Bipolar disorder

Cognition and bipolar disorder symptoms

What is the relationship between cognition and symptoms of bipolar disorder?

Bipolar disorder is characterised by episodes of depression and mania, which can include psychosis. 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. Psychotic symptoms such as hallucinations and delusions most commonly occur during manic episodes.

What is the evidence for the relationship between cognition and symptoms of bipolar disorder?

High quality evidence finds small effects of greater impairment in global cognition, verbal and working memory, processing speed, and executive functioning in people with bipolar disorder and a history of psychosis compared to people with bipolar disorder with no history of psychosis. Moderate to high quality evidence also finds greater impairment in social cognition in people with a history of psychosis. There were no differences in visual memory or attention.

Moderate to low quality evidence finds an association between poorer overall cognitive functioning and more mood episodes, more hospitalisations, and longer duration of illness.

September 2021

Image: ©matiasdelcarmine –

Last updated at: 1:59 pm, 15th February 2022
To view documentation related to this topic download the files below
Fact Sheet Technical Commentary

NeuRA Libraries

Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.