Neuropsychological performance, emotion processing and psychosocial function in bipolar disorder

Abstract

Background/aims: There is considerable evidence that euthymic individuals with bipolar disorder experience both significant impairment in cognitive function – especially verbal memory and executive function – and significant impairment in psychosocial function. There is also some evidence that bipolar disorder is associated with altered emotional processing, although the findings are somewhat mixed. The aims of the present study were to address some of the outstanding questions about these three areas in euthymic bipolar patients: 1) is there a relationship between verbal memory impairment and executive dysfunction? 2) Can cognitive function be improved? 3) Do patients show differences in the explicit and/or implicit processing of emotional information? 4) Is there a relationship between cognitive dysfunction, emotion‐processing impairment, and psychosocial functioning? Method: A large sample of euthymic patients with bipolar disorder and healthy controls underwent a battery of neuropsychological tests, tests of emotion processing, and had their social function measured via a selection of clinician‐ and self‐rated measures. Results: 1) Deficits in executive function were insufficient to explain the entire extent of the verbal memory impairment in this group, suggesting they are two distinct areas of impairment. 2) A subgroup of patients who underwent a simple self‐monitoring intervention significantly outperformed a control group of patients on several indices of one cognitive functioning measure. 3) Patients showed little evidence of impairment in emotion processing on either explicit or implicit measures. 4) Functioning was most strongly predicted by psychological factors, such as self‐esteem, anxiety and dysfunctional attitudes. Cognitive function was also a significant, although weaker, predictor. Overall models accounted for more than 60% of the variance in functioning. Conclusion: Cognitive dysfunction in bipolar disorder appears to be multi‐faceted and involve more than one area of impairment. Efforts to improve functional outcomes would be best served focusing on improving self‐esteem and psychological coping resources.