Altered cognition, attitudes mostly state related in bipolar disorder

By Mark Cowen, senior medwireNews Reporter

Altered cognitive processes and attitudes in patients with bipolar disorder (BD) are mostly associated with symptomatology, say researchers.

Nienke Jabben (VU University Medical Center, Amsterdam, the Netherlands) and team found that depressed BD patients showed attentional bias and dysfunctional attitudes compared with euthymic BD patients, the unaffected relatives of BD patients, and mentally healthy controls.

Furthermore, euthymic BD patients only differed from controls in higher levels of neuroticism, while unaffected relatives were similar to controls in all measures of cognition and attitude.

The findings, published in the Journal of Affective Disorders, do not support "the hypothesis that alterations in cognitive processes and attitudes may constitute a marker of the genetic vulnerability for BD," says the team.

The researchers studied 17 depressed BD patients, 60 euthymic BD patients, 39 of their unaffected first-degree relatives, and 39 mentally healthy controls without a family history of BD.

All of the participants were assessed for attentional processing using a dot probe task, in which their speed of response was measured to the appearance of positive-neutral, negative-neutral, and neutral-neutral emotive word pairs.

They were also assessed using the Dysfunctional Attitude Scale (DAS), and for neuroticism and extraversion using the Revised Eysenck Personality Scale (REPS).

The team found that depressed BD patients had significantly lower (more negative) attentional bias scores for positive words compared with euthymic patients, unaffected relatives, and controls, indicating that their attention was directed away from positive words.

Depressed BD patients also had significantly higher levels of neuroticism than euthymic patients, relatives, and controls, with REPS subscale scores of 8.31 versus 5.65, 2.95, and 2.41, respectively.

Furthermore, depressed BD patients also had lower levels of extraversion than euthymic patients, relatives, and controls, with REPS subscale scores of 5.77 versus 7.30, 8.55, and 7.88, respectively.

In addition, depressed BD patients had significantly higher scores on two of the three DAS subscales (goal attainment and achievement) than the other groups, indicating more dysfunctional attitudes in these areas.

Kabben et al conclude: "Alterations in cognitive processes and attitudes in BD are related to the expression of symptomatology and not to the vulnerability for the illness.

"Nevertheless, the presence of dysfunctional attitudes and attentional bias associated with the presence of bipolar depression suggests a possible beneficial effect of therapeutic interventions in addition to the pharmaceutical treatment of BD."

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  1. mani pavuluri mani pavuluri United States says:

    I think results depend on the tasks used, and not always tap into the quintessential elements of cognition per se. Tasks and scales used here are heavily bent on emotional systems/interface than hardcore cognitive function. These results, however, partly replicate others' findings in terms of bias to negative stimuli, inflated by depressive symptoms from residual mixed or depressive states.  Also, adult disorders with later onset, preserve cognition more than early onset bipolar disorder (relative, Clark et al, Sweeney et al., Rubenstein et al) . Which is why, patients with adult onset  show better prognosis than in case of pediatric onset where multi-system involvement is norm than exception. Again, I think large samples, life span studies, pure cognitive and affective and interface tasks in the same sample may provide ultimate answers. However, that said, good to keep these findings in mind as we navigate forwards.

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