Do we really need a “new” cognitive therapy for bipolar disorder? Paradigm refinements and treatment mechanisms for cognitive remediation

Abstract

Although more pronounced during mood episodes, widespread cognitive deficits also persist after symptom remission for a significant proportion of individuals with bipolar disorder (BD). These cognitive difficulties limit recovery and are strongly associated with a wide range of functional goals such as employment and interpersonal relationships. This mounting evidence of the importance of cognitive functions now requires action if we are to improve recovery outcomes for the long-term. Cognitive Remediation (CR), originally developed to treat people with a diagnosis of schizophrenia, has recently emerged as a potential treatment option to promote functional recovery by targeting cognitive difficulties in people with BD. Numerous controlled trials have established the efficacy of CR paradigms for people with schizophrenia and these provide a basisfor CR programs to be tested in other mental health conditions also characterized by cognitive difficulties. | HE TEROG ENEIT Y OF COG NITIVE D IFFICULTIE S IN PEOPLE WITH B DAdopting CR paradigms from schizophrenia appears reasonable for BD research when considering the similarities in the cognitive profiles across schizophrenia and BD. However, there are also differences between these two populations and appropriately adjusting treatment manuals could improve treatment outcomes. For example, whereas most patients with schizophrenia experience severe cognitive impairment across many cognitive domains, there are subgroups of BD patients presenting with discrete cognitive problems while others remain cognitively intact.Profile differences might result from differing developmental trajectories and illness progression among patient subgroups.Unlike in schizophrenia, where cognitive impairment is predominantly associated with neurodevelopmental factors, the longitudinal course of cognitive dysfunction for some people with BD seems to involve neurodevelopmental (eg, early-life premorbid deficits) and for others neuroprogressive (eg, effect of manic episodes) factors. 1 Thus, it is unclear whether we can just provide the same therapy paradigms developed for schizophrenia to people with BD or whether adaptations of CR paradigms are needed to account for the distinct characteristics of different BD subgroups.

Role of cognitive reserve in cognitive variability in euthymic individuals with bipolar disorder: cross-sectional cluster analysis

“…Different patient clusters may require modifications to adhere to and benefit from treatment, for example longer or more intensive therapy periods for those more severely impaired. 50 Our findings also suggest that considering the concept of cognitive reserve might be relevant in the context of designing and delivering cognitive interventions, either as a potential treatment target or as a factor enabling treatment engagement and outcomes. Clinical services for people with bipolar disorder should introduce cognitive assessment into their screening process for new or recurring patients.…”

Inflammatory biomarkers and cognitive functioning in individuals with euthymic bipolar disorder: exploratory study

“…lithium, lurasidone), intervention at present does not specifically target cognitive impairment in those with bipolar disorder, despite some emerging evidence of potential cognitive interventions. [8][9][10] However, our understanding of the physiological mechanisms underlying cognitive impairment and bipolar disorder is lacking, which hinders progress in treatment options.…”

Does cognitive improvement translate into functional changes? Exploring the transfer mechanisms of cognitive remediation therapy for euthymic people with bipolar disorder

“…This is in line with the recommendations of International Society of Bipolar Disorders (ISBD) for cognitive intervention trials suggesting the use of long-term follow-up assessments to examine the translation of cognitive benefits into functional improvements (Miskowiak et al, 2017). Providing models of how this transfer occurs is important for establishing the clinical significance of CR for people with BD (Tsapekos, Strawbridge, Cella, Wykes, & Young, 2020b).…”