Cognitive impairment in patients with a primary episode of bipolar affective disorder

  • Yu. I. Mysula I. Ya. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
Keywords: bipolar affective disorder, primary episode, cognitive functioning.


An increasing number of studies on cognitive impairment associated with bipolar disorder indicate the relevance of the topic in psychiatry. The aim of the study was to investigate the features of cognitive functioning of patients with primary episode of bipolar disorder, taking into account sex and clinical variant. According to the method of «Remembering the Ten Words», 153 patients were examined: with prevalence of depressive symptoms (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptoms or with rapid change of phases (6 men and 5 women). Statistical analysis was performed using the non-parametric Mann-Whitney test. It was found that in the depressive variant, the memorization curve was characterized by difficulties of fixing information and difficulty in holding it: 4.2±1.2 words, 4.6±1.4 words, 5.9±1.8 words, 5.8±1.4 words, 4.4±1.3 words, 2.6±1.4 words (in men – 4.2±1.4 words, 4.6±1.5 words, 6.1±1.9 words, 5.7±1.5 words, 4.4±1.3 words, 2.6±1.4 words, in women – 4.2±1.1 words, 4.5±1.4 words, 5,9±1.7 words, 5.8±1.3 words, 4.4±1.3 words, 2.5±1.3 words); at manic – rapid rise with subsequent decrease and the lowest reproduction rates in an hour: 4.7±1.3 words, 7.5±1.3 words, 7.2±1.3 words, 6.7±1.8 words , 4.7±1.0 words, 2.0±1.0 words (in men – 4.9±1.3 words, 7.3±1.3 words, 7.1±1.2 words, 6, 3±1.7 words, 4.7±0.9 words, 1.9±0.9 words, in women – 4.3±1.4 words, 7.9±1.4 words, 7.5±1,5 words, 7.5±1.7 words, 4.6±1.3 words, 2.3±1.2 words); when mixed – combined fixation difficulties and low reproduction rates: 4.5±0.9 words, 5.1±1.3 words, 5.9±1.1 words, 5.6±0.8 words, 4.2±1.1 words, 2.4±0.9 words (in men – 4.5±0.8 words, 5.5±1.0 words, 5.8±1.0 words, 5.8±0, 8 words, 4.5±1.0 words, 2.0±0.9 words, in women – 4.6±1.1 words, 4.6±1.5 words, 6.0±1.4 words, 5.4±0.9 words, 3.8±1.1 words, 2.8±0.8 words). Certain differences in cognitive impairment were found depending on the clinical version of the primary episode; however, the differences between men and women are insignificant. Further prospects are related to the improvement of methods for predicting and treating cognitive impairment in bipolar disorders.


[1] Almanac of psychological tests. Psychology of Personality. (1995). (pp. 92–-94). Moscow: KSP. ISBN: 5-88694-019-7.
[2] Baldessarini, R. J., Tondo, L., & Visioli, C. (2014). First-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatrica Scandinavica, 129, 383–-392. doi: DOI: 10.1111/acps.12204.
[3] Bora, E., & Pantelis, C. (2016). Social cognition in schizophrenia in comparison to bipolar disorder: a meta-analysis. Schizophr Res., 175, 72–-78. doi: 10.1016/j.schres.2016.04.018.
[4] Bora, E., Veznedaroğlu, B., & Vahip, S. (2016). Theory of mind and executive functions in schizophrenia and bipolar disorder: a cross-diagnostic latent class analysis for identification of neuropsychological subtypes. Schizophr Res., 176, 500–-505. doi: DOI: 10.1016/j.schres.2016.06.007.
[5] Borges, S. Q., Corrêa, T. X., Trindade, I. O., Amorim, R. F., & de Vilhena Toledo, M. A. (2019). Cognitive impairment in bipolar disorder Neuroprogression or behavioral variant frontotemporal dementia? Dementia & Neuropsychologia, 13(4), 475–-480. doi: DOI: 10.1590/1980-57642018dn13-040016.
[6] Bortolato, B., Miskowiak, K. W., Köhler, C. A., Vieta, E., & Carvalho, A. F. (2015). Cognitive dysfunction in bipolar disorder and schizophrenia: a systematic review of meta-analyses. Neuropsychiatr Dis Treat., 11, 3111–-3125. doi: doi: 10.2147/NDT.S76700.
[7] Chakrabarty, T., Alamian, G., Kozicky, J. M., Ivan, J. T., & Lakshmi, N. Y. (2018). Cognitive functioning in first episode bipolar I disorder patients with and without history of psychosis. Journal of Affective Disorders, 227, 109–-116. doi: DOI: 10.1016/j.jad.2017.10.003.
[8] Crump, C., Sundquist, K., Winkleby, M. A., & Sundquist, J. (2013). Comorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA Psychiatry, 70(9), 931–-939. doi: DOI: 10.1001/jamapsychiatry.2013.1394.
[9] del Mar Bonnín, C., Reinares, M., Martínez-Arán, A., Jiménez, E., Sánchez-Moreno, J., Solé, B., … & Vieta, E. (2019). Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. International Journal of Neuropsychopharmacology, 22(8), 467–-477. doi: DOI: 10.1093/ijnp/pyz018.
[10] Faedda, G. L., Serra, G., Marangoni, C., Salvatore, P., Sani, G., Vázquez, G. H., … & Koukopoulos, A. (2014). Clinical risk factors for bipolar disorders: a systematic review of prospective studies. J. Affect Disord., 168, 314–-321. doi: DOI: 10.1016/j.jad.2014.07.013.
[11] Forty, L., Ulanova, A., Jones, L., Jones, I., Gordon-Smith, K., Fraser, C., … & Craddock, N. (2014). Comorbid medical illness in bipolar disorder. British Journal of Psychiatry, 205, 465–-472. doi: DOI: 10.1192/bjp.bp.114.152249.
[12] Hayes, J. F., Miles, J., Walters, K., King, M., & Osborn, D. P. J. (2015). A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatrica Scandinavica, 131(6), 417–-425. doi: DOI: 10.1111/acps.12408.
[13] Lee, R. S. C., Hermens, D. F., Scott, J., Redoblado-Hodge, M. A., Naismith, S. L., Lagopoulos, J., … & Hickie, I. B. (2014). A meta-analysis of neuropsychological functioning in first-episode bipolar disorders. J. Psychiatr. Res., 57, 1–-11.
[14] Lera-Miguel, S., Andres-Perpina, S., Fatjo-Vilas, M., Fananas, L., & Lazaro, L. (2015). Two-year follow-up of treated adolescents with early-onset bipolar disorder: Changes in neurocognition. Journal of Affective Disorders, 172, 48–-54. doi: DOI: 10.1016/j.jad.2014.09.041.
[15] Lima, I. M. M., Peckham, A. D., & Johnson, S. L. (2015). Cognitive deficits in bipolar disorders: Implications for emotion. Clin. Psychol. Rev., 59, 126–-136. doi: DOI: 10.1016/j.cpr.2017.11.006.
[16] Martino, D. J., Samamé, C., Ibañez, A., & Strejilevich, S. A. (2015). Neurocognitive functioning in the premorbid stage and in the first episode of bipolar disorder: a systematic review. Psychiatry Res., 226, 23–-30. doi: 10.1016/j.psychres.2014.12.044.
[17] Marwaha, S., Durrani, A., & Singh, S. (2013). Employment outcomes in people with bipolar disorder: a systematic review. Acta Psychiatrica Scandinavica, 128(3), 179–-193. doi: DOI: 10.1111/acps.12087.
[18] Murri, B. M., Respino, M., Proietti, L., Bugliani, M., Pereira, B., D'Amico, E., … & Amore, M. (2019). Cognitive impairment in late life bipolar disorder: Risk factors and clinical outcomes. Journal of Affective Disorders, 257, 166–-172. doi: DOI: 10.1016/j.jad.2019.07.052.
[19] Passos, I. C., Mwangi, B., Vieta, E., Berk, M., & Kapczinski, F. (2016). Areas of controversy in neuroprogression in bipolar disorder. Acta Psychiatr Scand., 134, 91–-103. doi: doi: 10.1111/acps.12581.
[20] Patel, R., Shetty, H., Jackson, R., Broadbent, M., Stewart, R., Boydell, J., … & Taylor, M. (2015). Delays before diagnosis and initiation of treatment in patients presenting to mental health services with bipolar disorder. PLoS One, 10, 126–-129. doi: DOI: 10.1371/journal.pone.0126530.
[21] Ratheesh, A., Lin, A., Nelson, B., Wood, S. J., Brewer, W., Betts, J., & Bechdolf, A. (2013). Neurocognitive functioning in the prodrome of mania – an exploratory study. Journal of Affective Disorders, 147(1-3), 441–-445. doi: DOI: 10.1016/j.jad.2012.09.017.
[22] Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251–-269. doi: DOI: 10.1177/2045125318769235.
[23] Samamé, C., Martino, D. J., & Strejilevich, S. A. (2014). Longitudinal course of cognitive deficits in bipolar disorder: a meta-analytic study. J. Affect Disord., 164, 130–-138. doi: doi: 10.1016/j.jad.2014.04.028.
[24] Sanches, M., Bauer, I. E., Galvez, J. F., Zunta-Soares, G. B., & Soares, J. S. (2015). The Management of Cognitive Impairment in Bipolar Disorder: Current Status and Perspectives. Am. J. Ther., 22(6), 477–-486. doi: DOI: 10.1097/MJT.0000000000000120.
[25] Sofronov, A. G., Spikina, A. A., & Saveliev, A. P. (2012). Neurocognitive deficit and social functioning in schizophrenia: a comprehensive assessment and possible correction. Social and Clinical Psychiatry, 22 (1), 33–-37.
[26] Solé, B., Jiménez, E., Torrent, C., Reinares, M., del Mar Bonnin, C., Torres, I., … & Vieta, E. (2017). Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies. Int. J. Neuropsychopharmacol., 20(8), 670–-680. doi: DOI: 10.1093/ijnp/pyx032.
[27] Tseng, P. T., Zeng, B. S., Chen, Y. W., Wu, M. K., Wu, C. K., & Lin, P. Y. (2016). A meta-analysis and systematic review of the comorbidity between irritable bowel syndrome and bipolar disorder. Medicine (Baltimore), 95(33), e4617. doi: DOI: 10.1097/MD.0000000000004617.
[28] Xu, N., Huggon, B., & Saunders, K. E. A. (2020). Cognitive Impairment in Patients with Bipolar Disorder: Impact of Pharmacological Treatment. CNS Drugs, 34(1), 29–-46. doi: DOI: 10.1007/s40263-019-00688-2.
[29] Zhu, Y., Womer, F. Y., Leng, H., Chang, M., Yin, Z., Wei, Y., … & Wang, F. (2019). The Relationship Between Cognitive Dysfunction and Symptom Dimensions Across Schizophrenia, Bipolar Disorder, and Major Depressive Disorder. Front Psychiatry, 10, 253. doi: 10.3389/fpsyt.2019.00253
How to Cite
Mysula, Y. I. (2020). Cognitive impairment in patients with a primary episode of bipolar affective disorder. Biomedical and Biosocial Anthropology, (36), 5-10.