Subthreshold symptoms in bipolar disorder: Impact on neurocognition, quality of life and disability

Bonnín, Caterina del Mar; Sánchez-Moreno, José; Martínez‐Arán, Anabel; Solé, Brisa; Reinares, María; Rosa, Adriane Ribeiro; Goikolea, J. M.; Benabarre, Antonio; Ayuso-Mateos, José Luís; Ferrer, Montse; Vieta, Eduard; Torrent, Carla

doi:10.1016/j.jad.2011.10.012

Cited by 164 publications

(93 citation statements)

References 73 publications

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“…The results of this study confirm previous findings that showed a role of depressive symptoms and cognitive impairment in global functioning in BD patients, and highlight the fact that depressive symptoms also affect cognitive performance. 21 Our results are also partially consistent with a study by Bonnin et al, 34 which showed that patients exhibiting low levels of subthreshold symptomatology (Hamilton Depression Rating Scale [HDRS] p 3 and Young Mania Rating Scale [YMRS] p 2), defined as asymptomatic, and those with higher levels of subthreshold symptomatology (HDRS X 4 and YMRS X 3), defined as subsyndromic, both scored low on cognitive measures when compared to healthy controls. The subsyndromic group also had poorer functional outcomes than the asymptomatic group and healthy controls.…”

Section: Discussionsupporting

confidence: 91%

Cognition and functioning in bipolar depression

Kapczinski

Narvaez

Magalhães

et al. 2016

Rev. Bras. Psiquiatr.

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Objectives: Depressive symptoms are associated with worse outcomes in patients with bipolar disorder (BD). However, scarce data are available regarding neurocognitive profiles across different areas of functioning among BD patients with moderate and severe depression. Our objective was to assess cognition and global functioning in a group of patients with bipolar depression. Methods: Data were available for 100 patients with bipolar depression (78% female) and 70 controls (64% female) paired by age and education level. Cognitive function was assessed with a neuropsychological test battery. Functioning was assessed with the Functioning Assessment Short Test. Results: In patients, severe depression was associated with poorer cognitive performance on measures of executive function. Patients with severe depression showed worse global functioning than those with moderate depression (z = 2.54, p = 0.011). In patients with severe depression, lower global functioning was associated with lower scores in working memory (r = -0.200, p = 0.010), and executive function (r = -0.210, p = 0.007; and r = 0.293, p o 0.001). Conclusion: Our findings suggest cognitive impairment and global functioning impairment are associated with the severity of depressive symptoms in bipolar depression. Intensive treatment of depressive symptoms in patients with BD is crucial to improve cognitive functioning and, consequently, functional outcomes.

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Section: Discussionsupporting

confidence: 91%

Cognition and functioning in bipolar depression

Kapczinski

Narvaez

Magalhães

et al. 2016

Rev. Bras. Psiquiatr.

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“…Patients are unable to maintain proper work role function approximately 30% or more of the time 14. Quality of life is reduced in both symptomatic and non‐symptomatic patients when compared to healthy controls,15, 16, 17 and several domains of functioning have been identified by patients as being of particular importance‐ including physical, sleep, mood, cognition, leisure, social, spirituality, finances, household, self‐esteem, independence, identity, work, and education 18. For both psychosocial functioning and quality of life, impairments are more pronounced in patients with depressive symptoms,19, 20, 21 in those with more previous episodes/longer duration of illness,20, 22 and in those with lower cognition 23…”

Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Cognitive impairment may be considered a measure of allostatic load (36) and may correlate with some neuroinflammatory and oxidative stress markers (37,38). Neurocognitive impairment may reflect a poor course and outcome of the disease, especially concerning the number of manic episodes (39,40), a history of psychosis (41), subthreshold symptoms (42), and comorbidity (43). Although all studies control for the effects of medication, there are very few studies with medication-free patients (44), and the influence of drugs on cognitive performance may be bimodal, with both positive and negative effects (45,46).…”

Section: Cognition and Functioningmentioning

confidence: 99%

The bipolar maze: a roadmap through translational psychopathology

Vieta

2014

Acta Psychiatr Scand

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Subthreshold symptoms in bipolar disorder: Impact on neurocognition, quality of life and disability

Cited by 164 publications

References 73 publications

Cognition and functioning in bipolar depression

Cognition and functioning in bipolar depression

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

The bipolar maze: a roadmap through translational psychopathology

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