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

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2013

Open Access 01-12-2013 | Research article

Neurocognitive profiles in treatment-resistant bipolar I and bipolar II disorder depression

Authors: Ute Kessler, Helle K Schoeyen, Ole A Andreassen, Geir E Eide, Åsa Hammar, Ulrik F Malt, Ketil J Oedegaard, Gunnar Morken, Kjetil Sundet, Arne E Vaaler

Published in: BMC Psychiatry | Issue 1/2013

Login to get access

Abstract

Background

The literature on the neuropsychological profiles in Bipolar disorder (BD) depression is sparse. The aims of the study were to assess the neurocognitive profiles in treatment-resistant, acutely admitted BD depression inpatients, to compare the neurocognitive functioning in patients with BD I and II, and to identify the demographic and clinical illness characteristics associated with cognitive functioning.

Methods

Acutely admitted BD I (n = 19) and BD II (n = 32) inpatients who fulfilled the DSM-IV-TR criteria for a major depressive episode were tested with the MATRICS Consensus Cognitive Battery (MCCB), the Wechsler Abbreviated Scale of Intelligence, the National Adult Reading Test, and a battery of clinical measures.

Results

Neurocognitive impairments were evident in the BD I and BD II depression inpatients within all MCCB domains. The numerical scores on all MCCB-measures were lower in the BD I group than in the BD II group, with a significant difference on one of the measures, category fluency. 68.4% of the BD I patients had clinically significant impairment (>1.5 SD below normal mean) in two or more domains compared to 37.5% of the BD II patients (p = 0.045). A significant reduction in IQ from the premorbid to the current level was seen in BD I but not BD II patients. Higher age was associated with greater neurocognitive deficits compared to age-adjusted published norms.

Conclusions

A high proportion of patients with therapy-resistant BD I or II depression exhibited global neurocognitive impairments with clinically significant severity. The cognitive impairments were more common in BD I compared to BD II patients, particularly processing speed. These findings suggest that clinicians should be aware of the severe neurocognitive dysfunction in treatment-resistant bipolar depression, particularly in BD I.

Trial registration

Trial registration number: NCT00664976
Appendix
Available only for authorised users
Literature
1.
Quraishi S, Frangou S: Neuropsychology of bipolar disorder: a review. J Affect Disord. 2002, 72 (3): 209-226.CrossRefPubMed
2.
Goldberg JF, Chengappa KN: Identifying and treating cognitive impairment in bipolar disorder. Bipolar Disord. 2009, 11 (Suppl 2): 123-137.CrossRefPubMed
3.
Simonsen C, Sundet K, Vaskinn A, Birkenaes AB, Engh JA, Faerden A, Jonsdottir H, Ringen PA, Opjordsmoen S, Melle I, Friis S, Andreassen OA: Neurocognitive dysfunction in bipolar and schizophrenia spectrum disorders depends on history of psychosis rather than diagnostic group. Schizophr Bull. 2011, 37 (1): 73-83.CrossRefPubMed
4.
Basso MR, Lowery N, Neel J, Purdie R, Bornstein RA: Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder. Neuropsychology. 2002, 16 (1): 84-91.CrossRefPubMed
5.
Borkowska A, Rybakowski JK: Neuropsychological frontal lobe tests indicate that bipolar depressed patients are more impaired than unipolar. Bipolar Disord. 2001, 3 (2): 88-94.CrossRefPubMed
6.
Burdick KE, Gunawardane N, Goldberg JF, Halperin JM, Garno JL, Malhotra AK: Attention and psychomotor functioning in bipolar depression. Psychiatry Res. 2009, 166 (2–3): 192-200.CrossRefPubMed
7.
Malhi GS, Ivanovski B, Hadzi-Pavlovic D, Mitchell PB, Vieta E, Sachdev P: Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord. 2007, 9 (1–2): 114-125.CrossRefPubMed
8.
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 (2): 262-270.CrossRefPubMed
9.
Roiser JP, Cannon DM, Gandhi SK, Taylor Tavares J, Erickson K, Wood S, Klaver JM, Clark L, Zarate CA, Sahakian BJ, Drevets WC: Hot and cold cognition in unmedicated depressed subjects with bipolar disorder. Bipolar Disord. 2009, 11 (2): 178-189.CrossRefPubMedPubMedCentral
10.
Kurtz MM, Gerraty RT: A meta-analytic investigation of neurocognitive deficits in bipolar illness: profile and effects of clinical state. Neuropsychology. 2009, 23 (5): 551-562.CrossRefPubMedPubMedCentral
11.
Goodwin FK, Jamison KR: Manic-depressive illness: bipolar disorders and recurrent depression. 2007, New York: Oxford University Press, 2
12.
American Psychiatric Association: Text Revision (DSM-IV-TR). Fourth edition. Diagnostic and Statistical Manual of Mental Disorders. 2000, Washington, DC: American Psychiatric Association
13.
World Health Organization: The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. 1993, Geneva: World Health Organization
14.
Vieta E, Suppes T: Bipolar II disorder: arguments for and against a distinct diagnostic entity. Bipolar Disord. 2008, 10 (1 Pt 2): 163-178.CrossRefPubMed
15.
Torrent C, Martinez-Aran A, Daban C, Sanchez-Moreno J, Comes M, Goikolea JM, Salamero M, Vieta E: Cognitive impairment in bipolar II disorder. Br J Psychiatry. 2006, 189: 254-259.CrossRefPubMed
16.
Simonsen C, Sundet K, Vaskinn A, Birkenaes AB, Engh JA, Hansen CF, Jonsdottir 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 (2): 245-255.CrossRefPubMed
17.
Hsiao YL, Wu YS, Wu JY, Hsu MH, Chen HC, Lee SY, Lee IH, Yeh TL, Yang YK, Ko HC, Lu RB: Neuropsychological functions in patients with bipolar I and bipolar II disorder. Bipolar Disord. 2009, 11 (5): 547-554.CrossRefPubMed
18.
Bora E, Yucel M, Pantelis C, Berk M: Meta-analytic review of neurocognition in bipolar II disorder. Acta Psychiatr Scand. 2011, 123 (3): 165-174.CrossRefPubMed
19.
Summers M, Papadopoulou K, Bruno S, Cipolotti L, Ron MA: Bipolar I and bipolar II disorder: cognition and emotion processing. Psychol Med. 2006, 36 (12): 1799-1809.CrossRefPubMed
20.
Xu G, Lin K, Rao D, Dang Y, Ouyang H, Guo Y, Ma J, Chen J: Neuropsychological performance in bipolar I, bipolar II and unipolar depression patients: a longitudinal, naturalistic study. J Affect Disord. 2012, 136 (3): 328-339.CrossRefPubMed
21.
Goodwin GM, Martinez-Aran A, Glahn DC, Vieta E: Cognitive impairment in bipolar disorder: neurodevelopment or neurodegeneration? An ECNP expert meeting report. Eur Neuropsychopharmacol. 2008, 18 (11): 787-793.CrossRefPubMed
22.
Robinson LJ, Ferrier IN: Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disord. 2006, 8 (2): 103-116.CrossRefPubMed
23.
Denicoff KD, Ali SO, Mirsky AF, Smith-Jackson EE, Leverich GS, Duncan CC, Connell EG, Post RM: Relationship between prior course of illness and neuropsychological functioning in patients with bipolar disorder. J Affect Disord. 1999, 56 (1): 67-73.CrossRefPubMed
24.
Bora E, Yücel M, Pantelis C: Neurocognitive markers of psychosis in bipolar disorder: a meta-analytic study. J Affect Disord. 2010, 127 (1): 1-9.CrossRefPubMed
25.
Bruno SD, Papadopoulou K, Cercignani M, Cipolotti L, Ron MA: Structural brain correlates of IQ changes in bipolar disorder. Psychol Med. 2006, 36 (5): 609-618.CrossRefPubMed
26.
Kessler U, Vaaler AE, Schoyen H, Oedegaard KJ, Bergsholm P, Andreassen OA, Malt UF, Morken G: The study protocol of the Norwegian randomized controlled trial of electroconvulsive therapy in treatment resistant depression in bipolar disorder. BMC Psychiatry. 2010, 10: 16-CrossRefPubMedPubMedCentral
27.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59 (Suppl 20): 22-33.PubMed
28.
First M, Spitzer R, Gibbon M, Williams J: Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition. (SCID-I/NP). 2002, New York: Biometrics Research, New York State Psychiatric Institute
29.
Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979, 134: 382-389.CrossRefPubMed
30.
Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987, 13 (2): 261-276.CrossRefPubMed
31.
Pedersen G, Hagtvet KA, Karterud S: Generalizability studies of the global assessment of functioning-split version. Compr Psychiatry. 2007, 48 (1): 88-94.CrossRefPubMed
32.
Suppes T, Leverich GS, Keck PE, Nolen WA, Denicoff KD, Altshuler LL, McElroy SL, Rush AJ, Kupka R, Frye MA, Bickel M, Post RM: The stanley foundation bipolar treatment outcome network. II. demographics and illness characteristics of the first 261 patients. J Affect Disord. 2001, 67 (1-3): 45-59.CrossRefPubMed
33.
Post RM, Nolen WA, Kupka RW, Denicoff KD, Leverich GS, Keck PE, McElroy SL, Rush AJ, Suppes T, Altshuler LL, Frye MA, Grunze H, Walden J: The stanley foundation bipolar network. I. rationale and methods. Br J Psychiatry Suppl. 2001, 41: 169-176.CrossRef
34.
Schoeyen HK, Vaaler AE, Auestad BH, Malt UF, Melle I, Andreassen OA, Morken G: Despite clinical differences, bipolar disorder patients from acute wards and outpatient clinics have similar educational and disability levels compared to the general population. J Affect Disord. 2011, 132 (1–2): 209-215.CrossRefPubMed
35.
Morken G, Vaaler AE, Folden GE, Andreassen OA, Malt UF: Age at onset of first episode and time to treatment in in-patients with bipolar disorder. Br J Psychiatry. 2009, 194 (6): 559-560.CrossRefPubMed
36.
Leverich GS, Altshuler LL, Frye MA, Suppes T, Keck PE, McElroy SL, Denicoff KD, Obrocea G, Nolen WA, Kupka R, Walden J, Grunze H, Perez S, Luckenbaugh DA, Post RM: Factors associated with suicide attempts in 648 patients with bipolar disorder in the stanley foundation bipolar network. J Clin Psychiatry. 2003, 64 (5): 506-515.CrossRefPubMed
37.
Wechsler D: Wechsler Abbreviated Scale of Intelligence (WASI) Manual. 1999, San Antonio, TX: The Psychological Corporation
38.
Nelson HE, Willison JR: The National Adult Reading Test - Test Manual. 1991, Windsor: NFER-Nelson, 2
39.
Lezak M, Howieson D, Loring D: Neuropsychological Assessment. 2004, New York: Oxford University Press, 4
40.
Sundet K, Vaskinn A: Estimating premorbid IQ (in norwegian with english abstract). J Norwegian Psychol Assoc. 2008, 45 (9): 1108-1115.
41.
Nuechterlein KH, Green MF, Kern RS, Baade LE, Barch DM, Cohen JD, Essock S, Fenton WS, Frese FJ, Gold JM, Goldberg T, Heaton RK, Keefe RS, Kraemer H, Mesholam-Gately R, Seidman LJ, Stover E, Weinberger DR, Young AS, Zalcman S, Marder SR: The MATRICS consensus cognitive battery, part 1: test selection, reliability, and validity. Am J Psychiatry. 2008, 165 (2): 203-213.CrossRefPubMed
42.
Nuechterlein KH, Green MF: MATRICS Consensus Cognitive Battery, Manual. 2006, Los Angeles: The Regents of the University of California: Matrics Assessment Inc
43.
Yatham LN, Torres IJ, Malhi GS, Frangou S, Glahn DC, Bearden CE, Burdick KE, Martinez-Aran A, Dittmann S, Goldberg JF, Ozerdem A, Aydemir O, Chengappa KN: The international society for bipolar disorders-battery for assessment of neurocognition (ISBD-BANC). Bipolar Disord. 2010, 12 (4): 351-363.CrossRefPubMed
44.
Burdick KE, Goldberg TE, Cornblatt BA, Keefe RS, Gopin CB, Derosse P, Braga RJ, Malhotra AK: The MATRICS consensus cognitive battery in patients with bipolar I disorder. Neuropsychopharmacology. 2011, 36 (8): 1587-1592.CrossRefPubMedPubMedCentral
45.
Mohn C, Sundet K, Rund BR: The norwegian standardization of the MATRICS (measurement and treatment research to improve cognition in schizophrenia) consensus cognitive battery. J Clin Exp Neuropsychol. 2012, 34: 667-677.CrossRefPubMed
46.
Cohen J: Statistical power analysis for the behavioral sciences. 1988, Hillsdale, NJ: Lawrence Erlbaum Associates, 2
47.
Arts B, Jabben N, Krabbendam L, van Os J: Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychol Med. 2008, 38 (6): 771-785.CrossRefPubMed
48.
Bourne C, Aydemir Ö, Balanzá-Martínez V, Bora E, Brissos S, Cavanagh JTO, Clark L, Cubukcuoglu Z, Videira Dias V, Dittmann S, Ferrier IN, Fleck DE, Frangou S, Gallagher P, Jones L, Kieseppä T, Martínez-Aran A, Melle I, Moore PB, Mur M, Pfennig A, Raust A, Senturk V, Simonsen C, Smith DJ, Bio DS, Soeiro-de-Souza MG, Stoddart SDR, Sundet K, Szöke A: Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis. Acta Psychiatr Scand. in press
49.
Toulopoulou T, Quraishi S, McDonald C, Murray RM: The maudsley family study: premorbid and current general intellectual function levels in familial bipolar I disorder and schizophrenia. J Clin Exp Neuropsychol. 2006, 28 (2): 243-259.CrossRefPubMed
50.
Khan A, Ginsberg LD, Asnis GM, Goodwin FK, Davis KH, Krishnan AA, Adams BE: Effect of lamotrigine on cognitive complaints in patients with bipolar I disorder. J Clin Psychiatry. 2004, 65 (11): 1483-1490.CrossRefPubMed
51.
Depp CA, Moore DJ, Sitzer D, Palmer BW, Eyler LT, Roesch S, Lebowitz BD, Jeste DV: Neurocognitive impairment in middle-aged and older adults with bipolar disorder: comparison to schizophrenia and normal comparison subjects. J Affect Disord. 2007, 101 (1–3): 201-209.CrossRefPubMedPubMedCentral
52.
Zubieta JK, Huguelet P, O’Neil RL, Giordani BJ: Cognitive function in euthymic bipolar I disorder. Psychiatry Res. 2001, 102 (1): 9-20.CrossRefPubMed
53.
Gildengers AG, Mulsant BH, Begley A, Mazumdar S, Hyams AV, Reynolds CF, Kupfer DJ, Butters MA: The longitudinal course of cognition in older adults with bipolar disorder. Bipolar Disord. 2009, 11 (7): 744-752.CrossRefPubMedPubMedCentral
54.
Schouws SN, Stek ML, Comijs HC, Dols A, Beekman AT: Cognitive decline in elderly bipolar disorder patients: a follow-up study. Bipolar Disord. 2012, 14 (7): 749-755.CrossRefPubMed
Metadata
Title
Neurocognitive profiles in treatment-resistant bipolar I and bipolar II disorder depression
Authors
Ute Kessler
Helle K Schoeyen
Ole A Andreassen
Geir E Eide
Åsa Hammar
Ulrik F Malt
Ketil J Oedegaard
Gunnar Morken
Kjetil Sundet
Arne E Vaaler
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2013
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-13-105

Other articles of this Issue 1/2013

BMC Psychiatry 1/2013 Go to the issue

Research article

A case-linkage study of crime victimisation in schizophrenia-spectrum disorders over a period of deinstitutionalisation

Research article

Cognitive behaviour therapy response and dropout rate across purging and nonpurging bulimia nervosa and binge eating disorder: DSM-5 implications

Research article

Predictors of psychiatric disorders in combat veterans

Research article

Antipsychotic medications and cognitive functioning in bipolar disorder: moderating effects of COMT Val108/158Met genotype

Research article

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle

Research article

Risperidone long-acting injection in Schizophrenia Spectrum Illnesses compared to first generation depot antipsychotics in an outpatient setting in Canada