Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T00:14:51.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Differentiating bipolar disorders from unipolar depression by applying the Brief Assessment of Cognition in Affective Disorders

Published online by Cambridge University Press:  22 August 2017

C.-Y. Lee ,
L.-J. Wang ,
Y. Lee ,
C.-F. Hung ,
Y.-C. Huang ,
M.-I. Lee  and
S.-Y. Lee
C.-Y. Lee
Affiliation:
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
L.-J. Wang
Affiliation:
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Y. Lee
Affiliation:
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
C.-F. Hung
Affiliation:
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Y.-C. Huang
Affiliation:
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Chung Shan Medical University School of Medicine, Taichung, Taiwan
M.-I. Lee
Affiliation:
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
S.-Y. Lee*
Affiliation:
Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
*
*Address for correspondence: S.-Y. Lee, MD, MS, Department of Psychiatry, Kaohsiung Veterans General Hospital, 386 Da-Chung 1st Road, Kaohsiung, Taiwan. (E-mail: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Scholars continue to argue about whether bipolar disorders (BD) and unipolar depression (UD) are distinguishable with regard to neurocognitive function. This study aims to explore the cognitive profiles of UD and BD by applying the Brief Assessment of Cognition in Affective Disorders (BAC-A) for neuropsychological assessment.

Method

This cross-sectional study included 68 patients with UD, 67 patients with BD, and 135 healthy control subjects. We evaluated the participants’ cognitive functions at euthymic status using the BAC-A, which is made up of six traditional cognitive subtests and the Affective Processing Test. We then used a discriminant function analysis (DFA) to determine whether cognitive performance can be used to distinguish these participant groups.

Results

Healthy controls demonstrated better performance in all subtests of the BAC-A than both the UD and BD patients, with the exception of delayed recognition of affective interference. Compared with the BD group, the UD group exhibited better performance in working memory and emotion inhibition. Furthermore, using all BAC-A indexes, a total of 70% of participants could be correctly classified using a DFA model, and the discriminating validity between UD and BD was superior to using either the traditional cognitive domains or the Affective Processing Test alone.

Conclusions

We have found that UD patients may exhibit an intermediate performance between healthy subjects and BD patients in working memory and emotional inhibition tests. The BAC-A can potentially assist in differentiating BD patients from UD patients at euthymic status in clinical settings.

Keywords

Attentionclassificationdepressionemotionmanianeurocognitive tests
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 6 , April 2018 , pp. 929 - 938
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) . American Psychiatric Association: Washington, DC, USA.Google Scholar
Bauer, IE, Keefe, RS, Sanches, M, Suchting, R, Green, CE, Soares, JC (2015a). Evaluation of cognitive function in bipolar disorder using the Brief Assessment of Cognition in Affective Disorders (BAC-A). Journal of Psychiatric Research 60, 81–86.CrossRefGoogle ScholarPubMed
Bauer, IE, Ouyang, A, Mwangi, B, Sanches, M, Zunta-Soares, GB, Keefe, RS, Huang, H, Soares, JC (2015b). Reduced white matter integrity and verbal fluency impairment in young adults with bipolar disorder: a diffusion tensor imaging study. Journal of Psychiatric Research 62, 115–122.CrossRefGoogle ScholarPubMed
Bora, E, Harrison, BJ, Yucel, M, Pantelis, C (2013). Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychological Medicine 43, 2017–2026.CrossRefGoogle ScholarPubMed
Bourne, C, Aydemir, O, Balanza-Martinez, V, Bora, E, Brissos, S, Cavanagh, JT, Clark, L, Cubukcuoglu, Z, Dias, VV, Dittmann, S, Ferrier, IN, Fleck, DE, Frangou, S, Gallagher, P, Jones, L, Kieseppa, T, Martinez-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, SD, Sundet, K, Szoke, A, Thompson, JM, Torrent, C, Zalla, T, Craddock, N, Andreassen, OA, Leboyer, M, Vieta, E, Bauer, M, Worhunsky, PD, Tzagarakis, C, Rogers, RD, Geddes, JR, Goodwin, GM (2013). Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis. Acta Psychiatrica Scandinavica 128, 149–162.CrossRefGoogle ScholarPubMed
Canuto, A, Giannakopoulos, P, Moy, G, Rubio, MM, Ebbing, K, Meiler-Mititelu, C, Herrmann, FR, Gold, G, Delaloye, C, Weber, K (2010). Neurocognitive deficits and personality traits among euthymic patients with mood disorders in late life. Journal of the Neurological Sciences 299, 24–29.CrossRefGoogle ScholarPubMed
Cardoso de Almeida, JR, Phillips, ML (2013). Distinguishing between unipolar depression and bipolar depression: current and future clinical and neuroimaging perspectives. Biological Psychiatry 73, 111–118.CrossRefGoogle ScholarPubMed
Clark, L, Kempton, MJ, Scarna, A, Grasby, PM, Goodwin, GM (2005). Sustained attention-deficit confirmed in euthymic bipolar disorder but not in first-degree relatives of bipolar patients or euthymic unipolar depression. Biological Psychiatry 57, 183–187.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates: Hillsdale, NJ, USA.Google Scholar
Crowe, SF (2000). Does the letter number sequencing task measure anything more than digit span? Assessment 7, 113–117.CrossRefGoogle ScholarPubMed
Cusi, AM, Nazarov, A, Holshausen, K, Macqueen, GM, McKinnon, MC (2012). Systematic review of the neural basis of social cognition in patients with mood disorders. Journal of Psychiatry and Neuroscience 37, 154–169.CrossRefGoogle ScholarPubMed
Daniel, BD, Montali, A, Gerra, ML, Innamorati, M, Girardi, P, Pompili, M, Amore, M (2013). Cognitive impairment and its associations with the path of illness in affective disorders: a comparison between patients with bipolar and unipolar depression in remission. Journal of Psychiatric Practice 19, 275–287.CrossRefGoogle ScholarPubMed
Dresler, T, Meriau, K, Heekeren, HR, van der Meer, E (2009). Emotional Stroop task: effect of word arousal and subject anxiety on emotional interference. Psychological Research 73, 364–371.CrossRefGoogle ScholarPubMed
Forty, L, Smith, D, Jones, L, Jones, I, Caesar, S, Cooper, C, Fraser, C, Gordon-Smith, K, Hyde, S, Farmer, A, McGuffin, P, Craddock, N (2008). Clinical differences between bipolar and unipolar depression. The British Journal of Psychiatry 192, 388–389.CrossRefGoogle ScholarPubMed
Gildengers, AG, Butters, MA, Chisholm, D, Anderson, SJ, Begley, A, Holm, M, Rogers, JC, Reynolds, CF III, Mulsant, BH (2012). Cognition in older adults with bipolar disorder versus major depressive disorder. Bipolar Disorders 14, 198–205.CrossRefGoogle ScholarPubMed
Huang, Y, Matysiak, A, Heil, P, Konig, R, Brosch, M (2016). Persistent neural activity in auditory cortex is related to auditory working memory in humans and nonhuman primates. Elife 5, e15441.CrossRefGoogle ScholarPubMed
Kaiser, RH, Andrews-Hanna, JR, Spielberg, JM, Warren, SL, Sutton, BP, Miller, GA, Heller, W, Banich, MT (2015). Distracted and down: neural mechanisms of affective interference in subclinical depression. Social Cognitive and Affective Neuroscience 10, 654–663.CrossRefGoogle ScholarPubMed
Kaneda, Y (2009). Verbal working memory impairment in patients with current episode of unipolar major depressive disorder and in remission. Clinical Neuropharmacology 32, 346–347.CrossRefGoogle ScholarPubMed
Keefe, RS, Fox, KH, Davis, VG, Kennel, C, Walker, TM, Burdick, KE, Harvey, PD (2014). The Brief Assessment of Cognition in Affective Disorders (BAC-A): performance of patients with bipolar depression and healthy controls. Journal of Affective Disorders 166, 86–92.CrossRefGoogle ScholarPubMed
Keefe, RS, Goldberg, TE, Harvey, PD, Gold, JM, Poe, MP, Coughenour, L (2004). The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research 68, 283–297.CrossRefGoogle ScholarPubMed
Keefe, RS, Harvey, PD, Goldberg, TE, Gold, JM, Walker, TM, Kennel, C, Hawkins, K (2008). Norms and standardization of the Brief Assessment of Cognition in Schizophrenia (BACS). Schizophrenia Research 102, 108–115.CrossRefGoogle ScholarPubMed
Keefe, RS, Poe, M, Walker, TM, Harvey, PD (2006a). The relationship of the Brief Assessment of Cognition in Schizophrenia (BACS) to functional capacity and real-world functional outcome. Journal of Clinical and Experimental Neuropsychology 28, 260–269.CrossRefGoogle ScholarPubMed
Keefe, RS, Poe, M, Walker, TM, Kang, JW, Harvey, PD (2006b). The Schizophrenia Cognition Rating Scale: an interview-based assessment and its relationship to cognition, real-world functioning, and functional capacity. The American Journal of Psychiatry 163, 426–432.CrossRefGoogle ScholarPubMed
MacQueen, GM, Memedovich, KA (2017). Cognitive dysfunction in major depression and bipolar disorder: assessment and treatment options. Psychiatry and Clinical Neurosciences 71, 18–27.CrossRefGoogle ScholarPubMed
Papazacharias, A, Nardini, M (2012). The relationship between depression and cognitive deficits. Psychiatria Danubina 24(Suppl 1), S179–S182.Google ScholarPubMed
Paradiso, S, Lamberty, GJ, Garvey, MJ, Robinson, RG (1997). Cognitive impairment in the euthymic phase of chronic unipolar depression. The Journal of Nervous and Mental Disease 185, 748–754.CrossRefGoogle ScholarPubMed
Porter, RJ, Robinson, LJ, Malhi, GS, Gallagher, P (2015). The neurocognitive profile of mood disorders – a review of the evidence and methodological issues. Bipolar Disorders 17(Suppl 2), 21–40.CrossRefGoogle ScholarPubMed
Purcell, AL, Phillips, M, Gruber, J (2013). In your eyes: does theory of mind predict impaired life functioning in bipolar disorders? Journal of Affective Disorders 151, 1113–1119.CrossRefGoogle Scholar
Ramos-Brieva, JA, Cordero-Villafafila, A (1988). A new validation of the Hamilton Rating Scale for Depression. Journal of Psychiatric Research 22, 21–28.CrossRefGoogle ScholarPubMed
Robertson, HA, Kutcher, SP, Lagace, DC (2003). No evidence of attentional deficits in stabilized bipolar youth relative to unipolar and control comparators. Bipolar Disorders 5, 330–339.CrossRefGoogle ScholarPubMed
Rock, PL, Roiser, JP, Riedel, WJ, Blackwell, AD (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological Medicine 44, 2029–2040.CrossRefGoogle ScholarPubMed
Siegle, GJ, Ingram, RE, Matt, GE (2002). Affective interference: an explanation for negative attention biases in dysphoria? Cognitive Therapy and Research 26, 73–87.CrossRefGoogle Scholar
Smith, DJ, Muir, WJ, Blackwood, DH (2006). Neurocognitive impairment in euthymic young adults with bipolar spectrum disorder and recurrent major depressive disorder. Bipolar Disorders 8, 40–46.CrossRefGoogle ScholarPubMed
Szmulewicz, AG, Valerio, MP, Smith, JM, Samame, C, Martino, DJ, Strejilevich, SA (2017). Neuropsychological profiles of major depressive disorder and bipolar disorders during euthymia. A systematic literature review of comparative studies. Psychiatry Research 248, 127–133.CrossRefGoogle ScholarPubMed
Trivedi, MH, Greer, TL (2014). Cognitive dysfunction in unipolar depression: implications for treatment. Journal of Affective Disorders 152–154, 19–27.CrossRefGoogle ScholarPubMed
Wang, LJ, Huang, YC, Hung, CF, Chen, CK, Chen, YC, Lee, PY, Wang, SM, Liu, MH, Lin, CJ, Hsu, ST (2017). The Chinese version of the Brief Assessment of Cognition in Schizophrenia: data of a large-scale Mandarin-speaking population. Archives of Clinical Neuropsychology 32, 289–296.CrossRefGoogle ScholarPubMed
Wang, LJ, Lin, PY, Lee, Y, Huang, YC, Hsu, ST, Hung, CF, Chen, CK, Chen, YC, Wang, YL, Tsai, MC (2016). Validation of the Chinese version of Brief Assessment of Cognition in Schizophrenia. Neuropsychiatric Disease and Treatment 12, 2819–2826.CrossRefGoogle ScholarPubMed
Xu, G, Lin, K, Rao, D, Dang, Y, Ouyang, H, Guo, Y, Ma, J, Chen, J (2012). Neuropsychological performance in bipolar I, bipolar II and unipolar depression patients: a longitudinal, naturalistic study. Journal of Affective Disorders 136, 328–339.CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. The British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed
Zheng, YP, Zhao, JP, Phillips, M, Liu, JB, Cai, MF, Sun, SQ, Huang, MF (1988). Validity and reliability of the Chinese Hamilton Depression Rating Scale. The British Journal of Psychiatry 152, 660–664.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lee et al supplementary material

Tables S1-S2

Download Lee et al supplementary material(File)
File 733.7 KB