Progress in Neuro-Psychopharmacology and Biological Psychiatry
Residual symptoms in bipolar disorder: The effect of the last episode after remission
Introduction
Even though bipolar disorder is suggested to have a benign course with episodes and remissions, Angst et al. (1980) showed that 24% of bipolar patients have residual symptoms during the intervals between episodes in a longitudinal follow-up study. In bipolar patients with symptoms of residual mania or depression, cognitive symptoms are reported to be the most common, and mood symptoms are the second most common in the residual phase. Social, behavioral and neurovegetative symptoms are less important (Keitner et al., 1996).
These cognitive symptoms have been studied with a variety of neuropsychological testing batteries. Martinez-Aran et al. (2004a) reported cognitive dysfunction in verbal memory and frontal executive tasks in euthymic bipolar patients. Poorer performance was also detected on measures of verbal learning, executive functioning and motor coordination in BD patients compared to control volunteers (Zubieta et al., 2001). Clark et al. (2002) reported that bipolar I patients were impaired on tasks of attentional set shifting, verbal memory and sustained attention where they indicated that only sustained attention deficit survived controlling for mild affective symptoms. Likewise, when controlled for age, premorbid IQ and depressive symptoms, patients with euthymic bipolar disorder performed worse than control subjects on executive functions (Ferrier et al., 1999). Martinez-Aran et al. (2002) reported verbal fluency deficits and impairment in executive functioning in euthymic bipolar patients related to a poor social outcome. In their review, Quraishi and Frangou (2002) pointed out that impairment in verbal memory is reliably documented, and both residual manic and depressive symptoms result in deficits in the number of perseverative errors, verbal fluency and planning ability. It is also estimated that 30–50% of largely remitted patients fail to attain premorbid levels of psychosocial functioning due to their cognitive impairment (Quraishi and Frangou, 2002, Goodwin and Jamison, 1990).
Furthermore, even though symptomatic improvement is achieved in bipolar disorder, approximately 20–30% of the patients have impairment in social functioning (Ceylan and Oral, 2001). Social maladjustment such as impaired work adjustment, impaired social and leisure activities adjustment and impaired marital adjustment was demonstrated in recovered bipolar patients (Bauwens et al., 1998). Moreover, cognitive impairment may affect occupational and social functioning as well as quality of life (Vieta et al., 2002).
Interepisode symptoms warrant concern as they may engender considerable disability and impairment. Even though residual symptoms are well-known and well-studied, the nature of these symptoms is a topic of interest. It is not well-documented whether residual affective symptoms cause impairment in cognitive functions or cognitive impairment per se is the source of psychosocial dysfunction during remission. In this present study, it is aimed to assess remitted bipolar patients in terms of affective, cognitive and social functioning. In order to better understand the effect of the residual symptomatology of bipolar disorder, the patient group is divided into two subgroups according to their last episode—whether the last episode is manic or depressive. To our knowledge, this is the first study to assess the interepisode symptoms taking the last episodes into consideration.
Section snippets
Setting
The study was carried out in the Department of Psychiatry, Celal Bayar University Hospital, Manisa, Turkey between March and December 2005. Patients were recruited from the Unit for Mood Disorders in this department. All patients were being followed-up by the second author (OA).
Subjects
Bipolar patients were chosen according to their last affective episode. The inclusion criteria were being at the age of between 18 and 65, being in remission for at least 6 months, having a diagnosis of bipolar disorder
Demographical features
The demographical and clinical features of the bipolar and control groups are demonstrated in Table 1. There was no statistical difference between the groups in terms of demographical and clinical features. The only difference among the bipolar groups is that the BP-M group had a younger age of onset when compared to the BP-D group (t = − 1.119, p = .012).
Table 2 shows the medications that were used at the time of the study assessment. There was no statistical difference between the BP-D and BP-M
Discussion
The majority of the studies indicate that QoL is markedly impaired in patients with BD, even when they are considered to be clinically euthymic (Michalak et al., 2005). There is a growing interest in residual symptoms in bipolar disorders since they are related to the impairment of quality of life. Furthermore, residual symptoms are also related to the recurrences in bipolar disorder (Perlis et al., 2006). In this present study, the nature of the residual symptoms in bipolar disorder is
Acknowledgement
This study was granted by the Scientific and Research Project Committee of Celal Bayar University (2005-006).
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2020, Mental Health and Physical ActivityCitation Excerpt :RMoS are conceptualized as the persistence of any level of mood symptoms encompassed during the inter-episodic period designated as euthymia (Samalin et al., 2017; Serafini et al., 2018). Even though it is considered to be the asymptomatic period when patients are in clinical remission, the euthymic phase does not represent the complete absence of symptoms, whereas patients with BD commonly continue to experience a range of severe impairments in functionality (Kaya, Aydemir, & Selcuki, 2007; Samalin et al., 2017; Samalin, Reinares, de Charzon, Torrent, Bonnin, Hidalgo-Mazzei, et al., 2016). In fact, the presence of RMoS in the euthymic phase has been reported as an indicator of poor prognosis and long-term outcome (Bonnín et al., 2012; Serafini et al., 2018), being associated with an increased risk of affective relapse, recurrence and chronicity in BD (De Dios et al., 2012; Fagiolini et al., 2009; Judd et al., 2008).
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2019, Journal of Affective DisordersCitation Excerpt :History of psychosis was associated with 811 (60.9%) patients. There were more than 3 studies that measured P3a amplitude with an auditory paradigm (Andersson et al., 2008; Hamm et al., 2013; Jahshan et al., 2012; Suazo et al., 2016), P3b amplitude with an auditory paradigm (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Hamm et al., 2013; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Suazo et al., 2016; Vuurman et al., 2002), P3b latency with an auditory paradigm (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Vuurman et al., 2002), P3b amplitude with a visual paradigm (Bange and Bathien, 1998; Bestelmeyer, 2012; Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Ryu et al., 2010; Sokhadze et al., 2011), P3b latency with a visual paradigm (Bange and Bathien, 1998; Bestelmeyer, 2012; Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Sokhadze et al., 2011), P3b amplitude with an auditory paradigm in patients who had history of psychosis (Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Hamm et al., 2013; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Suazo et al., 2016), P3b latency with an auditory paradigm in patients who had history of psychosis (Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008), P3b amplitude with an auditory paradigm at euthymic phase (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Hall et al., 2015a, 2014, 2007; Hamm et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; Souza et al., 1995; Suazo et al., 2016; Vuurman et al., 2002), P3b amplitude with a visual paradigm at euthymic phase (Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Sokhadze et al., 2011), P3b latency with an auditory paradigm at euthymic phase (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Hall et al., 2015a, 2014, 2009; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; Souza et al., 1995; Vuurman et al., 2002), P3b latency with a visual paradigm at euthymic phase (Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Sokhadze et al., 2011), P3b amplitude with an auditory paradigm at manic phase (Muir et al., 1991; Salisbury et al., 1999; Strik et al., 1998), P3b latency with an auditory paradigm at manic phase (Muir et al., 1991; Salisbury et al., 1999; Strik et al., 1998), P3b amplitude with an auditory paradigm in patients with BD-I (Bersani et al., 2015; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Suazo et al., 2016; Vuurman et al., 2002), P3b amplitude with a visual paradigm in patients with BD-I (Bestelmeyer, 2012; Ryu et al., 2010; Sokhadze et al., 2011), P3b latency with an auditory paradigm in patients with BD-I (Bersani et al., 2015; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Vuurman et al., 2002), P3b amplitude with an auditory paradigm in patients with BD-II (Andersson et al., 2008; Bersani et al., 2015; Muir et al., 1991; Vuurman et al., 2002), and P3b latency with an auditory paradigm in patients with BD-II (Andersson et al., 2008; Bersani et al., 2015; Muir et al., 1991). We were not able to conduct meta-analyses of the studies with the other paradigms including P3a amplitude with a visual paradigm, P3a latency whit any paradigm, P3a amplitude or latency with any paradigm in patients with psychosis, euthymic phase, manic phase, depressive phase, BD-I, BD-II, P3b amplitude or latency with a visual paradigm patients with psychosis, manic phase or BD-II, P3b amplitude or latency with any paradigm in patients at depressive phase, P3b latency with visual paradigm in patients with BD-I due to insufficient number of studies.
Systematic review of cognitive event related potentials in euthymic bipolar disorder
2018, Clinical NeurophysiologyCitation Excerpt :Regarding latencies, the majority of studies (Fridberg et al., 2009; Bestelmeyer, 2012; Bestelmeyer et al., 2009; Bersani et al., 2015a; Kaya et al., 2007) excluding one (Muir et al., 1991) demonstrated normal P3b latencies (auditory and visual) in euthymic BD compared with healthy controls. It is important to note that task details and ERP measurements in the study of Kaya and colleagues (Kaya et al., 2007) are unknown, therefore the results need to be interpreted with caution. Results of the studies suggest that information processing speed in euthymic BD appears to be intact, and memory and/or attention seems to be compromised.
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