Cognition and symptoms

How are symptoms of bipolar disorder and cognition related?

Bipolar disorder is characterised by episodes of depression and mania. A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including one of the first two): intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes in appetite; loss of energy; difficulty concentrating, remembering or making decisions; and/or thoughts of death or suicide. A manic episode is a period of at least one week when a person is high spirited or irritable in an extreme way most of the day for most days. It involves changes in normal behaviour such as showing exaggerated self-esteem or grandiosity, less need for sleep, talking more than usual, talking more loudly and quickly, being easily distracted, doing many activities at once, scheduling more events in a day than can be accomplished, embarking on risky behaviour, uncontrollable racing thoughts, and/or quickly changing ideas or topics.

Cognitive deficits are also a core feature of bipolar disorder. These deficits may be present in chronic patients, as well as prior to onset of the disorder and during its early and acute stages.

What is the evidence for the relationship between cognition and symptoms?

High quality evidence suggests small significant effects of greater cognitive impairment in global cognition, verbal and working memory, processing speed, and executive functioning in people with a history of psychosis. Moderate to high quality evidence also suggests small significant effects of greater cognitive impairment in social cognition, with no differences in visual memory and attention.

Moderate to low quality evidence suggests a relationship between poor cognitive functioning and more mood episodes, more hospitalisations, and longer duration of illness.

March 2019

Last updated at: 9:52 pm, 30th March 2019
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