The effects of cognitive remediation on cognitive abilities and real-world functioning among people with bipolar disorder: A systematic review: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders.
Affective disorder
Bipolar disorder
Cognitive remediation
Functional remediation
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 10 2019
01 10 2019
Historique:
received:
30
05
2019
revised:
16
07
2019
accepted:
17
07
2019
pubmed:
5
8
2019
medline:
26
6
2020
entrez:
5
8
2019
Statut:
ppublish
Résumé
Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD. In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD. Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements. In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.
Sections du résumé
BACKGROUND
Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD.
METHODS
In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD.
RESULTS
Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements.
CONCLUSIONS
In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.
Identifiants
pubmed: 31377606
pii: S0165-0327(19)31424-7
doi: 10.1016/j.jad.2019.07.059
pmc: PMC6711788
mid: NIHMS1536896
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
691-697Subventions
Organisme : NIMH NIH HHS
ID : R43 MH114765
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
Références
J Clin Psychiatry. 2003 Jan;64(1):86-93
pubmed: 12590629
Psychol Med. 2004 Jul;34(5):811-21
pubmed: 15500302
J Affect Disord. 2006 Mar;91(1):53-6
pubmed: 16413611
J Affect Disord. 2006 Jul;93(1-3):105-15
pubmed: 16677713
Clin Pract Epidemiol Ment Health. 2007 Jun 07;3:5
pubmed: 17555558
Am J Psychiatry. 2009 Sep;166(9):1055-62
pubmed: 19570929
Expert Rev Neurother. 2009 Jul;9(7):957-66
pubmed: 19589046
BMJ. 2009 Jul 21;339:b2535
pubmed: 19622551
CNS Neurosci Ther. 2010 Oct;16(5):298-307
pubmed: 19895584
Am J Psychiatry. 2011 May;168(5):472-85
pubmed: 21406461
Clin Pract Epidemiol Ment Health. 2011;7:112-6
pubmed: 21687565
J Affect Disord. 2012 Dec 15;142(1-3):13-21
pubmed: 22840620
Am J Psychiatry. 2013 Aug;170(8):852-9
pubmed: 23511717
Acta Psychiatr Scand. 2013 Sep;128(3):149-62
pubmed: 23617548
Psychiatry Res. 2013 Nov 30;214(2):142-52
pubmed: 23993991
Bipolar Disord. 2014 May;16(3):217-29
pubmed: 24219657
Eur Neuropsychopharmacol. 2015 Feb;25(2):257-64
pubmed: 24906790
Am J Ther. 2015 Nov-Dec;22(6):477-86
pubmed: 25383489
PLoS One. 2015 Jun 12;10(6):e0127955
pubmed: 26070195
Psychol Med. 2016 Jan;46(2):291-301
pubmed: 26387583
Br J Psychiatry. 2016 Jan;208(1):87-93
pubmed: 26541692
Bipolar Disord. 2015 Dec;17 Suppl 2:41-55
pubmed: 26688289
Neuropsychiatr Dis Treat. 2015 Dec 17;11:3111-25
pubmed: 26719696
J Affect Disord. 2016 Apr;194:9-15
pubmed: 26800305
Psychiatr Rehabil J. 2017 Mar;40(1):53-60
pubmed: 27100095
JMIR Ment Health. 2016 Dec 13;3(4):e52
pubmed: 27965190
Eur Neuropsychopharmacol. 2017 Apr;27(4):350-359
pubmed: 28126401
Int J Bipolar Disord. 2017 Dec;5(1):8
pubmed: 28168631
Psychiatr Rehabil J. 2017 Mar;40(1):61-69
pubmed: 28368180
Neuropsychiatr Electrophysiol. 2017;3:null
pubmed: 28845238
J Clin Psychiatry. 2017 Nov/Dec;78(9):e1242-e1249
pubmed: 29045770
J Psychopharmacol. 2018 Oct;32(10):1075-1085
pubmed: 29969938