Background
Patients with bipolar disorder and schizophrenia have been shown to have neurocognitive
deficits when compared with control subjects. The degree and pattern of impairment
between psychiatric groups have rarely been compared, especially when subjects are
psychiatrically stable.
Methods
Using a standard neurocognitive battery, we compared euthymic outpatients with bipolar
disorder (n = 40), stable patients with schizophrenia (n = 20), and subjects with no psychiatric disorder (n = 22). The neurocognitive domains assessed included executive functioning, verbal
memory, visual memory, procedural learning, visuoconstructive ability, and language
functions. Effect sizes were calculated for each cognitive domain across groups.
Results
Stable schizophrenic subjects demonstrated a generalized cognitive impairment across
most domains compared with control subjects, with average effect sizes of .9. Euthymic
bipolar subjects were significantly impaired compared with control subjects only in
executive functioning (Wisconsin Card Sorting Task) and verbal memory (California
Verbal Learning Test) domains (effect sizes in the .8–.9 range). Performance on the
executive function measures was bimodal among bipolar subjects, suggesting two subgroups:
one with relatively normal and one with impaired executive functioning. No significant
differences between the bipolar patient group and control subjects were observed in
visuoconstructive ability, procedural learning, or language function.
Conclusions
Both euthymic bipolar subjects and relatively stable schizophrenic subjects differed
from control subjects in neurocognitive function. Among schizophrenic subjects, a
generalized cognitive impairment was observed, and the degree of impairment was greater
in the schizophrenic compared with the bipolar subjects. Subjects with bipolar disorder
were impaired in two specific domains (verbal memory and executive function). Furthermore,
within the bipolar group there was a subset with relatively normal executive functioning
and a subset with significant impairment. Possible reasons for the persistence of
these neurocognitive deficits in some subjects with bipolar disorder during periods
of euthymia are reviewed.
Key words
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References
- Contrasts in neuropsychological test profile between patients with first-episode schizophrenia and first-episode affective disorders.Acta Psychiatr Scand. 1996; 94: 87-93
- An MRI study of temporal lobe structures in men with bipolar disorder or schizophrenia.Biol Psychiatry. 2000; 48: 147-162
- Amygdala enlargement in bipolar disorder and hippocampal reduction in schizophrenia.Arch Gen Psychiatry. 1998; 55: 663-664
Altshuler LL, Bookheimer S, Proenza M, Townsend J, Sabb J, Firestine A, et al (in press): Increased amygdala activation during mania: A functional magnetic resonance imaging study. Am J Psychiatry.
- Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Press, Washington, DC1994
- Lithium and memory.Can J Psychiatry. 1987; 32: 312-316
- Behavioral inhibition, sustained attention and executive functions.Psychol Bull. 1997; 121: 65-94
- Psychological adjustment and adaptive impairments in young adults with ADHD.J Atten Disord. 1996; 1: 41-54
- Neuropsychological assessment of functional central nervous system disorders. I. Hemispheric functioning characteristics in schizophrenia and affective illness.Acta Psychiatr Scand. 1988; 78: 242-246
- Multilingual Aphasia Examination Manual–Revised.University of Iowa, Iowa City1978
- Volumetric brain imaging findings in mood disorders.Bipolar Disord. 2002; 4: 89-104
- Neuropsychology of first-episode schizophrenia.Am J Psychiatry. 2000; 157: 549-559
- Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder.Arch Gen Psychiatry. 2003; 60: 1201-1208
- Increased anterior cingulate and caudate activity in bipolar mania.Biol Psychiatry. 2000; 48: 1045-1052
- Reply to cognitive therapy and schizophrenia.Schizophr Bull. 1992; 18: 37-38
- Anatomical MRI findings in mood and anxiety disorders.Epidemiol Psichiatr Soc. 2002; 11: 88-99
- Sustained attention deficit in bipolar disorder.Br J Psychiatry. 1902; 180: 313-319
- Cognitive impairment and cerebral structure by MRI in bipolar disorder.Biol Psychiatry. 1990; 27: 1188-1196
- Interference effects of Stroop color-word test in childhood, adulthood and aging.J Genet Psychol. 1962; 100: 47-53
- California Verbal Learning Test.The Psychological Corporation, San Antonio1987
- Neuropsychological deficits in chronic schizophrenics. Relationship with symptoms and behavior.J Nerv Ment Dis. 1991; 179: 744-749
- Outpatients with schizophrenia and bipolar I disorder.Psychiatry Res. 2001; 102: 21-27
- Reduction of cingulate gray matter density in poor outcome bipolar illness.Psychiatry Res. 2004; 130: 153-159
- Subcortical abnormalities detected in bipolar affective disorder using magnetic resonance imaging. Clinical and neuropsychological significance.Arch Gen Psychiatry. 1990; 47: 55-59
- Electrophysiological and cognitive function in young euthymic patients with bipolar affective disorder.Bipolar Disord. 2001; 3: 79-87
- Impact of neuroleptic medications on continuous performance test measures in schizophrenia.Biol Psychiatry. 1996; 39: 902-905
- Neuropsychological function in euthymic patients with bipolar disorder.Br J Psychiatry. 1999; 175: 246-251
- On the safety of long-term treatment with lithium.Am J Psychiatry. 1977; 134: 1123-1126
- Cognitive deficits in schizophrenia on the WAIS-R NI Sentence Arrangement Subtest. Wechsler Adult Intelligence Scale-Revised Neuropsychological Inventory.J Clin Psychol. 1999; 55: 1085-1094
- The impact of symptomatic state and pharmacological treatment on cognitive functioning of patients with schizophrenia and mood disorders.in: Mohr E Brouwers P Handbook of Clinical Trials The Neurobehavioral Approach. Swets and Zeitlinger, Lisse, Netherlands1991: 185-214
Gold JM, Green MF (in press): Neurocognition in Schizophrenia. In: Kaplan HI, Sadock BJ, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. Baltimore: Lippincott, Williams & Wilkins.
- Neurocognitive functioning in patients with schizophrenia.in: Bloom F.E. Kupfer D.J. Psychopharmacology The Fourth Generation of Progress. Raven Press, New York1995: 1245-1257
- Contrasts between patients with affective disorders and patients with schizophrenia on a neuropsychological test battery.Am J Psychiatry. 1993; 150: 1355-1362
- What are the functional consequences of neurocognitive deficits in schizophrenia?.Am J Psychiatry. 1996; 153: 321-330
- Schizophrenia Revealed.W.W. Norton & Company, . New York1901
- Neurocognitive deficits and functional outcome in schizophrenia.Schizophr Bull. 1900; 26: 119-136
- Development and validation of a model for estimating premorbid verbal intelligence in the elderly.J Clin Exp Neuropsychol. 1991; 13: 933-949
- Impairments on neuropsychologic tests of temporohippocampal and frontohippocampal functions and word fluency in remitting schizophrenia and affective disorders.Arch Gen Psychiatry. 1988; 45: 623-629
- A rating scale for depression.J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
- Sustained attention deficit in bipolar disorder is not a working memory impairment in disguise.Neuropsychologia. 1902; 40: 1586-1590
- Outcome in manic disorders. A naturalistic follow-up study.Arch Gen Psychiatry. 1990; 47: 665-671
- Symptoms, cognitive functioning and adaptive skills in geriatric patients with lifelong schizophrenia.Am J Psychiatry. 1998; 155: 1080-1086
- Temporal lobe measurement in primary affective disorder by magnetic resonance imaging.J Neuropsychiatry Clin Neurosci. 1989; 1: 128-134
- Cognition, negative symptoms, and diagnosis.J Neuropsychiatry Clin Neurosci. 1997; 9: 81-89
- Neuropsychological deficits in schizophrenics. Relationship to age, chronicity and dementia.Arch Gen Psychiatry. 1994; 51: 469-476
- A Manual for the Wisconsin Card Sorting Test.Psychological Assessment Resources, . Odessa, Florida1981
- Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia, II.Am J Psychiatry. 1999; 156: 1951-1957
- Neuropsychological functioning of first-episode schizophreniform patients.Am J Psychiatry. 1992; 149: 898-903
- Lithium induced cognitive side-effects in bipolar disorder.Int Clin Psychopharmacol. 1999; 14: 167-171
- The contribution of neuropsychology to psychiatry.Am J Psychiatry. 1995; 152: 6-15
- Cognitive impairment in the euthymic phase of affective disorder.Psychol Med. 1998; 28: 1027-1038
- Neuropsychologic effects of lithium discontinuation.J Clin Psychopharmacol. 1993; 13: 268-275
- Regional prefrontal gray and white matter abnormalities in bipolar disorder.Biol Psychiatry. 2002; 52: 93-100
- Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome.Psychother Psychosom. 2002; 71: 39-46
- Performance on tests sensitive to impaired executive ability in schizophrenia, mania and well controls.Schizophr Res. 1997; 26: 127-137
- Neuropsychological function in manic-depressive psychosis. Evidence for persistent deficits in patients with chronic, severe illness.Br J Psychiatry. 1995; 167: 51-57
Meyer SE, Carlson GA, Wiggs EA, Martinez PE, Ronsaville DS, Klimes-Dougan B, et al (in press): A prospective study of the association among impaired executive functioning, childhood attentional problems and the development of bipolar disorder. Dev Psychopathol.
- Cognitive inflexibility and pre-frontal dysfunction in schizophrenia and mania.Br J Psychiatry. 1990; 157: 50-54
- Neurocognitive vulnerability factors for schizophrenia.in: Lenzenweger M.F. Dworkin R.H. Origins and Development of Schizophrenia Advances in Experimental Psychopathology. American Psychological Association, Washington, D.C1998: 299-327
- A heuristic vulnerability/stress model of schizophrenic episodes.Schizophr Bull. 1984; 10: 300-312
- Les test de copie d’une figure complexe; contribution de la perception et de la memoire. (Test of copying a complex figure; contribution to the study of perception and memory.Archives de Psychologie. 1944; 30: 206-356
- Cognitive impairment in the euthymic phase of chronic unipolar depression.J Nerv Ment Dis. 1997; 185: 748-754
- The relationship between thyroid status and neuropsychological performance in psychiatric outpatients on lithium.Neuropsychiatry Neuropsychol Behav Neurol. 1996; 9: 30-34
- The Halstead-Reitan Neuropsychological Test Battery.Neuropsychology Press, Tucson1985
- L’examen psychologique dans les cas d’encephalopathie traumatique. (The psychological examination in cases of traumatic encephalopathy.Archives de Psychologie. 1941; 28: 215-285
- Cognitive function in euthymic bipolar patients, stabilized schizophrenic patients and healthy controls.J Psychiatr Res. 1900; 34: 333-339
- Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder.Am J Psychiatry. 1900; 157: 466-468
- Mediational factors underlying cognitive changes and laterality in affective illness.Biol Psychiatry. 1987; 22: 979-986
- Halstead-Reitan Category Test in bipolar and unipolar affective disorders.J Nerv Ment Dis. 1980; 168: 297-304
- Neuropsychological function in schizophrenia. Selective impairment in memory and learning.Arch Gen Psychiatry. 1991; 48: 618-624
- Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia.Arch Gen Psychiatry. 1994; 51: 124-131
- Alterations in the functional anatomy of working memory in adult attention deficit hyperactivity disorder.Am J Psychiatry. 2000; 157: 278-280
- Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder.Neuropsychology. 2001; 15: 544-556
- A comparative profile analysis of neuropsychological functioning in patients with schizophrenia and bipolar psychoses.Schizophr Res. 2002; 53: 31-44
- An MRI study of subgenual prefrontal cortex in patients with familial and non-familial bipolar I disorder.J Affect Disord. 2003; 77: 167-171
- Brain magnetic resonance imaging of structural abnormalities in bipolar disorder.Arch Gen Psychiatry. 1999; 56: 254-260
- Relationships between medication treatments and neuropsychological test performance in schizophrenia.Psychiatry Res. 1991; 37: 297-308
- Information processing in schizophrenia and bipolar disorder.J Nerv Ment Dis. 1998; 186: 597-603
- Impaired neuropsychological performance in euthymic patients with recurring mood disorders.J Clin Psychiatry. 1997; 58: 26-29
- Four-year follow-up of twenty-four first-episode manic patients.J Affect Disord. 1990; 19: 79-86
- Declarative and procedural memory in bipolar disorder.Biol Psychiatry. 1999; 46: 525-531
- Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study.Arch Gen Psychiatry. 1998; 55: 41-46
- Training and quality assurance on the BPRS.Int J Methods Psychiatr Res. 1993; 3: 221-244
- Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P).Psychiatry Res. 1998; 79: 163-173
- Neuroleptic effects on neuropsychological test performance in schizophrenia.Schizophr Res. 1995; 14: 133-139
- Assessing children’s memory productions of the Rey-Osterrieth Complex Figure.J Clin Exp Neuropsychol. 1986; 8: 563-580
- Cognitive impairment, clinical course and treatment history in out-patients with bipolar affective disorder.Psychol Med. 1989; 19: 897-902
- Manual for the Wechsler Adult Intelligence Scale-Revised.The Psychological Corporation, New York1981
- Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. I. Regional cerebral blood flow evidence.Arch Gen Psychiatry. 1986; 43: 114-124
- Persistent attentional dysfunction in remitted bipolar disorder.Bipolar Disord. 2001; 3: 58-62
- Verbal memory deficits associated with major affective disorders.J Affect Disord. 1987; 13: 83-92
- A pilot family study of childhood-onset mania.J Am Acad Child Adolesc Psychiatry. 1995; 34: 1577-1583
- A rating scale for mania.Br J Psychiatry. 1978; 133: 429-435
- Cognitive deficits in schizophrenia and affective disorders.Acta Psychiatr Scand. 1998; 97: 351-357
- Cognitive function in euthymic bipolar I disorder.Psychiatry Res. 1901; 102: 9-20
Article info
Publication history
Accepted:
August 4,
2004
Received in revised form:
July 26,
2004
Received:
March 3,
2004
Identification
Copyright
© 2004 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
