title: Correlates of real world executive dysfunction in bipolar I disorder.
abstract: BACKGROUND
  Bipolar disorder is characterized by impairments in cognitive functioning, both during acute mood episodes and periods of euthymia, which interfere with functioning. Cognitive functioning is typically assessed using laboratory-based tests, which may not capture how cognitive dysfunction is experienced in real-life settings. Little is known about the specific illness characteristics of bipolar disorder that contribute to cognitive dysfunction in everyday life.
  
  
  METHODS
  Participants met DSM-IV criteria for bipolar I disorder (n = 68) in a depressed or euthymic state. Everyday executive functioning was evaluated using the Behavior Rating Inventory of Executive Functioning (BRIEF) and the Frontal Systems Behavior Rating Scale (FrSBe). Participants completed clinician rated measures of mood state (Hamilton Depression Rating Scale, Young Mania Rating Scale), prior illness course and co-morbidities (Mini International Neuropsychiatric Interview), as well as self-report measures of psychotropic medication use and medical co-morbidity.
  
  
  RESULTS
  Individuals in this study reported significant impairment in every domain of executive functioning. These deficits were associated with a multitude of illness factors, some directly impacted by mood symptoms and others shaped by illness chronicity, psychiatric comorbidity, medical co-morbidity, and medication use.
  
  
  CONCLUSIONS
  Executive functioning problems observed in everyday functioning in bipolar disorder are not entirely mood-state dependent. Cognitive rehabilitation for executive dysfunction should be considered an important adjunctive treatment for many individuals with bipolar disorder.
authors.affiliation: University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Amy T
authors.initials: AT
authors.lastname: Peters
authors.affiliation: Unversity of California at Berkeley, Berkeley, CA, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Peckham
authors.affiliation: Temple University, Philadelphia, PA, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Stange
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Hansen
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Salcedo
authors.affiliation: Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Rauch
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: tdeckersbach@partners.org.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D013223:Statistics as Topic; D055815:Young Adult
keywords: Bipolar; Cognition; Executive function