Official Journal of the International Academy of Integrative Anthropology
DOI: 10.31393
ISSN 1861-031Х
eISSN 2616-6208
Biomedical and Biosocial
№ 36, 2019
Scientific peer-reviewed journal in the fields of medicine, biology, anthropology and ecology
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Vinnytsya 2019
Biomedical and Biosocial Anthropology
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Mysula Yu. I. Cognitive impairment in patients with a primary episode of bipolar affective disorder .................... 5
Mateshuk-Vatseba L. R., Hirniak I. I. Features of the structural organization of the interlobular
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Tamm Т. I., Nepomnyaschy V. V., Shakalova O. А., Barduck А. Ya. Intestine wall histostructure
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Proskurina O. F., Yavorovenko M. F. Modern aspects of social protection of combatants depending
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Lysytsia Yu. N., Rymsha S. V. Anxiety and depressive disorders in children of early adolescence ................. 41
Halei M. M., Dziubanovskyi I. Ya., Marchuk I. P. Comparison of quality of life in postoperative
patients with cholecystolithiasis and choledocholithiasis. The difference between open and
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Fiks D. O. Correlations of medical and demographic indicators with unmodified factors of stroke,
tactics of its management and condition of the patient at hospitalization ......................................................... 52
Bartiuk R. S. Cerebral small vessel disease and its impact on the course and outcome of stroke .................. 58
Cognitive impairment in patients with a primary episode of bipolar
affective disorder
Mysula Yu. I.
I. Ya. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
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, 4.1.3 words, 2.1.4 words; in women - 4.2±1.1 words, 4.1.4 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 - 4.1.4 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, 2.0.9 words; in women - 4.6±1.1 words, 4.6±1.5 words, 6.1.4 words,
5.4±0.9 words, 3.8±1.1 words, 2.0.8 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
Keywords: bipolar affective disorder, primary episode, cognitive functioning.
Received: 3 June, 2019
Accepted: 10 July, 2019
UDC: 616.895.1- 616.895.6
Mysula Yu. I.
2019 National Pirogov Memorial Medical University, Vinnytsya
DOI: 10.31393/bba36-2019-01
Biomedical and Biosocial Anthropology, №36, Pages 5-10
ISSN 1861-031X eISSN 2616-6208
Bipolar affective disorder (BAD) is one of the most
pressing problems in modern psychiatric science and
practice. BAD has significant medical and social significance
due to its high prevalence, high level of concomitant somatic
morbidity and mortality from comorbid pathology and
accidents, as well as high suicidal activity [8, 10, 17, 20, 22].
Of particular importance for the quality treatment and
rehabilitation of patients with BAD is timely diagnosis of the
disease at the initial stages. Recent studies have shown
that the nature of future bipolar disorder is largely determined
by the features of its primary episode (PE), which determines
the relevance of the study of primary manifestations of this
pathology and improvement of prodromal identification tools
[2, 10, 11, 27].
An important component of the complex of
psychopathological changes in BAD is cognitive impairment,
which are detected at the pre-nosological stage and are
manifested both in the manic and depressive phase, and
during intermission [5, 7, 9, 21]. Cognitive disorders in BAD
are represented by a wide range of disorders, among which
- violations of the formal characteristics of thinking and its
content, executive functions, attention and memory [14, 18,
Official Journal of the International Academy
of Integrative Anthropology
journal homepage:
ISSN1861-031X eISSN 2616-6208 Biomedical and Biosocial Anthropology
Cognitive impairment in patients with a primary episode of bipolar affective disorder
24, 26]. At the same time, the peculiarities of cognitive
disorders in PE BAD are currently insufficiently studied due
to significant methodological and technical difficulties,
which complicates the development of therapeutic,
rehabilitation and preventive measures for BAD. Based on
this, the study of cognitive impairment in patients with PE
BAD has important scientific and practical significance.
The aim of the study was to investigate the features of
cognitive functioning of patients with the primary episode
of BAD, considering gender and the clinical variant of the
disease onset.
Materials and methods
In accordance with the principles of biomedical ethics,
on the basis of informed consent, we clinically examined
153 patients (65 men and 88 women) with an initial episode
of BAD who were treated at the Ternopil Regional
Psychoneurological Hospital in 2011-2016.
Among the examined men and women, we identified
three groups depending on the clinical variant of PE BAD:
with a predominance of depressive symptoms (depressive
variant), the number of 119 people (mean age 21.6.4 years
(median 19.0 years, interquartile range 17.0-23.0 years),
mean age of seeking medical care 21.5±6.4 years (19.0
years, 17.0-23.0 years)): 44 men (mean age 20.9±6.3 years,
respectively (18.0 years, 17.0-23.0 years), and 21.0±6.2
years (18.0 years, 17.0-23.5 years)) and 75 women (mean
age 21.7±6.5 years (19.0 years, 18.0-23.0 years) and
21.8±6.5 years (19.0 years, 18.0-23.0 years)); with a
predominance of manic or hypomanic symptoms (manic
variant), number of 23 persons (mean age, respectively,
20.5±7.5 years (18.0 years, 17.0-20.0 years), and 20.6±7.6
years (18.0 years, 17.0-20.0 years)): 15 men (mean age
19.2±3.8 years (18.0 years, 17.0-20.0 years) and 19.2±3.8
years (18.0 years, 17.0-20.0 years)) and 8 women (mean
age 23.1±11.8 years, respectively (19.5 years, 18.5-20.5
years). years) and 23.1±11.8 years (19.5 years, 18.5-20.5
years)), and with the simultaneous presence of depressive
and manic symptoms or with a rapid change of phases
(mixed version), the number of 11 people (mean age 21.4±5.4
years, (19.0 years, 18.0-26.0 years), and 21.5.2 years (19.0
years, 18.0-26.0 years)): 6 men (mean age 20.8±6.7 years,
respectively (18.5 years, 17.0-21.0 years) and 21.2±6.4 years
(18.5 years, 18.0-21.0 years)) and 5 women (mean age,
respectively, 22.2±4.0 years (20.0 years, 19.0-26.0 years)
and 22.2±4.0 years (20.0 years, 19.0-26.0 years)).
The survey was conducted using the test "Memorization
of ten words" by A. R. Luria [1].
Statistical analysis was performed using the
nonparametric Mann-Whitney test. The level of statistical
significance of differences over 95.0 % (p<0.05) was
considered acceptable.
The analysis of disorders in the cognitive sphere of
patients with different variants of PE BAD revealed some
differences associated with the peculiarities of the clinical
manifestations of the onset of the disease (Table 1).
In the depressive variant, the memory curve was
characterized by difficulties in recording information and
the difficulty of its retention: the maximum number of
memorized words was reached on the third or fourth
presentation and was characterized by low quantitative
values, then the memory curve gradually decreased, and
due to one hour patients were able to reproduce an average
of no more than three words. In general, 4.2±1.2 words were
memorized at the first presentation, 4.6±1.4 words at the
second, 5.9±1.8 words at the third, 5.8±1.4 words at the
fourth, 4.4±1.3 words at the fifth, through one hour - 2.6±1.4
words (Fig. 1). Such features reflect the difficulty of recording
information, slow mental processes and rapid fatigue,
inherent in a depressed state.
In the manic variant, another type of memory curve was
observed: with a rapid rise and achievement of the maximum
on the second - third presentation, and its subsequent
decrease; while the indicators of word reproduction after
one hour in patients with a manic variant of PE BAR were the
worst among all groups. The average value of memorization
at the first presentation was 4.7±1.3 words, at the second
presentation - 7.5±1.3 words, at the third presentation -
7.2±1.3 words, at the fourth presentation - 6.7±1.8 words, at
to the fifth presentation - 4.7±1.0 words, in one hour - 2.0±1.0
Patients with a mixed variant of PE BAD also showed
severe memory difficulties, and the curve differs from that
found in the manic variant of PE BAD and is similar to that
found in the depressive variant. At the first presentation,
patients memorized an average of 4.5±0.9 words, at the
second presentation - 5.1±1.3 words, at the third
presentation - 5.9±1.1 words, at the fourth presentation -
5.6±0.8 words, at the fifth presentation - 4.2±1.1 words, after
one hour - 2.4±0.9 words.
The analysis of the peculiarities of the test "Memorization
of ten words" considering gender differences revealed that
the profiles of men with depressed PE BAD are characterized
by inertia in memorization and a small number of words that
patients were able to remember (Fig. 2). The maximum
number of words that could be memorized falls on the third
presentation, while the average number of words in the first
presentation in men was 4.2±1.4 words, in the second
presentation - 4.6±1.5 words, in the third presentation
phenomenon - 6.1±1.9 words, at the fourth presentation -
5.7±1.5 words, at the fifth presentation - 4.4±1.3 words, in
one hour - 2.6±1.4 words.
In the manic variant of PE BAD, the memory profile in
men is characterized by maximum values in the second or
third presentations with a rapid decrease in the number of
words as the test continues. Thus, the average number of
words that the patient was able to remember, at the first
presentation was 4.9±1.3 words, at the second presentation
- 7.3±1.3 words, at the third presentation - 7.1±1.2 words, at
the fourth presentation. phenomenon - 6.3±1.7 words, at
№36, Page 5-10
Mysula Yu. I.
the fifth presentation - 4.7±0.9 words, after one hour - 1.9±0.9
In the mixed version of PE BAD, the memorization profile
is characterized by smoothing with a relatively low number
of words memorized by patients and a slow decrease in
time. Thus, the average number of words memorized by the
patient at the first presentation was 4.5±0.8 words, at the
second - 5.5±1.0 words, at the third - 5.8±1.0 words, at the
fourth presentation - 5.8±0.8 words, at the fifth presentation
- 4.5±1.0 words, in one hour - 2.0±0.9 words.
In women, the memorization profile was slightly different
from that of men (Fig. 3).
In the depressive variant of PE BAD, the memory curve
is characterized by maximum values in the third and fourth
presentation with approximately the same values in the
first, second and fifth presentations. The average value of
the indicator on the test was: at the first presentation 4.2±1.1
words, at the second presentation - 4.5±1.4 words, at the
Indicator (M± / Me (Q
total men women
Depressed version of PE BAD
First presentation 4.2±1.2 / 4.0 (3.0-5.0) 4.2±1.4 / 4.0 (3.0-5.0) 4.2±1.1 / 4.0 (3.0-5.0) >0.05
Second presentation 4.6±1.4 / 4.0 (3.0-5.0) 4.6±1.5 / 4.0 (3.0-6.0) 4.5±1.4 / 4.0 (3.0-5.0) >0.05
Third presentation 5.9±1.8 / 6.0 (5.0-7.0) 6.1±1.9 / 6.0 (5.0-7.0) 5.9±1.7 / 6.0 (5.0-7.0) >0.05
Fourth presentation 5.8±1.4 / 6.0 (5.0-7.0) 5.7±1.5 / 6.0 (5.0-7.0) 5.8±1.3 / 6.0 (5.0-7.0) >0.05
Fifth presentation 4.4±1.3 / 4.0 (3.0-5.0) 4.4±1.3 / 4.0 (3.0-5.0) 4.4±1.3 / 4.0 (3.0-5.0) >0.05
After one hour 2.6±1.4 / 2.0 (2.0-3.0) 2.6±1.4 / 2.0 (2.0-3.0) 2.5±1.3 / 2.0 (1.0-4.0) >0.05
Manic version of PE BAD
First presentation 4.7±1.3 / 4.0 (4.0-6.0) 4.9±1.3 / 5.0 (4.0-6.0) 4.3±1.4 / 4.0 (3.0-5.0) >0.05
Second presentation 7.5±1.3 / 7.0 (6.0-9.0) 7.3±1.3 / 7.0 (6.0-8.0) 7.9±1.4 / 8.5 (6.5-9.0) >0.05
Third presentation 7.2±1.3 / 7.0 (6.0-8.0) 7.1±1.2 / 7.0 (6.0-8.0) 7.5±1.5 / 7.5 (6.5-9.0) >0.05
Fourth presentation 6.7±1.8 / 7.0 (5.0-8.0) 6.3±1.7 / 6.0 (5.0-8.0) 7.5±1.7 / 8.0 (6.0-9.0) >0.05
Fifth presentation 4.7±1.0 / 5.0 (4.0-6.0) 4.7±0.9 / 5.0 (4.0-5.0) 4.6±1.3 / 4.5 (3.5-6.0) >0.05
After one hour 2.0±1.0 / 2.0 (1.0-3.0) 1.9±0.9 / 2.0 (1.0-3.0) 2.3±1.2 / 3.0 (1.5-3.0) >0.05
Mixed version of PE BAD
First presentation 4.5±0.9 / 4.0 (4.0-5.0) 4.5±0.8 / 4.0 (4.0-5.0) 4.6±1.1 / 5.0 (4.0-5.0) >0.05
Second presentation 5.1±1.3 / 5.0 (4.0-6.0) 5.5±1.0 / 5.5 (5.0-6.0) 4.6±1.5 / 4.0 (4.0-5.0) >0.05
Third presentation 5.9±1.1 / 6.0 (5.0-7.0) 5.8±1.0 / 5.5 (5.0-7.0) 6.0±1.4 / 6.0 (6.0-6.0) >0.05
Fourth presentation 5.6±0.8 / 6.0 (5.0-6.0) 5.8±0.8 / 6.0 (5.0-6.0) 5.4±0.9 / 6.0 (5.0-6.0) >0.05
Fifth presentation 4.2±1.1 / 4.0 (3.0-5.0) 4.5±1.0 / 4.5 (4.0-5.0) 3.8±1.1 / 3.0 (3.0-5.0) >0.05
After one hour 2.4±0.9 / 2.0 (2.0-3.0) 2.0±0.9 / 2.0 (1.0-3.0) 2.8±0.8 / 3.0 (2.0-3.0) >0.05
Table 1. Quantitative characteristics of indicators according to the test "Memorization of ten words" by A. R. Luria in the examined
patients, considering gender and clinical variant of PE BAD.
Fig. 1. Memorization curve according to the test "Memorization of
ten words" by A. R. Luria in all examined patients.
Fig. 2. Memorization curve according to the test "Memorization of
ten words" by A. R. Luria in men.
third presentation - 5.9±1.7 words, at the fourth presentation
- 5.8±1.3 words, at the fifth presentation - 4.4±1.3 words, in
one hour - 2.5±1.3 words.
In the manic variant, the memory curve in women is
characterized by a rapid increase with a peak at the second
presentation (although the quantitative characteristics of
memory in this group of patients are relatively low) with
approximately equal averages in the third and fourth
presentations. In the future, the number of words
decreases, and in an hour is almost no different from that
found in the depressive variant. The average value of the
test was: at the first presentation: 4.3±1.4 words, at the
second presentation - 7.9±1.4 words, at the third
presentation - 7.5±1.5 words, at the fourth presentation -
7.5±1.7 words, at the fifth presentation - 4.6±1.3 words, in
one hour - 2.3±1.2 words.
The mixed variant of PE BAD is characterized by a
specific memory curve with a relatively slow increase and
low values, followed by a rapid decline: at the first
presentation of 4.6±1.1 words, at the second presentation
of 4.6±1.5 words, at the third presentation of 6.0±1.4 words,
at the fourth presentation 5.4±0.9 words, at the fifth
presentation 3.8±1.1 words, in one hour 2.8±0.8 words.
Such features, in our opinion, reflect the heterogeneity of
this group in clinical symptoms, as well as the instability of
the emotional state with rapid phase change, inherent in
the mixed version of PE BAD.
In general, differences in the rates between men and
women in all presentations in all clinical variants of PE
BAD were not statistically significant (p>0.05).
When comparing groups with different clinical variants,
significant differences were found when comparing groups
of patients with depressive and manic (p<0.01), and with
manic and mixed (p<0.05) variants of PE BAD.
On the raised problem today, it is known that cognitive
dysfunction is considered as the main sign of bipolar
disorder [26]. Neurocognitive deficit is not considered specific
for bipolar disorder. Thus, it is known that up to 94 % of
patients with schizophrenia show neurocognitive deficits [25].
There is also evidence that in bipolar disorder cognitive
decline (impaired attention, verbal learning and memory,
impaired executive function), along with other
neurobiochemical changes, is present in all phases of the
disease, including premorbid stages before the disease
[16], in the early stages of the disease [4], in the primary
episode, does not depend on mood and condition [13], are
detected during euthymia [6].
However, patients with bipolar disorder are characterized
by variability in psychosocial functioning, which suggests
the existence of several neurocognitive subtypes among
them. According to Bora E. et al. (2016) neurocognitive
variability may reflect the etiological heterogeneity of bipolar
disorder, including potentially different subtypes associated
with different genetic susceptibility factors [3]. One of them is
characterized by normal cognitive functioning, the decrease
in cognitive functions of which is influenced by the number
of recurrent affective episodes [23]. However, the progress
of the violation after repeated episodes remains unclear.
Another subtype includes patients in whom the pattern of
cognitive impairment is similar to that of schizophrenia and
is characterized by low premorbid cognitive function before
the onset of the disease, which may be associated with
disorders of the nervous system. Obviously, such patients
will have common genetic risk factors for schizophrenia.
Therefore, early detection of such patients, who will
develop a neuroprogressive disorder, which is largely
decisive for the social prognosis of the disease, labor and
social maladaptation of patients, is an urgent problem of
psychiatry [19].
In our study, we found patterns of cognitive impairment in
PE BAD. The data obtained by us are consistent with the
results of studies by a number of authors [5, 9], who
emphasize the pronounced cognitive impairment in patients
with BAD, mainly in the form of a deficit of executive function,
attention and memory. Our data fit into the context of modern
ideas about cognitive impairment as one of the earliest
manifestations of BAD, which occur both at the nosological
[15, 28] and at the prenosological stage [29]. At the same
time, our selection of individual clinical variants of PE BAD
(depressive, manic and mixed) allowed to establish certain
differences in cognitive dysfunction depending on the clinical
variant of PE, which should be considered when assessing
the cognitive functions of patients with PE BAD.
Prospects for further research are related to the
development of comprehensive programs for early prediction
of cognitive impairment in BAD, and the development of
therapeutic and diagnostic measures to correct cognitive
disorders, which will reduce the risk of recurrence, prevent
complications and improve patients' quality of life.
1. The primary episode of BAD is characterized by
severe cognitive impairment.
2. Significant in determining the characteristics of
cognitive impairment is the clinical variant of the primary
Fig. 3. Memorization curve according to the test "Memorization of
ten words" by A. R. Luria in women.
ISSN1861-031X eISSN 2616-6208 Biomedical and Biosocial Anthropology
Cognitive impairment in patients with a primary episode of bipolar affective disorder
episode: depressive, manic or mixed.
3. In the depressive variant there are difficulties in
recording information and the difficulty of its retention, in
the manic - instability of attention with rapid displacement
of information from memory, and in the mixed - a combined
violation of memorization of information.
4. Gender differences in cognitive impairment in the
primary episode of BAD are not expressed.
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