Features of the cognitive sphere in patients with a mixed episode of bipolar affective disorder
Background. Data of various meta-analyzes confirm that the majority of patients with bipolar affective disorder (BAD) have neurocognitive dysfunction, even during remission. According to the latest research, disturbed domains with moderate to pronounced changes are attention, verbal learning and memory, as well as executive functions, whereas premorbid intelligence may remain unchanged. The main body of research is devoted to the study of cognitive impairment in the first episode of BAD, in manic, depressive episodes and euthymia. At the same time, the features of cognitive dysfunction in mixed forms of biologically active substances remain insufficiently studied.
Objective – to study the characteristics of the cognitive sphere in patients with a mixed episode of BAD.
Materials and methods. With the help of battery tests (a test to memorize ten unrelated words; Rey-Osterreith Complex Figure Test; Verbal Fluency Test Digit Symbol Substitution Test; Trail making test), the cognitive functions of 25 patients with mixed episodes, 16 patients with manic episodes, and 15 patients with depressive episode of BAD.
Results. Cognitive impairments were identified in all patients, regardless of the type of affective symptoms, in the form of a wide range of psychopathological phenomena, which are more pronounced in patients with a mixed episode BAD. The peculiarities of the phenomenological structure of cognitive impairment in patients with mixed phase BAD manifest themselves in the form of: a more pronounced deterioration of verbal memory, speed of information processing; more pronounced violations of spatial representations, impairment of visual memory, verbal associative performance and executive functions; reduction of attention and violations of its distribution.
Conclusions. The findings suggest that the presence of depressive symptoms in the structure of mixed affect plays a dominant role in the formation of these disorders.
2. Bora, E., Yucel, M., & Pantelis, C. (2008). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders, 113(1-2), 1-20. https://doi.org/10.1016/j.jad.2008.06.009
3. Bora, E., & Pantelis, C. (2015). Meta-analysis of cognitive impairment in first-episode bipolar disorder: comparison with first-episode schizophrenia and healthy controls. Schizophrenia Bulletin, 41(5), 1095–1104. https://doi.org/10.1093/schbul/sbu198
4. Bora, E. (2016). Differences in cognitive impairment between schizophrenia and bipolar disorder: Considering the role of heterogeneity. Psychiatry and Clinical Neurosciences, 70(10), 424–433. https://doi.org/10.1111/pcn.12410
5. Bortolato, B., Miskowiak, K. W., Kohler, C. A., Vieta, E., & Carvalho, A. F. (2015). Cognitive dysfunction in bipolar disorder and schizophrenia: a systematic review of meta-analyses. Neuropsychiatric Disease and Treatment, 11, 3111–3125. https://doi.org/10.2147/NDT.S76700
6. Catala-Lopez, F., Genova-Maleras, R., Vieta, E., & Tabares-Seisdedos, R. (2013). The increasing burden of mental and neurological disorders. European Neuropsycho pharmacology, 23(11), 1337–1339. https://doi.org/10.1016/j.euroneuro.2013.04.001
7. Robinson, L. J., Thompson, J. M., Gallagher, P., Goswami, U., Young, A. H., Ferrier, I. N., & Moore, P. B. (2006). A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. Journal of Affective Disorders, 93(1-3), 105–115. https://doi.org/10.1016/j.jad.2006.02.016
8. Samame, C., Martino, D. J., & Strejilevich, S. A. (2014). Longitudinal course of cognitive deficits in bipolar disorder: a meta-analytic study. Journal of Affective Disorders, 164, 130–138. https://doi.org/10.1016/j.jad.2014.04.028
9. De la Serna, E., Vila, M., Sanchez-Gistau, V., Moreno, D., Romero, S., Sugranyes, G., … Castro-Fornieles, J. (2016). Neuropsychological characteristics of child and adolescent offspring of patients with bipolar disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 65, 54–59. https://doi.org/10.1016/j.pnpbp.2015.08.014
10. Sole, B., Jimenez, E., Torrent, C., Del Mar Bonnin, C., Torres, I., Reinares, M., … Martinez-Aran, A. (2016). Cognitive variability in bipolar II disorder: who is cognitively impaired and who is preserved. Bipolar disorder, 18(3), 288–299. https://doi.org/10.1111/bdi.12385