The characteristics of a discrete mood episode, neuro-cognitive impairment and re-hospitalization in bipolar disorder

Abstract

This longitudinal study examined characteristics of a discrete mood episode that predict re-hospitalization for bipolar disorder, highlighting associated cognitive dysfunction as a potential mechanism linking episode severity and relapse. Eighty-two inpatients meeting DSM-IV-TR diagnostic criteria for bipolar I disorder completed the study. Twenty-two of the patients were readmitted to the hospital within 3 months of discharge. The study compared these patients to the remaining 60 patients who were not readmitted to the hospital during this period. Patients were compared on several factors related to the severity of the mood episode and the course of illness more generally. Analysis also compared the groups on measures of mood and neuro-cognitive functioning, assessed 24–48 hours before initial hospitalization discharge. Re-hospitalized patients had longer initial hospital stays (t = −3.10, p<0.01), higher rates of psychosis while in the hospital (Chi square=5.1, p<0.02), and lower GAF scores on discharge (t = 2.37, p<0.05). The groups did not differ in age of illness onset or number of previous psychiatric hospitalizations. With respect to neuro-cognitive functioning, analysis indicated poorer performance for re-hospitalized patients on measures of executive functioning (Wilks’ Lambda, F (7, 71) = 9.0, p<0.001), IQ (Wilks’ Lambda, F (2, 76) = 5.06, p<0.01), and memory (Wilks’ Lambda, F (6,72) = 4.19, p<0.001). Trends in the expected direction emerged for attention/working memory tests (Wilks’ Lambda, F (7, 71) = 1.79, p<0.10). Results highlight features of a discrete mood episode associated with increased rates of re-hospitalization. This study observed connections among episode severity, cognitive dysfunction at hospital discharge and re-hospitalization.

Disentangling Working Memory Functioning in Mood States of Bipolar Disorder: A Systematic Review

“…Only three studies used other experimental designs, such as cohort study (Levy et al, 2011), descriptive study (Miguélez-Pan et al, 2014), and prospective study (Deckersbach et al, 2008) (Table 1). …”

Cognitive and psychosocial functioning in bipolar disorder with and without psychosis during early remission from an acute mood episode: A comparative longitudinal study

“…In a different sample, all three variables, measured at hospital discharge, predicted re-hospitalization at a 3-month follow-up 24 . These studies controlled for clinical factors related to illness severity, and thus provide some support to the hypothesis that acute psychosis in the context of mood disturbance negatively affects the immediate post-hospital recovery of patients with BD.…”

“…To further explore this hypothesis, the current investigation aimed to extend our previous study, which linked psychosis and cognitive impairment at discharge to re-hospitalization 24 . Whereas the previous study employed a single assessment to predict relapse, the current study examined, in a longitudinal design that included two points of assessment, how psychosis was related to cognitive and psychosocial functioning in those patients who were not re-hospitalized.…”

Decreased global methylation in patients with bipolar disorder who respond to lithium

“…Bipolar Disorder (BD) has a lifetime prevalence of about 2% in the population (Levy et al, 2011;Merikangas et al, 2011). The aetiology and pathophysiology of BD is far from completely known, despite extensive effort.…”