocial functioning were used as outcomes. ResultsThe negative relationship between number of hypo/manic episodes and performance in executive functions decreased as a function of higher values of premorbid IQ. No other influences of premorbid IQ were found in the association between clinical severity measures and neurocognitive and psychosocial functioning. ConclusionsPremorbid IQ might moderate the relationship between the number of hypo/manic episodes and executive functioning in bipolar disorder. Possible interpretations of this finding are discussed.

Psychosocial functioning impairment in euthymic patients with bipolar disorder II: The role of clinical factors

IntroductionGrowing body of evidence have showed that euthymic bipolar patients have poor psychosocial functioning. Most of the studies have focused on the psychosocial functioning in euthymic bipolar disorder (BD)-I patients. On the contrary, there have been limited researches investigating psychosocial functioning in euthymic BD-II patients. Moreover, the factors associated with psychosocial functioning in euthymic patients with BD II have been also understudied.Objectives/aimsAim of our study was to investigate the association between clinical variables and poor psychosocial functioning in euthymic BD-II patients. Hypothesis of this study was that euthymic BD-II patients would have low level of psychosocial functioning compared with healthy individuals.MethodsBD-II (n = 37) and healthy subjects (n = 35) were compared in terms of their psychosocial functioning which were assessed by Functional Assessment Short Test (FAST). The euthymic state was confirmed by low scores both on the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). Anxiety symptoms were also assessed by Hamilton Anxiety Rating Scale (HARS) in both groups. Clinical variables were taken as independent variables and FAST scores were taken as dependent variable in order to run correlation analysis in BD-II group.ResultsNo socio-demographic differences were found between two groups. Euthymic BD-II patients had significantly higher FAST, HARS, HDRS YMRS scores compared with healthy individuals. Only HDRS scores correlated with FAST scores of BD-II patients.ConclusionsThis study indicated that euthymic BD-II patients had poorer psychosocial functioning. And subclinical depressive symptoms were associated with poor psychosocial functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neurocognitive impairments in euthymic patients with bipolar disorder type II

IntroductionMost of the studies have indicated that there have been neurocognitive impairments especially in the domains of executive functions, attention, verbal and working memory among euthymic patients with bipolar disorder type I (BD-I). However, there has been limited research investigating neurocognitive functioning in euthymic patients with BD- II.Objectives/aimsAim of this study was to investigate neurocognitive functions in euthymic BD-II patients. Our hypothesis was that euthymic BD-II patients would have neurocognitive impairments in the domains of executive functions, attention, verbal and working memory.MethodsEuthymic BD-II patients (n = 37) and healthy controls (HC) (n = 35) were compared in terms of their neurocognitive functioning in the domains of executive functions assesed by the number of perseverative errors, non-perseverative errors and category completed on the Wisconsin Cart Sorting Test (WCST); working memory assessed by Auditory Consonant Trigrams (ACT); immediate verbal memory assessed by the Logical Memory subscale of the Wechsler Memory Scale I (WMS I) and attention assesed by Stroop Colour-Word Interference Test (SCWIT). Euthymic state was confirmed by the low scores both on Hamilton Depression Rating Scale, Young Mania Rating Scale.ResultsSignificant differences were found between two groups in terms of WCST non-perseverative errors (Z = 3.8, P < 0.01) and category completed subtests (Z = 3.8, P < 0.01), ACT (t = 2.97, P < 0.01) WMSI (Z = 2.4, P = 0.01), SCWIT (t = 3.52, P < 0.01) performances.ConclusionsOur study indicated that euthymic BD-II patients had poorer performance on the domains of executive functions, attention, working memory and verbal memory than the HC group. But future studies with large samples are needed to support our results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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.

Neuropsychological performance in euthymic Indian patients with bipolar disorder type I: Correlation between quality of life and global functioning

This study aims to assess the neuropsychological performance, quality of life (QoL) and global functioning in euthymic patients and healthy controls. It also explores the hypothesis that poorer cognitive performance will adversely influence the QoL of patients with bipolar disorder. We carried out a cross-sectional assessment of 30 euthymic patients with bipolar disorder type I and compared them to a healthy control group. All the participants were evaluated for IQ, sustained attention, information processing speed, executive functions and memory using the Verbal Adult Intelligence Scale, the Trail Making Test A & B, the Stroop Color and Word Test, the N-Back test and Postgraduate Institute Memory Scale. Patients were also rated on World Health Organization QoL (BREF, Hindi version) and Global Assessment of Functioning. The patient and control group were comparable in age, sex distribution, education, and verbal IQ. Compared to controls, the patients performed poorly on tests for sustained attention, information processing speed, cognitive flexibility, delayed recall and verbal retention. Patients had significantly lower scores in psychological and social domains of QoL as well as global functioning. The test for sustained attention, executive functions and verbal retention showed a significant correlation to QoL domains. On stepwise multiple regression, cognitive flexibility and set shifting (Trail Making Test Part B) could significantly predict the psychological and social QoL domains, explaining 17% and 32% of the variance, respectively. Patients with bipolar disorder display cognitive impairments in the euthymic period, which appears to adversely affect their QoL and overall functioning.

A randomized, double‐blind, controlled trial evaluating the effect of intranasal insulin on neurocognitive function in euthymic patients with bipolar disorder

Neurocognitive deficits are prevalent, persistent, and implicated as mediators of functional impairment in adults with bipolar disorder. Notwithstanding progress in the development of pharmacological treatments for various phases of bipolar disorder, no available treatment has been proven to be reliably efficacious in treating neurocognitive deficits. Emerging evidence indicates that insulin dysregulation may be pertinent to neurocognitive function. In keeping with this view, we tested the hypothesis that intranasal insulin administration would improve measures of neurocognitive performance in euthymic adults with bipolar disorder. Sixty-two adults with bipolar I/II disorder (based on the Mini International Neuropsychiatric Interview 5.0) were randomized to adjunctive intranasal insulin 40 IU q.i.d. (n = 34) or placebo (n = 28) for eight weeks. All subjects were prospectively verified to be euthymic on the basis of a total score of ≤ 3 on the seven-item Hamilton Depression Rating Scale (HAMD-7) and ≤ 7 on the 11-item Young Mania Rating Scale (YMRS) for a minimum of 28 consecutive days. Neurocognitive function and outcome was assessed with a neurocognitive battery. There were no significant between-group differences in mean age of the subjects {i.e., mean age 40 [standard deviation (SD) = 10.15] years in the insulin and 39 [SD = 10.41] in the placebo groups, respectively}. In the insulin group, n = 27 (79.4%) had bipolar I disorder, while n = 7 (21.6%) had bipolar II disorder. In the placebo group, n = 25 (89.3%) had bipolar I disorder, while n = 3 (10.7%) had bipolar II disorder. All subjects received concomitant medications; medications remained stable during study enrollment. A significant improvement versus placebo was noted with intranasal insulin therapy on executive function (i.e., Trail Making Test-Part B). Time effects were significant for most California Verbal Learning Test indices and the Process Dissociation Task-Habit Estimate, suggesting an improved performance from baseline to endpoint with no between-group differences. Intranasal insulin was well tolerated; no subject exhibited hypoglycemia or other safety concerns. Adjunctive intranasal insulin administration significantly improved a single measure of executive function in bipolar disorder. We were unable to detect between-group differences on other neurocognitive measures, with improvement noted in both groups. Subject phenotyping on the basis of pre-existing neurocognitive deficits and/or genotype [e.g., apolipoprotein E (ApoE)] may possibly identify a more responsive subgroup.

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 …

Impaired functioning in euthymic patients with bipolar disorder — HSV-1 as a predictor

There is a possible association between infectious agents and psychiatric disorders. Previous studies in the US provided evidence for cognitive impairment correlated with Herpes simplex virus type 1 (HSV-1) infection. For a replication study in Europe we chosed individuals diagnosed with bipolar disorder to analyse the correlation with HSV-1 infection. Antibody prevalence was analyzed by using solid phase immunoassay techniques. Cognitive functioning was tested with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Form A, the Trail Making Test A&B, and two subtests from the WAIS III: the Letter Number Sequencing Task and the subtest on information. History and psychopathology was assessed using structured interviews and validated rating scales (SCID, HRSD-21, YMRS, PANSS). Additionally, we investigated social functioning and quality of life using self-assessment-scales (SAS, LQLP). Prevalence rates of antibodies against diverse infectious agents did not differ significantly between patients and controls. We found a significant correlation between cognitive impairment in patients with bipolar disorder and the prevalence of antibodies directed against HSV-1. Cognitive functions were significantly impaired including language, attention, and immediate memory. The results of this study confirm previous findings suggesting that HSV-1 affects cognitive functions in patients with bipolar disorder. This may also result in more impaired functioning, less quality of life and difficulties in social adjustment.

Insight, quality of life and cognitive functioning in euthymic patients with bipolar disorder

Introduction The relationship between insight, quality of life and cognition in bipolar disorder has not been clearly established. Method A neuropsychological battery assessing attention, mental control, perceptual-motor skills, executive functions, verbal fluency, abstraction and visuo-spatial attention was administered to 70 remitted bipolar patients and 50 healthy controls. Insight was assessed using the Scale to Assess Unawareness of Mental Disorder; Quality of Life was assessed using the Portuguese version of the WHO Quality of Life Assessment – Abbreviated version (WHOQOL–BREF–PT). Results No differences in QoL and cognitive performance were observed between bipolar patients with ‘impaired’ and ‘preserved’ insight. Insight was found to be correlated with poorer psychological and environmental QoL. A multiple regression model showed that depressive symptoms were significant predictors of physical, psychological and environmental QoL. Conclusion The present study adds to the notion that depressive symptoms, even of low intensity, are strong predictors of QoL. The present study suggests that the impact of insight on self-reported QoL may be subtle during remission and may be more substantially affected in the presence of manic symptoms.

Cognitive functions in euthymic patients with bipolar disorder.

BACKGROUNDRecent studies have focused on the nature of cognitive dysfunction in bipolar patients. The purpose of the current study was to investigate cognitive performance of individuals with bipolar disorder compared to healthy control subjects during a well-established euthymic period.METHODSThe sample consisted of 27 bipolar euthymic patients and 21 control subjects. Verbal and visual memory performance, attention, executive functions and psychosocial functions were evaluated for each participant.RESULTSBipolar patients showed significant attentional deficit and executive dysfunction and also poor performance on verbal and visual memory tasks compared to the controls. Illness duration and lifetime total episode number and previous episode with psychotic features was associated with worsened performance on attention, executive and memory tasks. Psychosocial functioning was not associated with cognitive deficit.CONCLUSIONSThe present study showed persistent cognitive impairment on inhibitory control and selective attention as well as poor performance on verbal and visual memory tests in a group of bipolar euthymic patients. The impaired neuropsychological performance was associated with duration of illness, total number of episodes per lifetime, and previous episodes with psychotic features. Attentional dysfunction seemed to be a trait abnormality for the sample studied.

Cognitive functions in euthymic patients with bipolar disorder

Cognitive functions in euthymic patients with bipolar disorder

Sleep-Related Functioning in Euthymic Patients With Bipolar Disorder, Patients With Insomnia, and Subjects Without Sleep Problems

The authors investigated sleep-related functioning in euthymic patients with bipolar disorder. Euthymic patients with bipolar disorder (N=20), patients with insomnia (N=20), and subjects with good sleep (N=20) were compared on data from interviews and questionnaires and on findings from eight consecutive days and nights of sleep diary keeping (subjective sleep estimate) and actigraphy (objective sleep estimate). Seventy percent of the euthymic patients with bipolar disorder exhibited a clinically significant sleep disturbance. Compared with the other groups, the bipolar disorder group exhibited impaired sleep efficiency, higher levels of anxiety and fear about poor sleep, lower daytime activity levels, and a tendency to misperceive sleep. The bipolar disorder group held a level of dysfunctional beliefs about sleep that was comparable to that in the insomnia group and significantly higher than that in the good sleeper group. Insomnia is a significant problem among euthymic patients with bipolar disorder. Components of cognitive behavior therapy for insomnia, especially stimulus control and cognitive therapy, may be a helpful adjunct to treatment for patients with bipolar disorder.

Case-control study of neurocognitive function in euthymic patients with bipolar disorder: an association with mania.

Neurocognitive impairments in euthymic patients with bipolar disorder may represent trait rather than state variables. To test the hypothesis that euthymic patients with bipolar disorder would exhibit impairment in verbal learning and memory and executive function compared with healthy controls matched for age, gender and premorbid IQ. Twenty euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty healthy community controls. Cases and controls were tested with a battery of neuropsychological tests. Impairments were found in cases compared with controls in tests of verbal learning and memory. Verbal learning and memory correlated negatively with the number of manic episodes. Impaired verbal learning and memory may be a trait variable in bipolar disease. There are implications for adherence to medication and relapse and for the role of early treatment interventions. Prospective designs and targeting first-episode groups may help to differentiate trait v. disease process effects.