Are There Core Neuropsychological Abnormalities in Bipolar Disorder?

Guy M. Goodwin, M.D.
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Abstract
The abnormalities of mania are underpinned by disturbance of brain function. Neuropsychological paradigms offer fresh insight into the links between symptomatology, elemental cognitive functions, and the underlying neural substrates of abnormal mental states. The renewed emphasis on identifying elemental psychological functions has led to the development of improved tests, especially of those functions believed to be subserved by prefrontal cortex, such as attention, working memory, planning, set learning, set shifting and decision making.

The manic phase of bipolar disorder is characterised by impaired performance across a range of tasks assessing executive, mnemonic and attentional functioning. However, two measures, verbal learning (the CVLT) and sustained attention (the RVIP), are particularly potent indicators of the deficit in mania, correctly classifying 87% of manic subjects and 91% of subjects overall. Additional tests do not contribute to the classification of manic subjects and therefore do not represent core markers of the manic state. In the euthymic state only performance on RVIP was impaired after controlling for low levels of affective symptoms. The effect was almost as large as in the acute group and appeared to reflect deterioration of sustained attention as bipolar disorder becomes more chronic. The CVLT was only impaired in patients with persisting affective symptoms.

The central tenet of recovery in bipolar patients has already been challenged by the high incidence of occupational and psychological difficulties during remission and independent neuroimaging reports of stable structural abnormalities and MRI signal hyperintensities in the brains of bipolar patients. The present findings confirm that there are functional consequences even in the euthymic state. Impaired sustained attention may represent a trait marker for bipolar disorder, related to vulnerability to the disorder at a structural and/or neurochemical level while impaired memory function is a state marker sensitive to mood elevation or depression.

Update on Pharmacotherapy

Paul E. Keck, Jr., M.D.
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Abstract
A number of new medications are being actively studied as potential treatments for patients with bipolar disorder. Broadly speaking, these medications fall into two main groups: the new antiepileptic agents and the atypical antipsychotics. This symposium will discuss the latest data from randomized, controlled trials regarding the efficacy and safety of these medications in studies of bipolar mania, depression and as maintenance treatment. Possible mechanisms by which these agents might exert therapeutic effects in bipolar disorder will also be discussed.

Part II:  "Updates on Stanley Foundation Programs in Bipolar Disorder"

Neuropathology

Paul Harrison, M.D., M.R.C.Psych.
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Abstract
'The neuropathology of bipolar disorder is finally receiving serious attention. This has come about for several reasons: MRI findings, progress in schizophrenia neuropathology and, pragmatically, the availability of tissue thanks to the Stanley Foundation Brain Bank. The cingulate gyrus is a focus of particular interest, with several positive findings indicative of abnormalities in neurons, synapses and glia. Similar results are also seen in other medial prefrontal regions and in the hippocampus and amygdala, together suggestive of a 'limbic pathology'. The data and their interpretation will be discussed, including a comparison with schizophrenia.

An Update on the Stanley Foundation Bipolar Network (SFBN)

Robert M. Post, M.D.
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Abstract

Not currently available.

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