title: Performance monitoring and executive control of attention in euthymic bipolar disorder: employing the CPT-AX paradigm.
abstract: Reduced cognitive test performance has been demonstrated in patients with bipolar disorder (BD), even when euthymic. Several studies have explored aspects of attention, including sustained attention, and reported patients show lower accuracy compared to controls. It is necessary to modify existing attentional paradigms to fully characterise such deficits. The present study sought to examine if there are changes in the profile of performance and error-types during a sustained attention task in BD. Twenty-two euthymic patients with DSM-IV diagnosed BD and 21 healthy controls were recruited. Participants completed a modified CPT-AX paradigm with a high proportion of target trials (70%) with cues and probes presented at continuous intervals. This modification increases the demands on response inhibition and permits the deconstruction of attentional/executive deficits previously described. Overall, BD patients showed significantly poorer target discriminability compared to controls. In block one (first quarter) of the task, patients showed no significant differences to controls, but by the final fourth block (last quarter) they made significantly fewer hits and more errors (both 'AX' misses and 'BX' false alarms). BD patients completed initial stages of the task similarly to controls, but as demands on the attentional system continued difficulties emerged, consistent with problems in context-maintenance.
authors.affiliation: Institute of Neuroscience (Academic Psychiatry), Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, NE4 5PL, UK.
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Robinson
authors.forename: Jill M
authors.initials: JM
authors.lastname: Thompson
authors.forename: Peter
authors.initials: P
authors.lastname: Gallagher
authors.forename: John M
authors.initials: JM
authors.lastname: Gray
authors.forename: Allan H
authors.initials: AH
authors.lastname: Young
authors.forename: I Nicol
authors.initials: IN
authors.lastname: Ferrier
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology; D016022:Case-Control Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011597:Psychomotor Performance / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D013647:Task Performance and Analysis
keywords: Affective disorders; Cognition; Mood disorders; Neuropsychology