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Nervenheilkunde 2014; 33(12): 873-876
DOI: 10.1055/s-0038-1627761
Bipolare Störungen
Schattauer GmbH

Kognitive Störungen bei bipolaren Patienten

Cognitive impairments in patients with bipolar disorders
C. Torrent
1   Programm für Bipolare Störungen, Klinisches Institut für Neurowissenschaften, Hospital Clinic of Barcelona, Abteilung für Psychiatrie, IDIBAPS, CIBERSAM, Barcelona, Spanien
,
F. Seemüller
2   Kbo-Lech-Mangfall Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Garmisch-Partenkirchen
3   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
,
C. del Mar Bonnin
1   Programm für Bipolare Störungen, Klinisches Institut für Neurowissenschaften, Hospital Clinic of Barcelona, Abteilung für Psychiatrie, IDIBAPS, CIBERSAM, Barcelona, Spanien
,
A. Martínez-Arán
1   Programm für Bipolare Störungen, Klinisches Institut für Neurowissenschaften, Hospital Clinic of Barcelona, Abteilung für Psychiatrie, IDIBAPS, CIBERSAM, Barcelona, Spanien
,
E. Vieta
1   Programm für Bipolare Störungen, Klinisches Institut für Neurowissenschaften, Hospital Clinic of Barcelona, Abteilung für Psychiatrie, IDIBAPS, CIBERSAM, Barcelona, Spanien
› Author Affiliations
Further Information

Publication History

eingegangen am: 15 September 2014

angenommen am: 18 September 2014

Publication Date:
22 January 2018 (online)

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Zusammenfassung

Bipolare Patienten leiden auch im episodenfreien Intervall unter deutlichen kognitiven Beeinträchtigungen. Sehr wahrscheinlich sind die kognitiven Störungen auch Ursache der erheblichen beruflichen Schwierigkeiten, über die bis zu 68% aller Betroffenen klagen. Insbesondere Aufmerksamkeit, verbales Gedächtnis, Arbeitsgedächtnis und Exekutivfunktionen scheinen bei bipolar Erkrankten beeinträchtigt zu sein. Vor allem Defizite im Gedächtnis sowie in den Exekutivfunktionen scheinen mit dem psychosozialen Funktionsniveau assoziiert zu sein. Insbesondere die Länge der Krankheitsdauer, die Anzahl maniformer Episoden, subsyndromale Symptome und einige biologische Marker, z. B. ein erhöhtem Homocysteinspiegel, sind mit kognitiven Störungen assoziiert. Medikamente scheinen die Kognition nicht maßgeblich zu beeinträchtigen, hier ist noch weitere Forschung nötig.

Die rechtzeitige und suffiziente akut und rückfallprophylaktische Behandlung bleibt die wirkungsvollste Therapie bei der Prävention und Behandlung kognitiver Störungen bei bipolaren Patienten. Nach einer akuten Phase sollten auf mögliche kognitive Störungen im Rahmen der Wiedereingliederung besonders Rücksicht genommen werden (z. B. Hamburger Modell). In einigen Fällen mit erheblichen Einbußen kann eine medizinische Rehabilitation indiziert sein.

Summary

Patients with bipolar disorder suffer also during euthymic periods form cognitive impairments. Cognitive impairments are most probably the number one reason for occupational impairment and working difficulties. About 68% of all bipolar patients complain about such problems. The cognitive domains most often affected are attention, verbal memory, working memory and executive functioning. Memory deficits and impairment in executive functioning go hand in hand with worse psychosocial functioning. Length of illness duration, number of prior episodes (specifically manic episodes) and subsyndromal symptoms as well as some biological markers like for instance elevated homocysteine blood levels are associated with cognitive functioning in bipolar disorder. Compared to illness activity, medication seems not to negatively affect cognition in bipolar disorder, although further research is still warranted.

The early and sufficient acute and relapse preventing treatment which should include psychoeducation, remains the most efficient treatment and prevention strategy for cognitive deficits in bipolar disorder. After remission from an acute phase, cognitive impairments need to be considered during the vocational reintegration process (e. g. Hamburger Modell). In some cases with severe impairments also the use of vocational and medical rehabilitation can be indicated.

Schlüsselwörter

Bipolare Störungen - Kognition - kognitive Defizite

Keywords

Bipolar disorders - cognition - cognitive impairment
 

  • Literatur

  • 1 Arts B, Jabben N, Krabbendam L, van Os J. Metaanalyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychol Med 2008; 38 (06) 771-85.
    PubMedGoogle Scholar
  • 2 Bora E, Yucel M, Pantelis C. Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord 2009; 113 (1–2): 1-20.
    CrossrefPubMedGoogle Scholar
  • 3 Robinson LJ, Ferrier IN. Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disord 2006; 08 (02) 103-16.
    CrossrefPubMedGoogle Scholar
  • 4 Torres IJ, Boudreau VG, Yatham LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl 2007; 434: 17-26.
    Google Scholar
  • 5 Mann-Wrobel MC, Carreno JT, Dickinson D. Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disord 2011; 13 (04) 334-42.
    CrossrefPubMedGoogle Scholar
  • 6 Bourne C. et al. Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis. Acta Psychiatr Scand 2013; 128 (03) 149-62.
    CrossrefPubMedGoogle Scholar
  • 7 Tohen M. et al. Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am J Psychiatry 2000; 157 (02) 220-8.
    CrossrefPubMedGoogle Scholar
  • 8 Martínez-Arán A. et al. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004; 06 (03) 224-32.
    CrossrefPubMedGoogle Scholar
  • 9 Martínez-Arán A. et al. Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004; 161 (02) 262-70.
    CrossrefPubMedGoogle Scholar
  • 10 Daban C. et al. Specificity of cognitive deficits in bipolar disorder versus schizophrenia. A systematic review. Psychother Psychosom 2006; 75 (02) 72-84.
    CrossrefPubMedGoogle Scholar
  • 11 Albus M. et al. Neurocognitive functioning in patients with first-episode schizophrenia: results of a prospective 5-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2006; 256 (07) 442-51.
    CrossrefPubMedGoogle Scholar
  • 12 Martinez-Aran A. et al. Neurocognitive impairment in bipolar patients with and without history of psychosis. J Clin Psychiatry 2008; 69 (02) 233-9.
    CrossrefPubMedGoogle Scholar
  • 13 Selva G. et al. Bipolar I patients with and without a history of psychotic symptoms: do they differ in their cognitive functioning?. J Psychiatr Res 2007; 41 (3–4): 265-72.
    CrossrefPubMedGoogle Scholar
  • 14 Brissos S, Dias VV, Soeiro-de-Souza MG, Balanzá-Martínez V, Kapczinski F. The impact of a history of psychotic symptoms on cognitive function in euthymic bipolar patients: a comparison with schizophrenic patients and healthy controls. Rev Bras Psiquiatr São Paulo Braz 2011; 33 (04) 353-61.
    Google Scholar
  • 15 Torrent C. et al. Cognitive impairment in bipolar II disorder. Br J Psychiatry J Ment Sci 2006; 189: 254-9.
    CrossrefPubMedGoogle Scholar
  • 16 Harkavy-Friedman JM. et al. Are BPI and BPII suicide attempters distinct neuropsychologically?. J Affect Disord 2006; 94 (1–3): 255-9.
    CrossrefPubMedGoogle Scholar
  • 17 Kessler U. et al. Neurocognitive profiles in treatment-resistant bipolar I and bipolar II disorder depression. BMC Psychiatry 2013; 13: 105.
    CrossrefPubMedGoogle Scholar
  • 18 López-Jaramillo C. et al. Effects of recurrence on the cognitive performance of patients with bipolar I disorder: implications for relapse prevention and treatment adherence. Bipolar Disord 2010; 12 (05) 557-67.
    CrossrefPubMedGoogle Scholar
  • 19 Bonnín CM. et al. Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: a long-term, follow-up study. J Affect Disord. 2010 121. (1–2): 156-60.
    PubMedGoogle Scholar
  • 20 Kessing LV. Cognitive impairment in the euthymic phase of affective disorder. Psychol Med 1998; 28 (05) 1027-38.
    CrossrefPubMedGoogle Scholar
  • 21 Martínez-Arán A. et al. Cognitive dysfunctions in bipolar disorder: evidence of neuropsychological disturbances. Psychother Psychosom 2000; 69 (01) 2-18.
    CrossrefPubMedGoogle Scholar
  • 22 Martinez-Aran A. et al. Neuropsychological performance in depressed and euthymic bipolar patients. Neuropsychobiology 2002; 46 (Suppl. 01) 16-21.
    CrossrefPubMedGoogle Scholar
  • 23 Thompson JM. et al. Neurocognitive impairment in euthymic patients with bipolar affective disorder. Br J Psychiatry J Ment Sci 2005; 186: 32-40.
    CrossrefPubMedGoogle Scholar
  • 24 Aminoff SR, Hellvin T, Lagerberg TV, Berg AO, Andreassen OA, Melle I. Neurocognitive features in subgroups of bipolar disorder. Bipolar Disord 2013; 15 (03) 272-83.
    CrossrefPubMedGoogle Scholar
  • 25 Van Gorp WG, Altshuler L, Theberge DC, Wilkins J, Dixon W. Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study. Arch Gen Psychiatry 1998; 55 (01) 41-6.
    CrossrefPubMedGoogle Scholar
  • 26 Sanchez-Moreno J. et al. Neurocognitive dysfunctions in euthymic bipolar patients with and without prior history of alcohol use. J Clin Psychiatry 2009; 70 (08) 1120-7.
    CrossrefPubMedGoogle Scholar
  • 27 Larson EB, Yaffe K, Langa KM. New insights into the dementia epidemic. N Engl J Med 2013; 369 (24) 2275-7.
    CrossrefPubMedGoogle Scholar
  • 28 Dittmann S. et al. Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results. Bipolar Disord 2007; 09 (1–2): 63-70.
    CrossrefPubMedGoogle Scholar
  • 29 Elshahawi HH, Essawi H, Rabie MA, Mansour M, Beshry ZA, Mansour AN. Cognitive functions among euthymic bipolar I patients after a single manic episode versus recurrent episodes. J Affect Disord 2011; 130 (1–2): 180-91.
    CrossrefPubMedGoogle Scholar
  • 30 Savitz J, Solms M, Ramesar R. Neuropsychological dysfunction in bipolar affective disorder: a critical opinion. Bipolar Disord 2005; 07 (03) 216-35.
    CrossrefPubMedGoogle Scholar
  • 31 Tabarés-Seisdedos R. et al. Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up. J Affect Disord 2008; 109 (03) 286-99.
    CrossrefPubMedGoogle Scholar
  • 32 Gourovitch ML, Torrey EF, Gold JM, Randolph C, Weinberger DR, Goldberg TE. Neuropsychological performance of monozygotic twins discordant for bipolar disorder. Biol Psychiatry 1999; 45 (05) 639-46.
    CrossrefPubMedGoogle Scholar
  • 33 Zalla T. et al. Executive dysfunctions as potential markers of familial vulnerability to bipolar disorder and schizophrenia. Psychiatry Res 2004; 121 (03) 207-17.
    CrossrefPubMedGoogle Scholar
  • 34 Antila M, Tuulio-Henriksson A, Kieseppä T, Eerola M, Partonen T, Lönnqvist J. Cognitive functioning in patients with familial bipolar I disorder and their unaffected relatives. Psychol Med 2007; 37 (05) 679-87.
    CrossrefPubMedGoogle Scholar
  • 35 Kessing LV, Andersen PK. Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?. J Neurol Neurosurg Psychiatry 2004; 75 (12) 1662-6.
    CrossrefPubMedGoogle Scholar
  • 36 Colom F. et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003; 60 (04) 402-7.
    CrossrefPubMedGoogle Scholar
  • 37 Seemüller F. et al. [The challenge of treating bipolar outpatients]. Fortschr Neurol Psychiatr 2013; 81 (Suppl. 01) S35-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Martínez-Arán A. et al. Functional remediation for bipolar disorder. Clin Pract Epidemiol Ment Health CP EMH 2011; 07: 112-6.
    Google Scholar