Cognitive deficits in bipolar disorders: Implications for emotion

Abstract

Prominent cognitive deficits have been documented in bipolar disorder, and multiple studies suggest that these deficits can be observed among non-affected first-degree relatives of those with bipolar disorder. Although there is variability in the degree of cognitive deficits, these deficits are robustly relevant for functional outcomes. A separate literature documents clear difficulties in emotionality, emotion regulation, and emotion-relevant impulsivity within bipolar disorder, and demonstrates that these emotion-relevant variables are also central to outcome. Although cognitive and emotion domains are typically studied independently, basic research and emergent findings in bipolar disorder suggest that there are important ties between cognitive deficits and the emotion disturbances observed in bipolar disorder. Understanding these relationships has relevance for fostering more integrative research, for clarifying relevant aspects related to functionality and vulnerability within bipolar disorder, and for the development of novel treatment interventions. Bipolar disorder (BD) is a severe psychiatric illness that has been ranked as one of the 20 leading medical causes of disability (WHO, 2011). BD has been shown to be the psychiatric disorder with the highest rates of completed suicide across two major cohort studies (Ilgen et al., 2010; Nordentoft, Mortensen, & Pedersen, 2011). In a cross-national representative sample, one in four persons diagnosed with bipolar I disorder reported a suicide attempt (Merikangas et al., 2011). Rates of relapse remain high despite available treatments (Gitlin, Swendsen, Heller, & Hammen, 1995), and in the year after hospitalization for manic episode, two-thirds of patients do not return to work (Strakowski et al., 1998). Poverty, homelessness, and incarceration are all too common (Copeland et al., 2009). Despite the often poor outcomes, there is also evidence for outstanding accomplishments and creativity among those with milder forms of the disorder and their family members (Coryell et al., 1989; Jamison, 1993; Murray & Johnson, 2010). Some individuals appear to achieve more than the general population, suggesting the importance of understanding the variables that predict differential outcome within bipolar disorder. Within this paper, we focus on two key predictors of outcomes within bipolar disorder: cognition and emotionality. We review evidence that problems in cognition and emotionality are prominent among those diagnosed with the disorder, are not artifacts of symptom state, and relate substantively to poorer outcomes. Although traditionally studied separately, new work points toward the idea that cognition and emotionality are intricately linked within bipolar disorder. Drawing from research within bipolar disorder as well as outside of bipolar disorder, we build a model of how cognition and emotionality might be tied within bipolar disorder. We then provide suggestions for future research. Before considering findings, it is worth noting that there are several forms of th...

Neurophysiological effects of multiple mood episodes in bipolar disorder

“…41,42 While the latter is particularly associated with successful emotional regulation, social skills may independently impact clinical outcome, suggesting that the neurological effect of disease burden in bipolar disorder may impair long-term functionality through multiple mechanisms. 43,44 In contrast to our initial hypothesis, the relatively lower prefrontal activation observed in multi-episode bipolar subjects was not associated with greater amygdala activation. Instead, we found lower amygdala activity in multi-episode subjects.…”

“…35 These findings are consistent with previous observations of functional differences across posterior parietal regions of bipolar patients; and with observations of executive dysfunction and functional decline associated with bipolar progression. While the latter is particularly associated with successful emotional regulation, social skills may independently impact clinical outcome, suggesting that the neurological effect of disease burden in bipolar disorder may impair long-term functionality through multiple mechanisms 43,44. Activity in Brodmann area 22 may have been mobilized by the social cognition aspects of viewing negative anthropinistic pictures, and decrements in activation of this region are consistent with observations of impaired social cognition and verbal fluency in many individuals with bipolar disorder 41,42.…”

Distinct and shared contributions of diagnosis and symptom domains to cognitive performance in a case-control study of severe mental illness in the Paisa population

“…The bifurcation of cognitive profiles was the most striking finding with respect to diagnoses: compared to healthy controls, SCZ and BP-I showed pronounced deficits across executive function, social cognition and motor speed tests relative to memory and complex cognition, while BP-II and MDD displayed mild cognitive impairment, across domains, with intact nonverbal reasoning. This result aligns with a growing body of evidence indicating heterogeneity of neurocognitive function within BPD (27), and provides a possible explanation for a similarly bifurcated pattern of genetic correlations between the SMI diagnoses revealed in recent large-scale GWAS datasets (28). The large trans-diagnostic sample also enabled us to identify a significant interaction between test domain, diagnosis and sex, as females with SCZ, BP-I, and MDD were slower than males in measures of executive speed.…”

Prospective memory, working memory, planning, and attention in schizophrenia and bipolar disorder: A comparative study

“…Zhou et al () conducted a study on PM deficits in euthymic bipolar disorder patients and found that patients performed poorly on both TB and EB PM. The current findings, therefore, can be attributed to the fact that cognitive impairments are common in bipolar disorder (Lima, Peckham, & Johnson, ; Martínez‐Arán et al, ; Robinson et al, ).…”

“…Absolute mood stability is unusual in bipolar disorder, and subclinical depressive symptoms are commonly seen in such populations (Goodwin, Martinez‐Aran, Glahn, & Vieta, ), which were also found in the participants of this study during the clinical interview. Research states that there is the potential for an effect of prevailing affective state to reduce cognitive functions (Patterson et al, ; Lima et al, ) and so it can be assumed that such symptomatology of the participants has resulted in a deficit in prospective remembering in the study. Moreover, most of the participants of the present study had a chronic course, which can also be an attributing factor to worsened cognitive functioning.…”