Cognitive performance of post-covid patients in mild, moderate, and severe clinical situations.

BACKGROUND: Studying individuals with varying symptoms, from mild to severe, can provide valuable insights into the spectrum of cognitive outcomes after COVID-19. We investigated the cognitive performance of adults who recovered from the novel coronavirus disease (COVID-19) without prior cognitive complaints, considering mild (not hospitalized), moderate (ward), and severe (intensive care unit) symptoms. METHODS: This cross-sectional study included 302 patients who recovered from COVID-19 (mild, n = 102; moderate, n = 102; severe, n = 98). We assessed intellectual quotient (IQ), attention, memory, processing speed, visual-constructive ability, as well as symptoms of depression, anxiety, and stress, at least eighteen months after infection. The mean length of hospitalization was Mdays=8.2 (SD = 3.9) and Mdays=14.4 (SD = 8.2) in the moderate and severe groups, respectively. RESULTS: Cognitive difficulties were present in all three groups: mild (n = 12, 11.7%), moderate (n = 40, 39.2%), and severe (n = 48, 48.9%). Using Multinomial Logistic Regression and considering the odds ratio, our results indicated that a one-point increase in sustained attention, visual memory, and working memory might decrease the odds of being categorized in the severe group by 20%, 24%, and 77%, respectively, compared to the mild group. CONCLUSIONS: Our findings provide empirical evidence regarding the long-term cognitive effects of COVID-19, particularly in individuals experiencing severe manifestations of the disease. We also highlighted the need for a comprehensive, multidimensional approach in rehabilitation programs to address the enduring cognitive impacts of COVID-19.

Behavioral self-regulation in pediatric bipolar disorder and healthy offspring of bipolar patients.

OBJECTIVES: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. METHODS: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. CONCLUSIONS: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.

Behavioral self-regulation in pediatric bipolar disorder and healthy offspring of bipolar patients

Objectives: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. Methods: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Results: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. Conclusions: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.

Cognitive Processes and Legal Capacity in Patients With Bipolar Disorder: A Brief Research Report.

The current study verified the association between cognitive process such as attention, executive functioning, and legal capacity in patients with bipolar disorder (BD). The sample consisted of 72 participants, assorted to episodic patients (n = 21), euthymic patients (n = 22), and healthy controls (HCs) (n = 29). We used the following neuropsychological measures: subtests of the Wechsler Abbreviated Intelligence Scale (WASI): vocabulary and matrix reasoning; Continuous Performance Test (CPT); Five Digit Test (FDT); and Rey-Osterrieth Complex Figure (ROCF). Euthymic patients expressed slower processing speed (FDT) compared to HC. They tended to make more errors with slightly worse discrimination, suggesting more impulsiveness (CPT, p < 0.01). On the contrary, episodic patients showed worse discrimination, committed more omissions, were more inconsistent with regard to response speed (CPT-3, p < 0.01), showed more difficulties in organizing their actions (ROCF: copy, p = 0.03), and were more rigid (FDT: flexibility, p = 0.03). The results suggest that bipolar patients in episode express more cognitive impairments that can compromise the quality of legal capacity. These results highlight the need for more protective support for episodic BD patients regarding legal capacity.

Exploratory study on the psychological impact of COVID-19 on the general Brazilian population.

The COVID-19 pandemic has become one of the main international concerns regarding its impact on mental health. The present study aims to investigate the prevalence of depression, anxiety, and stress symptoms, and behavioral aspects amidst the COVID-19 pandemic in a Brazilian population. An online survey was administered from May 22 to June 5, 2020 using a questionnaire comprising of sociodemographic information, the Depression, Anxiety, and Stress Scale (DASS-21), and the Coping Strategies Inventory. Participants comprised 3,000 people from Brazil's 26 states and the Federal District, with an average age of 39.8 years, women (83%), married (50.6%), graduates (70.1%) and employees (46.7%). Some contracted the virus (6.4%) and had dead friends or relatives (22.7%). There was more consumption of drugs, tobacco, medication, and food (40.8%). Almost half of participants expressed symptoms of depression (46.4%), anxiety (39.7%), and stress (42.2%). These were higher in women, people without children, students, patients with chronic diseases, and people who had contact with others diagnosed with COVID-19. The existence of a group more vulnerable to situations with a high stress burden requires greater attention regarding mental health during and after the pandemic. That said, it should be emphasized that these findings are preliminary and portray a moment still being faced by many people amid the pandemic and quarantine measures. Therefore, we understand that the magnitude of the impacts on mental health will only be more specific with continuous studies after total relaxation of the quarantine.

Cognitive behavioral rehabilitation for bipolar disorder patients: A randomized controlled trial.

OBJECTIVES: Bipolar disorder is frequently associated with cognitive impairment even during euthymia. Previous studies have reported significant impairments in functional and quality of life outcomes and a possible relationship between these variables and cognitive performance. Cognitive rehabilitation interventions have been proposed to address these outcomes but positive results are still scarce. The objective of the present study is to evaluate the efficacy of a new intervention developed to address both cognitive and functional impairment. METHODS: Thirty-nine individuals were included in this randomized controlled trial. All participants were evaluated by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and completed functional and quality of life (QOL) scales. Patients were randomized to either treatment as usual (TAU) or Cognitive Behavior Rehabilitation (CBR), an add-on treatment delivered in 12 weekly group sessions. All individuals were revaluated after 12 weeks. RESULTS: A total of 39 bipolar type I or II patients were included in the analysis, 19 in the TAU group and 20 in the CBR condition. At the entrance of the study, both groups were statistically similar regarding clinical, socio-demographics and cognitive variables. After the end of the intervention, CBR individuals had significantly improved reaction time, visual memory and emotion recognition. In contrast, individuals in the CBR did not present a statistically change in functional and QOL scores after the 12-week intervention. CONCLUSIONS: CBR intervention showed promising results in improving some of the commonly impaired cognitive domains in BD. A longer follow-up period may be necessary to detect changes in functional and QOL domains.

The association between social skills deficits and family history of mood disorder in bipolar I disorder

Objective: To compare social skills and related executive functions among bipolar disorder (BD) patients with a family history of mood disorders (FHMD), BD patients with no FHMD and healthy control (HCs). Methods: We evaluated 20 euthymic patients with FHMD, 17 euthymic patients without FHMD, and 31 HCs using the Social Skills Inventory (SSI) and a neuropsychological battery evaluating executive function, inhibitory control, verbal fluency and estimated intelligence. Results: Both BD groups had lower SSI scores than controls. Scores for one subfactor of the social skills questionnaire, conversational skills and social performance, were significantly lower among patients with FHMD than among patients without FHMD (p = 0.019). Both groups of BD patients exhibited significant deficits in initiation/inhibition, but only BD patients with FHMD had deficits in verbal fluency, both compared to HC. There were no associations between social skills questionnaire scores and measures of cognitive function. Conclusion: Euthymic BD patients have lower social skills and executive function performance than HC. The presence of FHMD among BD patients is specifically associated with deficits in conversational and social performance skills, in addition to deficits in verbal fluency. Both characteristics might be associated with a common genetically determined pathophysiological substrate.

The association between social skills deficits and family history of mood disorder in bipolar I disorder.

OBJECTIVE: To compare social skills and related executive functions among bipolar disorder (BD) patients with a family history of mood disorders (FHMD), BD patients with no FHMD and healthy control (HCs). METHODS: We evaluated 20 euthymic patients with FHMD, 17 euthymic patients without FHMD, and 31 HCs using the Social Skills Inventory (SSI) and a neuropsychological battery evaluating executive function, inhibitory control, verbal fluency and estimated intelligence. RESULTS: Both BD groups had lower SSI scores than controls. Scores for one subfactor of the social skills questionnaire, conversational skills and social performance, were significantly lower among patients with FHMD than among patients without FHMD (p = 0.019). Both groups of BD patients exhibited significant deficits in initiation/inhibition, but only BD patients with FHMD had deficits in verbal fluency, both compared to HC. There were no associations between social skills questionnaire scores and measures of cognitive function. CONCLUSION: Euthymic BD patients have lower social skills and executive function performance than HC. The presence of FHMD among BD patients is specifically associated with deficits in conversational and social performance skills, in addition to deficits in verbal fluency. Both characteristics might be associated with a common genetically determined pathophysiological substrate.

Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder.

OBJECTIVE: Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF). METHOD: We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Diagnosis of the offspring was determined through the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) interview. RESULTS: There were statistically significant differences between aBDF, uBDF and CF in cohesion (p = 0.003), intellectual-cultural orientation (p = 0.01), active-recreational orientation (p = 0.007), conflict (p = 0.001), control (p = 0.01), moral-religious emphasis (p = 0.01) and organization (p = 0.001). The aBDF showed higher levels of control (p = 0.02) when compared to the uBDF. CONCLUSIONS: Families with a BD parent presented more dysfunctional interactions among members. Moreover, the presence of BD or other psychiatric disorders in the offspring of parents with BD is associated with higher levels of control. These results highlight the relevance of psychosocial interventions to improve resilience and family interactions.

A clinical study comparing manic and mixed episodes in patients with bipolar disorder.

OBJECTIVE: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. METHOD: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. RESULTS: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. CONCLUSION: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.

A clinical study comparing manic and mixed episodes in patients with bipolar disorder

OBJECTIVE: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. METHOD: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. RESULTS: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. CONCLUSION: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.

OBJETIVO: Estados mistos têm sido descritos como mais graves que episódios de mania, especialmente pela maior duração dos episódios, maiores taxas de suicídio, hospitalização e sintomas psicóticos. O objetivo deste estudo foi comparar a severidade entre episódios mistos e mania pura definidos segundo critérios do DSM-IV, avaliando-se características clínicas e sociodemográficas dos pacientes. MÉTODO: Vinte e nove pacientes bipolares do tipo I em estado misto foram comparados a 20 pacientes bipolares do tipo I em episódio de mania aguda de acordo com os critérios do DSM-IV. Analisou-se transversalmente a duração dos episódios, presença de sintomas psicóticos, tentativa de suicídio, hospitalização, escores da Escala de Sintomas de Mania de Young, escores da Escala de Depressão de Hamilton e Escala de Avaliação Clínica Global. RESULTADOS: As pontuações na escala de avaliação de mania de Young foram maiores nos episódios de mania quando comparadas às de episódios mistos. Não houve diferença estatisticamente significativa na freqüência de gêneros, nas pontuações da CGI, nas taxas de hospitalização, tentativa de suicídio e sintomas psicóticos entre episódios mistos e de mania. Pacientes com episódio agudo misto tinham idade menor que pacientes em episódio agudo de mania. CONCLUSÃO: Em nossa amostra, episódios mistos ocorreram em idade menor que em episódios de mania. Ao contrário da literatura, não houve diferenças significativas entre episódios de mania e mistos no que se refere à severidade da sintomatologia, exceto para a pontuação de sintomas de mania, que foi maior em pacientes em mania aguda. Isto pode ser explicado, em parte, pela diferença nos critérios adotados por estudos anteriores.

[Neuropsychological disturbances in bipolar disorder]. / Alterações neuropsicológicas no transtorno bipolar.

OBJECTIVE: Systematic literature review of the controlled studies published in the last 15 years on neuropsychological deficits in Bipolar Disorder. METHOD: Bibliographical research was completed through Medline, Lilacs, PubMed and ISI, specifically for 1990 to 2005 period. Selected studies were organized beginning with the comparison among the selected sample (bipolar versus other pathology versus control healthy). We included only controlled studies with a patient sample larger than 10, and 73 papers were found, being that 53 selected for this systematic review. RESULTS: Patients with Bipolar Disorder present difficulties in several cognitive domains which partially persist even after acute episodes acute episodes. The deficits impaired basically the executive functions. When compared to schizophrenia, bipolar patients present milder deficits in the neuropsychological tests, which may explain differences in terms of disease outcome and specific circuitry abnormalities. There was a positive correlation between cognitive deficits and number of episodes or hospitalizations. The medications used for mood stabilization can produce a negative impact on cognition. CONCLUSIONS: The abnormalities suggest a dysfunction in specific frontostriatal circuits, and may partially explain the difficulties in the psychosocial adaptation of these patients. Future studies should evaluate the effectiveness of neuropsychological rehabilitation programs, which seek through cognitive training to minimize the impact of these deficits in the every day life.

Alterações neuropsicológicas no transtorno bipolar / Neuropsychological disturbances in bipolar disorder

OBJETIVO: Revisão sistemática dos estudos controlados publicados nos últimos 15 anos sobre alterações neuropsicológicas no transtorno bipolar. MÉTODO: Foi realizado um levantamento bibliográfico no Medline, Lilacs, PubMed e ISI, selecionando-se o período de 1990 a 2005. Os estudos foram organizados a partir da comparação entre a amostra selecionada (bipolar versus outra patologia versus controles saudáveis). Nós só incluímos estudos controlados e com uma amostra de pacientes maior que 10, totalizando 73 artigos, do quais 53 foram selecionados para esta revisão. RESULTADOS: Pacientes com transtorno bipolar apresentam dificuldades em vários domínios cognitivos, sendo que alguns persistem mesmo após remissão dos sintomas. Os déficits encontrados se localizaram basicamente nas funções executivas. Na comparação com pacientes portadores de esquizofrenia, os bipolares apresentam perfil de alterações cognitivas mais leves, o que aponta para diferenças em termos de prognóstico da doença e para anormalidades em circuitos neuroanatômicos específicos. Houve correlação positiva entre déficits cognitivos e número de episódios ou internações. As medicações utilizadas para estabilização do humor podem ter um impacto negativo na cognição. CONCLUSÕES: Os prejuízos são sugestivos de disfunção em circuitos fronto-estriatais específicos que podem, em parte, explicar as dificuldades na adaptação psicossocial destes pacientes. Estudos futuros devem avaliar a eficácia de programas de reabilitação neuropsicológica, os quais visam, por meio de treinos cognitivos, minimizar o impacto dos déficits encontrados na vida diária dos pacientes.

OBJECTIVE: Systematic literature review of the controlled studies published in the last 15 years on neuropsychological deficits in Bipolar Disorder. METHOD: Bibliographical research was completed through Medline, Lilacs, PubMed and ISI, speciafically for 1990 to 2005 period. Selected studies were organized beginning with the comparison among the selected sample (bipolar versus other pathology versus control healthy). We included only controlled studies with a patient sample larger than 10, and 73 papers were found, being that 53 selected for this systematic review. RESULTS: Patients with Bipolar Disorder present difficulties in several cognitive domains which partially persist even after acute episodes acute episodes. The deficits impaired basically the executive functions. When compared to schizophrenia, bipolar patients present milder deficits in the neuropsychological tests, which may explain differences in terms of disease outcome and specific circuitry abnormalities. There was a positive correlation between cognitive deficits and number of episodes or hospitalizations. The medications used for mood stabilization can produce a negative impact on cognition. CONCLUSIONS: The abnormalities suggest a dysfunction in specific frontostriatal circuits, and may partially explain the difficulties in the psychosocial adaptation of these patients. Future studies should evaluate the effectiveness of neuropsychological rehabilitation programs, which seek through cognitive training to minimize the impact of these deficits in the every day life.