Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM).
BACKGROUND
Although manic episodes reportedly contribute to cognitive deficits in bipolar I disorder, the contribution of depressive episodes is poorly researched.


OBJECTIVE
We investigated the impact of depressive episodes on cognitive function early in the course of bipolar I disorder.


METHODS
A total of 68 patients and 38 controls from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM) first-episode mania programme were examined. We conducted (a) a cross-sectional analysis of the impact of prior depressive episodes on baseline cognitive function and (b) a prospective analysis assessing the contribution of depression recurrence within 1 year following a first episode of mania on cognitive functioning.


RESULTS
The cross-sectional analysis showed no significant differences between patients with past depressive episodes compared with those without, on overall or individual domains of cognitive function (all P>0.09). The prospective analysis failed to reveal a significant group×time interaction for cognitive decline from baseline to 1 year (P = 0.99) in patients with a recurrence of depressive episodes compared with those with no recurrence. However, impaired verbal memory at baseline was associated with a depression recurrence within 1 year.


CONCLUSIONS
Although deficits in all domains of cognitive function are seen in patients early in the course of bipolar disorder, depressive episodes do not confer additional burden on cognitive function. However, poorer verbal memory may serve as a marker for increased susceptibility to depression recurrence early in the course of illness.
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Kesavan
K
Muralidharan
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Ivan J
IJ
Torres
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Leonardo E
LE
Silveira
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Jan-Marie
JM
Kozicky
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Joana
J
Bücker
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Nadeesha
N
Fernando
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Lakshmi N
LN
Yatham
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D055815:Young Adult