RESIDENT: A Case Study of Cognition in a Euthymic Bipolar Patient: An objective measurement of cognitive ability before and after their diagnosis and their subjective experience.
Presenting Author(s): Eric Gee
Date and time: 24 Mar 2018 from 15:00 to 15:15
Location: Hawthorn C
Presenting Author: Dr. Eric Gee
Co-Author(s) Names:
Email: egee@ualberta.ca
Learning Objectives:
- Explore cognitive profiles in euthymic bipolar patients
- Examine the subjective cognitive experience in a euthymic bipolar patient.
- Compare objective psycho-educational testing before and after the diagnosis of bipolar disorder.
Literature Reference:
Burdick, K. E., Endick, C. J. & Goldberg, J. F. Assessing cognitive deficits in bipolar disorder: are self-reports valid? Psychiatry Res 136, 43–50 (2005).
Glahn, D. C. et al. The neurocognitive signature of psychotic bipolar disorder. Biol. Psychiatry 62, 910–916 (2007).
Roux, P. et al. Cognitive profiles in euthymic patients with bipolar disorders: results from the FACE-BD cohort. Bipolar Disord 19, 146–153 (2017).
Soraggi-Frez, C., Santos, F. H., Albuquerque, P. B. & Malloy-Diniz, L. F. Disentangling Working Memory Functioning in Mood States of Bipolar Disorder: A Systematic Review. Front Psychol 8, 574 (2017).
Vrabie, M. et al. Cognitive impairment in manic bipolar patients: important, understated, significant aspects. Ann Gen Psychiatry 14, 41 (2015).
Abstract
Patients with bipolar affective disorder (BAD) have neuropsychological deficits regardless of the phase of illness. 75% of euthymic BAD patients were found to score 1 standard deviation below controls in at least 4 cognitive domains. These deficits can be measured after 1 and 2 years of sustained remission and are associated with a lower global assessment of functioning score. Studies have measured cognition only after the diagnosis of BAD. It is unknown if cognitive deficits pre-exist diagnosis or are a consequence of BAD onset.
Our case study examines the formal cognitive testing done in a patient before and after the diagnosis of BAD. Forty-eight hours after the patient’s second cognitive test, the Young Mania Scale and Hamilton Rating Scale for Depression suggested the patient was not manic or depressed. Six domains were measured both before and after the diagnosis of BAD. The patient’s perceptual reasoning, processing speed and visual spatial abilities declined by more than 20 percentile points. A subjective experience around cognition was elicited from the patient and echoed the deficits found by testing. For this patient, it seems that the cognitive impairments were a consequence of BAD onset. The patient’s subjective experience and objective measures indicate cognitive deficits that impact the patient’s life and should be considered when treating patients with BAD.