Associations between residual depressive symptoms, cognition, and functioning in patients with euthymic bipolar disorder: results from the FACE-BD cohort

Roux, Paul; Raust, Aurélie; Cannavo, Anne-Sophie; Aubin, V.; Aouizerate, Bruno; Azorin, Jean‐Michel; Bellivier, Frank; Belzeaux, Raoul; Bougerol, Thierry; Cussac, I.; Courtet, Philippe; Étain, Bruno; Gard, Sébastien; Job, Sophie; Kahn, Jean‐Pierre; Leboyer, Marion; Olié, Émilie; Henry, Chantal; Passerieux, Christine

doi:10.1192/bjp.bp.117.201335

Cited by 32 publications

(25 citation statements)

References 36 publications

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“…Three studies 34,37,38 included samples composed only of BD‐I patients; the other 10 studies reported data on mixed BD samples (composed of type I, type II and/or not otherwise specified). The sample size mostly varied between 12 and 150 individuals, with only one study having a large sample of 241 individuals, 39 thus differing from the others.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 13 papers included in this review, 12 had or provided enough information to qualify for inclusion in the meta‐analysis stage. In the first step (mean difference), three studies were excluded, 35,39,40 as they lacked data from the control group. In the second step (proportion estimation), 1 study 41 was excluded, as it lacked the proportion of the sample falling below the cut‐off point defined for impairment.…”

Section: Resultsmentioning

confidence: 99%

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Functioning in euthymic patients with bipolar disorder: A systematic review and meta‐analysis using the Functioning Assessment Short Test

2020

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Objectives Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. Methods Meta‐analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand‐searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two‐step meta‐analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed‐effects model for categorical variables. Results In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI. Conclusions This study reinforces the relevant functional impact of BD in this population and suggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Functioning in euthymic patients with bipolar disorder: A systematic review and meta‐analysis using the Functioning Assessment Short Test

2020

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“…Treating cognitive impairment in people with BD may benefit psychosocial difficulties and improve occupational outcomes . This review evaluated the evidence on cognitive enhancement interventions for people with BD focusing on the different treatment paradigms available and the methodological quality of the included studies.…”

Section: Discussionmentioning

confidence: 99%

“…The association between cognition and function has been extensively explored, with most evidence suggesting significant contributions of cognitive impairment to reduced functional capacities . Cognitive measures have been found to predict psychosocial functioning independently to residual depressive symptoms . Importantly, recent evidence from a large meta‐analysis showed that cognitive performance, particularly verbal memory and executive function, is one of the strongest predictors of favorable employment outcomes .…”

Section: Introductionmentioning

confidence: 99%

Cognitive enhancement interventions for people with bipolar disorder: A systematic review of methodological quality, treatment approaches, and outcomes

et al. 2019

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Background:Patients with bipolar disorder (BD) suffer from cognitive deficits across several domains. The association between cognitive performance and psychosocial functioning has led to the emergence of cognition as a treatment target.Objective: This study reviews the existing literature on cognitive enhancement interventions for people with BD, focusing on different treatment approaches and methodological quality. Methods:We conducted a systematic search following the PRISMA guidelines. Sample characteristics and main outcomes for each study and treatment characteristics for each approach were extracted. Study quality was assessed using the Clinical Trials Assessment Measure (CTAM) and Cochrane Collaboration's Risk of Bias tool by independent raters.Results: Eleven articles reporting data from seven original studies were identified encompassing 471 participants. Two treatment approaches were identified, cognitive and functional remediation. For controlled studies, methodological quality was modest (average CTAM score = 60.3), while the overall risk of bias was considered moderate. Beneficial effects on cognitive or functional outcomes were reported in the majority of studies (91%), but these findings were isolated and not replicated across studies. Key methodological limitations included small sample sizes, poor description of randomization process, high attrition rates, and participant exclusion from the analysis. Conclusions:Findings are promising but preliminary. Quality studies were few and mostly underpowered. Heterogeneity in sample characteristics, outcome measures, and treatment approaches further limit the ability to generalize findings. Adequately powered trials are required to replicate initial findings, while moderators of treatment response and mechanisms of transfer need to be explored. K E Y W O R D S bipolar disorder, cognition, cognitive remediation, functional remediation, functioning, methodological quality | 217 TSAPEKOS ET Al

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“…This overlap and its potential impact on underlying neurobiological mechanism should be taken into account when investigating NS and depression in a transdiagnostic way. Furthermore, it is well known that BD-I patients in the euthymic state as determined by diagnostic criteria and structured interviews, display a broad range of neuropsychological and psychopathological impairments, including sub-syndromal depressive symptoms (Bourne et al , 2013, Roux et al , 2017). These residual depressive symptoms – in contrast to residual hypomanic symptoms – are an important predictor of functional outcome and quality of life (Bonnin et al , 2010, Dias et al , 2008).…”

Section: Discussionmentioning

confidence: 99%

Shared and dissociable features of apathy and reward system dysfunction in bipolar I disorder and schizophrenia

Kirschner

Cathomas

Manoliu

et al. 2019

Preprint

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BackgroundBipolar disorder I (BD-I) is defined by episodes of mania, depression, and euthymic states. These episodes are among other symptoms characterized by altered reward processing and negative symptoms (NS), in particular apathy. However, the neural correlates of these deficits are not well understood.MethodsWe first assessed the severity of negative symptoms in 25 euthymic BD-I patients compared to 25 healthy controls (HC) and 27 patients with schizophrenia (SZ). Then, we investigated ventral and dorsal striatal activation during reward anticipation in a Monetary Incentive Delayed Task and its association with NS.ResultsIn BD-I patients NS were clearly present and the severity of apathy was comparable to SZ patients. Apathy scores in the BD-I group but not in the SZ group correlated with sub-syndromal depression scores. At the neural level, we found significant ventral and dorsal striatal activation in BD-I patients and no group differences with HC or SZ patients. In contrast to patients with SZ, apathy did not correlate with striatal activation during reward anticipation. Explorative whole brain analyses revealed reduced extra-striatal activation in BD-I patients compared to HC and an association between reduced activation of the inferior frontal gyrus and apathy.ConclusionThis study found that in BD-I patients apathy is present to an extent comparable to schizophrenia, but is more strongly related to sub-syndromal depressive symptoms. The findings support the view of different pathophysiological mechanisms underlying apathy in the two disorders and suggest that extra-striatal dysfunction may contribute to impaired reward processing and apathy in BD-I.

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Associations between residual depressive symptoms, cognition, and functioning in patients with euthymic bipolar disorder: results from the FACE-BD cohort

Cited by 32 publications

References 36 publications

Functioning in euthymic patients with bipolar disorder: A systematic review and meta‐analysis using the Functioning Assessment Short Test

Functioning in euthymic patients with bipolar disorder: A systematic review and meta‐analysis using the Functioning Assessment Short Test

Cognitive enhancement interventions for people with bipolar disorder: A systematic review of methodological quality, treatment approaches, and outcomes

Shared and dissociable features of apathy and reward system dysfunction in bipolar I disorder and schizophrenia

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