This thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and...Show moreThis thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and subjectively. Previous studies have established that a long delay occurs between the onset of mood symptoms in BD and the first form of treatment received, estimates ranging between 6 and 11 years. Cognitive impairments in the domains of executive functions, processing speed and memory were found to persist in BD patients even during euthymia. Such cognitive impairments burden BD patients, prevent them from regaining an appropriate level of general functioning and diminish their quality of life. Thus, in order to determine whether treatment delay impacts the cognitive impairments present in BD, 69 participants were followed over the course of one year, at three different time points. The participants took part in clinical interviews, and then were asked to complete multiple measures, such as the YMRS, the QIDS, four WAIS subscales (Block Design, Arithmetic, Information and Digit symbol), and the Cognition subscale of the WHODAS. The average treatment delay found in the current sample was 14.53 years. The results of the current study suggest that longer treatment delays did not significantly predict worse cognitive functioning in BD patients, either when measured subjectively, or when measured objectively.Show less
Bipolar disorder (BD), characterized by fluctuations of mood and motivation, depicts behavioral and neurological impairments in reward processing. These impairments seem to be related to anhedonia....Show moreBipolar disorder (BD), characterized by fluctuations of mood and motivation, depicts behavioral and neurological impairments in reward processing. These impairments seem to be related to anhedonia. The clinical assessment of anhedonia is associated with anticipatory experience of pleasure (AEP). Deficits in AEP in major depressive disorder (MDD) and schizophrenia (SCZ) seem to predict a lower effort expenditure for reward. BD is underrepresented in AEP studies, and AEP’s effect on effort expenditure. More research is needed to determine if AEP is in deficit; and if improving this can decrease disability and mortality rates in BD. This study aims to confirm deficits in AEP and effort expenditure in BD and explore possible interactions between BD, AEP, and effort. Data was obtained from the Positive Valence study. 46 BD patients (59% female, M age = 57.6 years, SD = 11.2) and 39 controls (46% female, M age = 49.2 years, SD = 14.1) participated. Participants completed the Temporal Experience of Pleasure Scale (TEPS), a self-report measure to score AEP, and the multi-trial Effort Expenditure for Reward Task (EEFRT). This study found a group difference in effort expenditure (p = .012), but not in AEP (p = .963), nor an interaction effect between group + AEP and effort (p = .407). AEP did not predict effort within the BD group (p = .488). This study found that BD patients expended less effort than healthy controls but found no deficits in AEP. It was proposed that anhedonia could be a deficit in consummatory pleasure instead of AEP in BD. More research for AEP in BD is needed to conclude if no deficits occur at all (accounting for the presence/severity of depressive symptoms, medication use, and treatment). Future research in effort expenditure in BD should control for psychomotor activity. This study states that the similarity between BD, MDD and SCZ is overestimated and that therapeutic interventions should be tailored specifically to BD.Show less
Patients with bipolar disorder type I (BD-I) who consume alcohol, experience stronger than average negative effects from this consumption, as it leads to lower adherence to treatment and increased...Show morePatients with bipolar disorder type I (BD-I) who consume alcohol, experience stronger than average negative effects from this consumption, as it leads to lower adherence to treatment and increased suicide attempts. Independently, excessive alcohol consumption is associated with lower reward anticipation, which is a mechanism that helps making decisions that minimize harm. Using the concept of reward anticipation, this observational and crosssectional study, aimed to understand the relation between BD-I and alcohol consumption. Understanding this relation could eventually help improve treatment of alcohol related problems among BD-I patients. First is hypothesized that BD-I diagnosis is related to more alcohol consumption, second that lower reward anticipation is related to more alcohol consumption, and third that lower reward anticipation is stronger related to more alcohol consumption in BD-I patients than control participants. Reward anticipation was studied both objectively, with a Monetary Incentive Delay Task (MID), and subjectively, with the Positive Valence Systems Scale (PVSS-21). This created an opportunity to include a fourth hypothesis that the MID and the PVSS-21 are correlated. In collaboration with the Erasmus MC, participants completed online surveys and games to measure reward anticipation and alcohol consumption. The participants included 35 BD-I patients (20 female, Mage = 55.94, SDage = 11.17) and 15 control participants (6 female, Mage = 49.08, SDage = 13.35). First, no relation between BD-I diagnosis and alcohol consumption (OR = .87, 95%CI [.21, 3.59]) was found. Second, no relation between reward anticipation (ORMID = 1.20, 95%CI [.91, 1.57]; ORPVSS = 1.01, 95%CI [.97, 1.05]) and alcohol consumption was found. Third, no stronger relation between reward anticipation (ORMID = 1.20, 95%CI [.88, 1.63]; ORPVSS = 1.00, 95%CI [.99, 1.01]) and alcohol consumption for BD-I patients was found. Fourth, no correlation between scores MID and the PVSS-21 was found (r (50) = .18, p = .21). The results, conflicting with previous research, are likely influenced by the small amount of alcohol consumed by the participants. Making it difficult to make conclusions about the relation between BD-I diagnosis, reward anticipation and alcohol consumption. Further research is recommended with a larger group of participants with more age distribution.Show less
Intellectual deficits have been known as a core feature of bipolar disorder for decades and are hypothesized to be responsible for the unfavorable psychosocial outcome and high unemployment rates....Show moreIntellectual deficits have been known as a core feature of bipolar disorder for decades and are hypothesized to be responsible for the unfavorable psychosocial outcome and high unemployment rates. Those alterations seem to be permanent and are present not only during active- but also during euthymic phases. The focus of this study was on investigating a possible link between mood symptoms, assessed through the clinician-rated questionnaire YMRS and the self-rated QIDS, and the IQ together with cognitive abilities in four different domains. Measured was the performance of 50 recently diagnosed patients participating in the BINCO-study. Furthermore, the focus was on observing differences in scoring between different symptomatic states and the two types of disorder. The impact of confounders, including the intake of antipsychotic medication, benzodiazepines, and the educational level, were considered. While no significant association between depressive symptoms and the subscale-derived IQ could be detected, a quadratic relation was found between manic symptoms and SDIQ score, pointing towards lower scoring in patients with subclinical symptoms and higher performance in patients with mild to moderate symptoms. The QIDS-score significantly impacted the performance in the sub-scale „information”, which provides the verbal comprehension index. The YMRS- score again showed a curvilinear association with the same subtest. The intake of antipsychotic medication seemed to show the greatest confounding effect on the dependent variable. Further research is needed to elucidate the effect of manic symptoms on IQ and verbal comprehension, as well as the role of antipsychotic medication. Also, larger sample sizes would determine the actual impact of each mood phase on the IQ.Show less
