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Questions and Answers

Which cognitive domain is NOT typically impaired in patients with bipolar disorder?

  • Attention
  • Sensory Processing (correct)
  • Executive function
  • Memory

According to the information, what is the best cognitive predictor of poor functional outcome in bipolar disorder?

  • Deficits in executive function
  • Impaired attention span
  • Reduced working memory capacity
  • Delayed verbal recovery of information (correct)

Which statement BEST describes the persistence of cognitive impairments in bipolar disorder?

  • Cognitive impairments only occur during acute episodes of illness.
  • Cognitive impairments resolve completely with successful mood stabilization.
  • Cognitive impairments are primarily observed in patients with co-occurring schizophrenia.
  • Cognitive impairments can persist even when patients are in a euthymic or recovered state. (correct)

Why is the assessment of cognitive impairment important for the follow-up care of patients with bipolar disorder?

<p>To plan personalized cognitive remediation strategies. (A)</p> Signup and view all the answers

The neurodevelopmental model of cognitive impairment in bipolar disorder is characterized by which of the following?

<p>Pre-morbid cognitive impairments detectable before the onset of the illness. (B)</p> Signup and view all the answers

The neuroprogressive model of cognitive impairment in bipolar disorder is characterized by which of the following?

<p>Intact pre-morbid cognitive functioning followed by decline related to symptom onset and episodes. (C)</p> Signup and view all the answers

According to the information, which subtype of bipolar patients is the neurodevelopmental model of cognitive impairment most likely to apply to?

<p>Patients with a strong family history of schizophrenia. (C)</p> Signup and view all the answers

What is the MAIN difference between the neurodevelopmental and neuroprogressive models of cognitive impairment in bipolar disorder?

<p>The timing of cognitive decline relative to the onset of symptoms. (B)</p> Signup and view all the answers

What was the primary focus of the 1978 Telford and Worral study in Glasgow regarding bipolar disorder?

<p>The effects of pharmaceutical interventions on cognitive function in bipolar disorder. (D)</p> Signup and view all the answers

Which factor primarily explains the initial slower research progress in cognition related to bipolar disorder compared to schizophrenia?

<p>A greater initial emphasis on investigating cognitive impairments in schizophrenia. (C)</p> Signup and view all the answers

According to the information presented, how does the cognitive performance of individuals with bipolar disorder typically compare to that of healthy controls and individuals with schizophrenia?

<p>Bipolar disorder presents cognitive performance that falls between healthy controls and schizophrenia on average. (D)</p> Signup and view all the answers

Burdick's research identified distinct cognitive subgroups within bipolar disorder. Which of the following best describes these subgroups?

<p>A group mirroring healthy controls, a group mirroring schizophrenia, and a group with intermediate performance. (C)</p> Signup and view all the answers

What implication does Burdick's identification of cognitive subgroups within bipolar disorder have for understanding the condition?

<p>It highlights the importance of considering varying cognitive profiles in diagnosis and treatment. (D)</p> Signup and view all the answers

How does the cognitive performance of individuals with bipolar disorder change over time, according to the information presented?

<p>Individuals may transition between cognitive performance subgroups as the disorder progresses. (A)</p> Signup and view all the answers

What is the significance of referencing Professor Eileen Joyce's article when discussing cognitive impairment in bipolar disorder?

<p>To draw parallels with the understanding of cognitive impairment in schizophrenia. (D)</p> Signup and view all the answers

Which of the following is the MOST accurate conclusion based on the information?

<p>Research into the connection between cognition and bipolar disorder is a relatively recent and rapidly growing field. (D)</p> Signup and view all the answers

Based on the Dunedin Study, what cognitive pattern is typically observed in individuals who later develop schizophrenia, even before the onset of the illness?

<p>Noticeably poorer average cognitive performance compared to healthy controls. (D)</p> Signup and view all the answers

According to the information presented, how does the cognitive trajectory of bipolar disorder typically differ from that of schizophrenia before the onset of the first episode?

<p>Individuals with bipolar disorder tend to have cognitive performance on par with or slightly better than healthy controls, unlike those with schizophrenia. (C)</p> Signup and view all the answers

What characterizes the cognitive decline associated with bipolar disorder as described?

<p>A stepwise decline associated with episodes of illness. (C)</p> Signup and view all the answers

Which statement accurately reflects the potential for cognitive improvement in individuals with bipolar disorder?

<p>Cognitive function may improve with stabilization of the illness and cognitive remediation strategies. (B)</p> Signup and view all the answers

What does the neuroprogressive model of cognitive decline primarily emphasize, as supported by longitudinal studies?

<p>The association between the course of an illness and progressive cognitive decline over time. (B)</p> Signup and view all the answers

What key question remains uncertain and controversial regarding the long-term cognitive deficits in bipolar disorder?

<p>Whether cognitive deficits inevitably lead to impairment or if some individuals can fully recover. (C)</p> Signup and view all the answers

If a bipolar patient presents with global cognitive deficits, which cognitive trajectory are they MOST likely to follow?

<p>A neurodevelopmental trajectory, similar to that seen in people with schizophrenia. (A)</p> Signup and view all the answers

Compared to individuals with global deficits, which cognitive trajectory are bipolar patients with intact or selective deficits more likely to follow?

<p>A neuroprogressive trajectory, presenting increased deficits after each mood episode. (D)</p> Signup and view all the answers

Flashcards

Dunedin Study

A longitudinal study tracking cognitive performance from childhood through illness onset.

Schizophrenia Trajectory

Cognitive performance is lower on average from childhood/adolescence, declining slightly after diagnosis.

Bipolar Disorder Trajectory

Cognitive function is similar to healthy controls before illness onset, with a stepwise decline after each episode.

Long-Term Decline in Schizophrenia

Cognitive abilities gradually diminish over time in individuals with schizophrenia.

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Cognitive Remediation

Cognitive function improvements may be possible through illness stabilization and cognitive strategies.

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Neuroprogressive Model

Illness course is linked with gradual cognitive decline, which can only be seen through longitudinal studies.

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Bipolar Disorder Uncertainty

The long-term cognitive outcomes in bipolar disorder are not fully understood.

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Cognitive Subgroups

Patients exhibit relative strengths and weaknesses in certain areas of cognition.

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Bipolar Disorder

Historically termed 'manic-depressive illness,' it's a mood disorder distinct from schizophrenia.

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MCCB

A cognitive test battery used to assess cognitive performance across various domains.

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Cognitive Heterogeneity in Bipolar Disorder

Cognitive performance varies in bipolar disorder, with some individuals performing similarly to healthy controls, others to those with schizophrenia, and some in between.

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Cognitive Impairment in Schizophrenia

Individuals with schizophrenia show impairments across cognitive domains such as processing speed and working memory, as measured by the MCCB.

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First paper on cognition in Bipolar

The first paper on bipolar disorder and cognition was done in 1978 in Glasgow in Scotland by Telford and Worral

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Who differentiated Bipolar from Schizophrenia?

Bipolar disorder was differentiated from Schizophrenia in the 19th century

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Cognitive impairment in Schizophrenia

People with schizophrenia are generally impaired across a range of cognitive domains

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The three subgroups in Bipolar

There are three subgroups within Bipolar disorder, mapping onto 1) healthy controls, 2) people with schizophrenia and 3) a group in the middle

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Schizophrenia: Cognitive Impairment

Cognitive impairment starts before psychosis onset.

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Bipolar Disorder: Cognitive Impairments

Impacts attention, memory, and executive function.

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Bipolar Disorder: Predictor of Outcome

Poor delayed verbal recall predicts poorer functional outcomes.

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Bipolar Disorder: Cognitive Persistence

Impairments persist even when mood is stable.

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Bipolar Disorder: Cognitive Decline

Cognitive abilities slowly get worse as the disorder goes on.

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Neurodevelopmental Model

Suggests early neurodevelopmental issues before illness onset.

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Bipolar Disorder: Initial Cognitive Functioning

Function is intact at first but deteriorates with the onset of symptoms.

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Study Notes

  • Bipolar disorder was distinguished it from schizophrenia in the 19th century by Emil Kraepelin; it was initially called dementia praecox (now schizophrenia) and manic-depressive illness (now bipolar disorder).
  • The first paper on bipolar disorder and cognition was published in 1978 in Glasgow, Scotland, focusing on the effects of drugs.
  • By 1998, fewer than 10 papers on bipolar disorder and cognition were published, while over 200 papers on schizophrenia had been published.
  • By 2020, nearly 6,000 papers on bipolar disorder and cognition were published, indicating a significant increase in research in this area.
  • Performance on the MCCB cognitive battery shows that people with schizophrenia are generally more impaired across various cognitive domains.
  • Those with bipolar disorder tend to fall in the middle range of cognitive performance compared to healthy controls and individuals with schizophrenia.
  • Burdick research indicates existence of three subgroups with bipolar disorder: one group maps onto healthy controls, another onto schizophrenia performance levels, and a third group falls in the middle.
  • Cognitive impairment in schizophrenia is typically present before and at the onset of psychosis, correlating with functional outcomes and is part of the neurodevelopmental risk.
  • Cognitive impairments in bipolar patients include issues with attention, memory, and executive function.
  • Delayed recall of verbal information stands out as the best cognitive predictor of adverse functional outcomes in bipolar disorder.
  • Cognitive impairments in bipolar disorder persist even when patients are in euthymic or recovered states, and there's early evidence of accelerated cognitive decline in some patients as the disorder advances.
  • The neurodevelopmental model suggests pre-morbid cognitive impairments detectable early on, potentially before illness manifestation, indicating an abnormal early development process, which is closely linked to schizophrenia.
  • The neuroprogressive model involves intact or even superior pre-morbid cognitive functioning, with deterioration aligning with symptom onset and further incremental decline related to illness episodes.
  • Research by Lewandowski indicates that those with bipolar disorder map onto healthy controls before the onset of illness, even having slightly better IQ scores on average.
  • Episodes of illness are associated with incremental, stepwise decline.
  • Cognitive function with illness stabilization and cognitive remediation strategies can be improved.
  • Longitudinal studies are essential of uncovering associations between the course of bipolar disorder illness and progressive cognitive decline.
  • Various subgroups in bipolar disorder i.e. intact, selective deficits, or global deficits, have different cognitive trajectories.
  • Factors such as inflammation, oxidative stress, mitochondrial dysfunction, HPA access dysfunction, and epigenetic changes can lead to cellular damage, apoptosis, inhibited neuronal growth, and structural abnormalities, contributing to cognitive decline and vulnerability to further episodes.

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Description

Explore the history of bipolar disorder, its distinction from schizophrenia, and the evolution of research in this area. Cognitive performance in bipolar disorder, compared to schizophrenia and healthy controls, is also examined. Burdick's research identifies subgroups within bipolar disorder.

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