Cognitive flexibility and problem-solving in patients with bipolar disorder
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Methods: This was a cross sectional descriptive study with purposive sampling method. The population was the Harmony in Diversity Group in Surabaya, Indonesia. Twenty-two patients agreed to be subjects and each of them finished the Wisconsin Card Sorting Test (WCST) to measure cognitive flexibility and the Tower of London (TOL) to measure problem-solving.
Results: The WCST score are below normal for 90.9% of the patients. Higher cognitive flexibility is found in patients with bachelor's degree and euthymic patients, while lower cognitive flexibility is found in patients in depression episode, manic episode, and mixed episode. No patients could finish the TOL within the minimum required steps. Better problem-solving is found in patients in manic episode and euthymic patients while lower problem-solving is found in mixed episode and depressive episode.
Conclusion: The cognitive flexibility and problem-solving in patients with bipolar disorder are lower than the normal cut off. The type of episode and chronicity are contributing factors. Euthymic patients tend to have better cognitive flexibility and manic patients tend to have better problem-solving ability.
Treatment Advocacy Center. Bipolar Disorder - Fact Sheet [Internet]. 2018. Available from: https://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/463-bipolar-disorder-fact-sheet
Jamison K. Suicide and bipolar disorder. J Clin Psychiatry [Internet]. 2000;61(9):47–51.
Depression and Bipolar Support Alliance (Institution/Organization). Bipolar Disorder [Internet]. 2019. Available from: https://www.dbsalliance.org/education/bipolar-disorder/
Solé B, Jiménez E, Torrent C, Reinares M, Bonnin CDM, Torres I, et al. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies. Int J Neuropsychopharmacol. 2017 Aug;20(8):670–80.
Torrent C, Bonnin C del M, Martinez-Aran A, Valle J, Amann BL, Gonzalez-Pinto A, et al. Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am J Psychiatry. 2013 Aug;170(8):852–9.
Lima IMM, Peckham AD, Johnson SL. Cognitive deficits in bipolar disorders: Implications for emotion. Clin Psychol Rev. 2018 Feb;59:126–36.
Depp CA, Dev S, Eyler LT. Bipolar Depression and Cognitive Impairment: Shared Mechanisms and New Treatment Avenues. Psychiatr Clin North Am [Internet]. 2015/12/11. 2016 Mar;39(1):95–109.
Lara E, Olaya B, Garin N, Ayuso-Mateos JL, Miret M, Moneta V, et al. Is cognitive impairment associated with suicidality? A population-based study. Eur Neuropsychopharmacol. 2015 Feb;25(2):203–13.
Martínez-Arán A, Vieta E, Colom F, Torrent C, Sánchez-Moreno J, Reinares M, et al. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord [Internet]. 2004;6(3):224–32.
Sweeney J, Kmiec J, Kupfer D. Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biol Psychiatry [Internet]. 2000;48(7):674–84.
Scott J, Stanton B, Garland A, Ferrier I. Cognitive vulnerability in patients with bipolar disorder. Psychol Med [Internet]. 2000;30(2):467–72.
Clark L, Sahakian BJ. Cognitive neuroscience and brain imaging in bipolar disorder. Dialogues Clin Neurosci [Internet]. 2008 Jun;10(2):153–63.
Nuffield Foundation. Investigating the Wisconsin Card Sorting Test [Internet]. 2019. Available from: https://www.nuffieldfoundation.org/applied-science/investigating-wisconsin-card-sorting-test
Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G. The Wisconsin Card Sorting Test Manual. Psychological Assessment Resources, Inc.; 1993.
Temmerman A, Sabbe B, Morrens M. Social cognition in bipolar disorder. Tijdschr Psychiatr [Internet]. 2015;57(6):405–14.
Torrent C, Martinez-Aran A, Bonnin C del M, Reinares M, Daban C, Solé B, et al. Long-Term Outcome of Cognitive Impairment in Bipolar Disorder. J Clin Psychiatry. 2012;73(7):e899–905.
Mur M, Portella MJ, Martinez-Aran A, Pifarré J, Vieta E. Long-Term Stability of Cognitive Impairment in Bipolar Disorder: A 2-Year Follow-Up Study of Lithium-Treated Euthymic Bipolar Patients. J Clin Psychiatry. 2008;69(5):712–9.
Abdel Aal M, Molokhia T, El Kholy O, Sheshtawy H. Cognitive dysfunction in depressive and mixed episodes of bipolar disorder and major depressive disorder: is there a difference? egyptian experience. Egypt J Psychiatry [Internet]. 2018 Jan 1;39(1):28–34.
Vrabie M, Marinescu V, Talaşman A, Tăutu O, Drima E, MicluÅ£ia I. Cognitive impairment in manic bipolar patients: important, understated, significant aspects. Ann Gen Psychiatry [Internet]. 2015 Nov 25;14:41.
Clark L, Iversen SD, Goodwin GM. A Neuropsychological Investigation of Prefrontal Cortex Involvement in Acute Mania. Am J Psychiatry [Internet]. 2001 Oct 1;158(10):1605–11.
Bearden CE, Glahn DC, Monkul ES, Barrett J, Najt P, Kaur S, et al. Sources of declarative memory impairment in bipolar disorder: mnemonic processes and clinical features. J Psychiatr Res. 2006 Feb;40(1):47–58.
Abé C, Ekman C-J, Sellgren C, Petrovic P, Ingvar M, Landen M. Manic episodes are related to changes in frontal cortex: a longitudinal neuroimaging study of bipolar disorder 1. Brain. 2015 Nov;138(Pt 11):3440–8.
Kapczinski NS, Narvaez JC, Magalhaes P V, Bucker J, Peuker AC, Loredo AC, et al. Cognition and functioning in bipolar depression. Rev Bras Psiquiatr. 2016;38(3):201–6.
Berk M, Dodd S, Malhi GS. ‘Bipolar Missed States': The Diagnosis and Clinical Salience of Bipolar Mixed States. Aust New Zeal J Psychiatry [Internet]. 2005 Apr 1;39(4):215–21.
Sax KW, Strakowski SM, McElroy SL, Keck Jr. PE, West SA. Attention and formal thought disorder in mixed and pure mania. Biol Psychiatry [Internet]. 1995 Mar 15;37(6):420–3.
Clark L, Iversen SD, Goodwin GM. Sustained attention deficit in bipolar disorder. Br J Psychiatry [Internet]. 2018/01/02. 2002;180(4):313–9.
Daglas R, Yücel M, Cotton S, Allott K, Hetrick S, Berk M. Cognitive impairment in first-episode mania: a systematic review of the evidence in the acute and remission phases of the illness. Int J bipolar Disord [Internet]. 2015 Apr 25;3:9.
Latalova K, Prasko J, Diveky T, Velartova H. Cognitive impairment in bipolar disorder. Biomed Pap [Internet]. 2011;155(1):19–26.
Veeh J, Kopf J, Kittel-Schneider S, Deckert J, Reif A. Cognitive remediation for bipolar patients with objective cognitive impairment: a naturalistic study. Int J bipolar Disord [Internet]. 2017 Apr 13;5(1):8.
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