Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of General Psychiatry
Published in: Annals of General Psychiatry 1/2010

Open Access 01-12-2010 | Primary research

Poorer sustained attention in bipolar I than bipolar II disorder

Authors: Chian-Huei Kung, Sheng-Yu Lee, Yun-Hsuan Chang, Jo Yung-Wei Wu, Shiou-Lan Chen, Shih-Heng Chen, Chun-Hsien Chu, I-Hui Lee, Tzung-Lieh Yeh, Yen-Kuang Yang, Ru-Band Lu

Published in: Annals of General Psychiatry | Issue 1/2010

Login to get access

Abstract

Background

Nearly all information processing during cognitive processing takes place during periods of sustained attention. Sustained attention deficit is among the most commonly reported impairments in bipolar disorder (BP). The majority of previous studies have only focused on bipolar I disorder (BP I), owing to underdiagnosis or misdiagnosis of bipolar II disorder (BP II). With the refinement of the bipolar spectrum paradigm, the goal of this study was to compare the sustained attention of interepisode patients with BP I to those with BP II.

Methods

In all, 51 interepisode BP patients (22 with BP I and 29 with BP II) and 20 healthy controls participated in this study. The severity of psychiatric symptoms was assessed by the 17-item Hamilton Depression Rating Scale and the Young Mania Rating Scale. All participants undertook Conners' Continuous Performance Test II (CPT-II) to evaluate sustained attention.

Results

After controlling for the severity of symptoms, age and years of education, BP I patients had a significantly longer reaction times (F(2,68) = 7.648, P = 0.001), worse detectability (d') values (F(2,68) = 6.313, P = 0.003) and more commission errors (F(2,68) = 6.182, P = 0.004) than BP II patients and healthy controls. BP II patients and controls scored significantly higher than BP I patients for d' (F = 6.313, P = 0.003). No significant difference was found among the three groups in omission errors and no significant correlations were observed between CPT-II performance and clinical characteristics in the three groups.

Conclusions

These findings suggested that impairments in sustained attention might be more representative of BP I than BP II after controlling for the severity of symptoms, age, years of education and reaction time on the attentional test. A longitudinal follow-up study design with a larger sample size might be needed to provide more information on chronological sustained attention deficit in BP patients, and to illustrate clearer differentiations between the three groups.
Literature
1.
Buckley PF: Second-generation antipsychotic medications in the treatment of mood disorders: focus on aripiprazole. Drugs Today (Barc). 2005, 41: 5-11. 10.1358/dot.2005.41.1.875774.CrossRef
2.
Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, Solomon DA, Leon AC, Keller MB: A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003, 60: 261-269. 10.1001/archpsyc.60.3.261.CrossRefPubMed
3.
Goodwin F, Jameson KR: Manic Depressive Illness. 1990, New York, USA: Oxford University Press
4.
Rubinsztein JS, Michael A, Paykel ES, Sahakian BJ: Cognitive impairment in remission in bipolar affective disorder. Psychol Med. 2000, 30: 1025-36. 10.1017/S0033291799002664.CrossRefPubMed
5.
Vieta E: Defining the bipolar spectrum and treating bipolar II disorder. J Clin Psychiatry. 2008, 69: 12-10.4088/JCP.0408e12.CrossRef
6.
Akiskal HS: The emergence of the bipolar spectrum: validation along clinical-epidemiologic and familial-genetic lines. Psychopharmacol Bull. 2007, 40: 99-115.PubMed
7.
Coryell W, Endicott J, Reich T, Andreasen N, Keller M: A family study of bipolar II disorder. Br J Psychiatry. 1984, 145: 49-54. 10.1192/bjp.145.1.49.CrossRefPubMed
8.
Sadovnick AD, Remick RA, Lam R, Zis AE, Haggins MJ: Mood disorders service genetic database: morbidity risks for mood disorders in 3942 first-degree relatives of 671 index cases with single depression, recurrent depression, bipolar I or bipolar II. Am J Med Genet. 1994, 54: 132-140. 10.1002/ajmg.1320540208.CrossRefPubMed
9.
Kato T, Takahashi S, Shioiri T, Mirashita J, Hawakawa H, Inubishi T: Reduction of brain phosphocreatine in bipolar II disorder detected by phosphorus-31 magnetic resonance spectroscopy. J Affect Disord. 1994, 31: 125-133. 10.1016/0165-0327(94)90116-3.CrossRefPubMed
10.
Cassano GB, Akiskal HS, Savino M, Musetti L, Perugi G: Proposed subtypes of bipolar II and related disorders: with hypomanic episodes (or cyclothymia) and with hyperthymic temperament. J Affect Disord. 1992, 26: 127-140. 10.1016/0165-0327(92)90044-7.CrossRefPubMed
11.
Von Zerssen D, Tauscher R, Possl J: The relationship of premorbid personality to subtypes of an affective illness. A replication study by means of an operationalized procedure for the diagnosis of personality structures. J Affect Disord. 1994, 32: 61-72. 10.1016/0165-0327(94)90062-0.CrossRefPubMed
12.
Akiskal HS: Dysthymic and cyclothymic depressions: therapeutic considerations. J Clin Psychiatry. 1994, 55 (Suppl): 46-52.PubMed
13.
Torrent C, Martinez-Aran A, Daban C, Sánchez-Moreno J, Comes M, Goikolea JM, Salamero M, Vieta E: Cognitive impairment in bipolar II disorder. Br J Psychiatry. 2006, 189: 254-259. 10.1192/bjp.bp.105.017269.CrossRefPubMed
14.
Summers M, Papadopoulou K, Brunoi S, Cipolotti L, Maria AR: Bipolar I and bipolar II disorder: cognition and emotion processing. Psychol Med. 2006, 36: 1799-1809. 10.1017/S0033291706008804.CrossRefPubMed
15.
Harkavy-Friedman JM, Keilp JG, Grunebaum MF, Sher L, Printz D, Burke AK, Mann JJ, Oquendo M: Are BPI and BPII suicide attempters distinct neuropsychologically?. J Affect Disord. 2006, 94: 255-259. 10.1016/j.jad.2006.04.010.CrossRefPubMed
16.
Martinez-Aran A, Vieta E, Reinares M, Colom F, Torrent C, Sanchez-Moreno J, Benabarre A, Goikolea JM, Comes M, Salamero M: Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry. 2004, 161: 262-270. 10.1176/appi.ajp.161.2.262.CrossRefPubMed
17.
Simonsen C, Sundet K, Vaskinn A, Birkenaes AB, Engh JA, Hansen CF, Jónsdóttir H, Ringen PA, Opjordsmoen S, Friis S, Andreassen OA: Neurocognitive profiles in bipolar I and bipolar II disorder: differences in pattern and magnitude of dysfunction. Bipolar Disord. 2008, 10: 245-255. 10.1111/j.1399-5618.2007.00492.x.CrossRefPubMed
18.
Porges S: Individual differences in attention: a possible physiological substrate. Advances in Special Education. 1980, Greenwich, CT, USA: JAI Press, 2: 111-134.
19.
Richards JE, Hunter SK: Attention and eye movement in young infants: neural control and development. Cognitive Neuroscience of Attention: A Developmental Perspective. Edited by: Richards JE. 1998, Mahwah, NJ, USA: Lawrence Erlbaum Associates, 131-162.
20.
DeGangi GA, Porges S: Neuroscience Foundations of Human Performance. 1990, Rockville, Md: American Occupational Therapy Association Inc
21.
Glahn DC, Bearden CE, Niendam TA, Escamilla MA: The feasibility of neuropsychological endophenotypes in the search for genes associated with bipolar affective disorder. Bipolar Disord. 2004, 6: 171-182. 10.1111/j.1399-5618.2004.00113.x.CrossRefPubMed
22.
Quarishi S, Frangou S: Neuropsychology of bipolar disorder: a review. J Affect Disord. 2002, 72: 209-226. 10.1016/S0165-0327(02)00091-5.CrossRef
23.
Savitz J, Solms M, Ramesar R: Neuropsychological dysfunction in bipolar affective disorder: a critical opinion. Bipolar Disord. 2005, 7: 216-235. 10.1111/j.1399-5618.2005.00203.x.CrossRefPubMed
24.
Thompson JM, Gallagher P, Hughes JH, Watson S, Gray JM, Ferrier IN: Neurocognitive impairment in euthymic patients with bipolar affective disorder. Br J Psychiatry. 2005, 186: 32-40. 10.1192/bjp.186.1.32.CrossRefPubMed
25.
Bearden CE, Hoffman KM, Cannon TD: The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review. Bipolar Disord. 2001, 3: 106-150. 10.1034/j.1399-5618.2001.030302.x.CrossRefPubMed
26.
Clark L, Iversen SD, Goodwin GM: Sustained attention deficits in bipolar disorder. Br J Psychiatry. 2002, 180: 313-319. 10.1192/bjp.180.4.313.CrossRefPubMed
27.
Clark L, Kempton MJ, Scarnà A, Grasby PM, Goodwin GM: Sustained attention-deficit confirmed in euthymic bipolar disorder but not in first-degree relatives of bipolar patients or euthymic unipolar depression. Biol Psychiatry. 2005, 57: 183-187. 10.1016/j.biopsych.2004.11.007.CrossRefPubMed
28.
Bora E, Vahip S, Akdeniz F: Sustained attention deficits in manic and euthymic patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006, 30: 1097-1102. 10.1016/j.pnpbp.2006.04.016.CrossRefPubMed
29.
Endicott J, Spitzer RL: A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry. 1978, 35: 837-844.CrossRefPubMed
30.
Huang SY, Lin WW, Ko HC, Lee JF, Wang TJ, Chou YH, Lu RB: Possible interaction of alcohol dehydrogenase and aldehyde dehydrogenase genes with the dopamine D2 receptor gene in anxiety-depressive alcohol dependence. Alcohol Clin Exp Res. 2004, 28: 374-384. 10.1097/01.ALC.0000117832.62901.61.CrossRefPubMed
31.
Merikangas KR, Mehta RL, Molnar BE, Walters EE, Swendsen JD, Aguilar-Gaziola S, Bijl R, Borges G, Caraveo-Anduaga JJ, DeWit DJ, Kolody B, Vega WA, Wittchen HU, Kessler RC: Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology. Addict Behav. 1998, 23: 893-907. 10.1016/S0306-4603(98)00076-8.CrossRefPubMed
32.
Angst J, Gamma A, Benazzi E: Towards a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar II, minor bipolar disorders and hypomania. J Affect Discord. 2003, 73: 133-146. 10.1016/S0165-0327(02)00322-1.CrossRef
33.
34.
Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978, 133: 429-435. 10.1192/bjp.133.5.429.CrossRefPubMed
35.
Ko HC, Lu RB, Shiah IS, Hwang CC: Plasma free 3-methoxy-4-hydroxyphenylglycol predicts response to fluoxetine. Biol Psychiatry. 1997, 41: 774-781. 10.1016/S0006-3223(96)00207-7.CrossRefPubMed
36.
Yen CF, Chen CS, Ko CH, Yen JY, Huang CF: Changes in insight among patients with bipolar I disorder: a 2-year prospective study. Bipolar Disord. 2007, 9: 238-242. 10.1111/j.1399-5618.2007.00407.x.CrossRefPubMed
37.
Conners CK, MHS Staff: Conners' Continuous Performance Test (CPT II). 2000, North Tonawanda, NY: Multi-Health Systems Inc
38.
Lachman R, Lachman JL, Butterfield EC: Cognitive Psychology and Information Processing. 1979, Hillsdale, NJ, USA: Erlbaum
39.
Najt P, Glahn D, Bearden CE, Hatch JP, Monkul ES, Kaur S, Villarreal V, Bowden C, Soares JC: Attention deficits in bipolar disorder: a comparison based on the continuous performance test. Neurosci Lett. 2005, 379: 122-126. 10.1016/j.neulet.2004.12.051.CrossRefPubMed
40.
Pachella RG: The interpretation of reaction time in information-processing research. Human Information Processing: Tutorial in Performance and Recognition. Edited by: Kantowitz B. 1974, Hillsdale, NJ, USA: Erlbaum, 41-82.
41.
Fleck DE, Shear PK, Strakowski SM: Processing efficiency and directed forgetting in bipolar disorder. J Int Neuropsychol Soc. 2005, 11: 871-880.PubMed
42.
Nuechterlein KH: Vigilance in schizophrenia and related disorders. Handbook of Schizophrenia: Neuropsychology, Psychophysiology, and Information Processing. Edited by: Steinhauer SR, Gruzelier JH, Zubin J. 1991, Amsterdam, The Netherlands: Elsevier, 5: 397-433.
43.
Swann AC, Dougherty DM, Pazzaglia PJ, Pham M, Steinberg JL, Moeller FG: Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder. Am J Psychiatry. 2005, 162: 1680-1687. 10.1176/appi.ajp.162.9.1680.CrossRefPubMed
44.
Ferrier IN, Stanton BR, Kelly TP, Scott J: Neuropsychological function in euthymic patients with bipolar disorder. Br J Psychiatry. 1999, 175: 246-251. 10.1192/bjp.175.3.246.CrossRefPubMed
45.
Clark L, Iversen SD, Goodwin GM: A neuropsychological investigation of prefrontal cortex involvement in acute mania. Am J Psychiatry. 2001, 158: 1605-1611. 10.1176/appi.ajp.158.10.1605.CrossRefPubMed
46.
Wilder-Willis KE, Sax KW, Rosenberg HL, Fleck DE, Shear PK, Strakowski SM: Persistent attentional dysfunction in remitted bipolar disorder. Bipolar Disorder. 2001, 3: 58-62. 10.1034/j.1399-5618.2001.030202.x.CrossRef
47.
Markovska-Simoska S, Pop-Jordanova N: Comparison of visual and emotional continuous performance test related to sequence of presentation, gender and age. Prilozi. 2009, 30: 167-178.PubMed
48.
Coull JT, Frith CD, Frackowiak RS, Grasby PM: A fronto-parietal network for rapid visual information processing: a PET study of sustained attention and working memory. Neuropsychologia. 1996, 34: 91085-91095. 10.1016/0028-3932(96)00029-2.CrossRef
49.
Paus T, Zatorre RJ, Hofle N, Caramanos Z: Time-related changes in neural systems underlying attention and arousal during the performance of an auditory vigilance task. J Cogn Neurosci. 1997, 9: 392-408. 10.1162/jocn.1997.9.3.392.CrossRefPubMed
50.
Manly T, Robertson IH: Sustained attention and the frontal lobes. Methodology of Frontal and Executive Function. Edited by: Rabbitt P. 1997, Hove, UK: Psychology Press, 135-150.
Metadata
Title
Poorer sustained attention in bipolar I than bipolar II disorder
Authors
Chian-Huei Kung
Sheng-Yu Lee
Yun-Hsuan Chang
Jo Yung-Wei Wu
Shiou-Lan Chen
Shih-Heng Chen
Chun-Hsien Chu
I-Hui Lee
Tzung-Lieh Yeh
Yen-Kuang Yang
Ru-Band Lu
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Annals of General Psychiatry / Issue 1/2010
Electronic ISSN: 1744-859X
DOI
https://doi.org/10.1186/1744-859X-9-8

Other articles of this Issue 1/2010

Annals of General Psychiatry 1/2010 Go to the issue

Primary research

Serum glutamine, set-shifting ability and anorexia nervosa

Primary research

Diachronic trends of employment outcome of prevocational training in psychiatric rehabilitation

Primary research

Assessment of the emotional responses produced by exposure to real food, virtual food and photographs of food in patients affected by eating disorders

Primary research

How possible is the development of an operational psychometric method to assess the presence of the 5-HTTLPR s allele? Equivocal preliminary findings

Primary research

Predicting hospital admission and discharge with symptom or function scores in patients with schizophrenia: pooled analysis of a clinical trial extension

Primary research

The combined effect of gender and age on post traumatic stress disorder: do men and women show differences in the lifespan distribution of the disorder?