Acta Psychiatrica Scandinavica最新文献

Introduction: Individuals hospitalized with depression are particularly impacted by cognitive impairment. Identifying variables that predict improvements in cognition across treatment may inform more targeted and effective treatment approaches. We conducted secondary analyses to investigate baseline predictors of objective cognitive change in a severely depressed inpatient sample.

Methods: A randomized controlled trial (RCT) comparing 2 weeks of Activation Therapy (AT; Cognitive Activation combined with Behavioural Activation) with treatment-as-usual (TAU) was conducted in inpatients with major depression. Research assessments were conducted at baseline (on admission) and at 14 weeks (12 weeks after treatment-end). A series of analyses of covariance models were conducted to examine associations between change in executive functioning/attention, verbal learning and memory, visuospatial learning and memory, and psychomotor speed, in global cognition, and a range of putative baseline predictor variables (e.g., demographic, mood, cognition, general functioning, childhood trauma) across the whole RCT sample. Treatment arm was included as a fixed factor in all models. Sensitivity analyses were run in the AT group only to examine predictors of cognitive change in those receiving this targeted cognitive treatment.

Results: Sixty-eight individuals completed baseline and follow-up cognitive testing assessments in the RCT (AT, n = 32, TAU, n = 36). Significantly poorer domain-specific baseline cognitive functioning was associated with greater cognitive improvement in all four domains. Older age was associated with less cognitive change in verbal learning and memory, visuospatial learning and memory, psychomotor speed, and global cognition. Sensitivity analyses (AT group only) identified these same factors as significant predictors.

Conclusion: Age and domain-specific baseline cognitive performance were consistently associated with cognitive change in this RCT. Findings suggest that cognition seems to recover better in younger inpatients with poorer baseline cognitive functioning.

Clinical registration: Australian New Zealand Clinical Trials Registry [ANZCTR], ACTRN12617000024347p.

Introduction: Cognitive impairment is well-established in bipolar disorder and significantly impacts daily functioning. However, the relationship between self-evaluated cognitive functions and objective cognitive tests is inconsistent. This heterogeneity in cognitive function necessitates flexible and accessible testing methods. An Internet-based test platform can address this need. This study examines cognitive function in individuals with bipolar disorder in full or partial remission using an Internet-based test platform. It explores associations with subjective cognitive function and clinical severity.

Methods: In this cross-sectional study, the Memoro Internet-based cognitive test platform was used to assess objective cognitive functions. We recruited 84 participants with bipolar disorder type I or II in full or partial remission at the time of assessment, aged 18 to 65 years, from a bipolar outpatient clinic at a university hospital. We examined the completion rates of cognitive tests, reported technical issues, and differences between cognitively normal and impaired groups. Subjective cognition was measured using Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA).

Results: A total of 84 participants completed the Memoro assessment of objective cognitive performance. No significant differences were observed in the completion rates of cognitive subtests or reported technical issues across groups. Of the participants, 61.9% were classified as cognitively normal, while 38.1% had cognitive impairments. 86.9% reported cognitive complaints. Correlation analysis indicated relationships between cognitive complaints (COBRA), symptoms of anxiety, and verbal memory. Multiple regression analyses identify symptoms of anxiety and age as significant predictors of verbal immediate recall and cognitive complaints.

Conclusion: Objective measurements showed fewer cognitive problems than subjective reports. Additionally, anxiety symptoms may contribute to overreporting cognitive complaints.

Clinical registration: ClinicalTrials.gov identifier: NCT04454073.

Introduction: Aberrant cognition is common among individuals at familial risk for mood disorders (MD) and those already affected. However, long-term prospective studies are needed to determine whether specific cognitive features predict illness onset and relapse; and whether cognitive impairments reflect neurodevelopmental traits or neuroprogressive decline.

Methods: This seven-year prospective study examined the relationship between cognition and illness progression in monozygotic twins with mood disorders, their healthy high-risk monozygotic co-twins, and low-risk twins without a family history. Emotional and non-emotional cognition was assessed at baseline (n = 204) and follow-up (n = 124). Cox regression models tested whether baseline cognition predicted future illness onset in unaffected individuals (n = 89) or relapse in affected ones (n = 112). Longitudinal cognitive changes were analyzed using mixed models.

Results: Greater attentional vigilance toward consciously processed happy faces at baseline was associated with a reduced risk of both illness onset (Exp(B) = 0.995, CI [0.990; 1.000], p = 0.03) and relapse (Exp(B) = 0.997, CI [0.995; 0.999], p = 0.003). Paradoxically, better verbal fluency at baseline was linked to an increased risk of illness onset (Exp(B) = 1.589, CI [1.204; 2.097], p < 0.001). Over time, onset was associated with increasing avoidance of subliminal fearful faces (group-by-time interaction, p < 0.001), whereas avoidance decreased in those who remained well. Verbal fluency declined in twins who developed a mood disorder (p = 0.02) but remained stable in those who stayed unaffected. No significant longitudinal cognitive differences emerged between affected twins with and without relapse.

Conclusions: Positive attentional biases may protect against illness onset and relapse, while greater baseline verbal fluency may unexpectedly signal vulnerability. Verbal fluency decline after illness onset likely reflects scar effects. The findings underscore the importance of early identification of cognitive-emotional vulnerabilities and suggest targets for preventive interventions.