September 4, 2019
Psychiatry Advisor
Laurel Ranger

Results of a recent study published in the Journal of Affective Disorders support the use of cognitive remediation (CR)/functional remediation (FR) in patients with bipolar disorder, with evidence of improvements in cognitive and functional domains.

CR was developed to target cognitive symptoms in those with traumatic brain injury and in patients with psychotic illnesses. Its efficacy in bipolar disorder has been explored only in the past decade. FR is an integrated intervention developed to restore psychosocial functioning by means of psychoeducation regarding cognitive dysfunctions and their impact on general functioning.

Marcella Bellani, MD, PhD, of the Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, and colleagues used a systematic literature review to identify studies that evaluated CR/FR in patients with bipolar disorder.

The investigators identified 11 studies for inclusion in the analysis. Three were randomized controlled trials that compared CR/FR with a control condition, five were secondary analyses that further examined data from these trials, two were single-arm studies, and one was a naturalistic study.

Overall, investigators determined that approaches that prioritized the systematic training of cognitive operations induced medium to large effects, primarily in problem solving, working memory, and processing speed. Specific cognitive strategies were associated with improved interpersonal, occupational, and psychosocial functioning.

“Findings from this review show cognitive and functional improvements as well as some promising reduction of depressive symptoms following CR/FR, and support their use in [bipolar disorder],” investigators wrote. They added, “The scarcity of currently published [randomized controlled trials] as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.

“[If] we are to develop and implement CR/FR interventions for [bipolar disorder] that are robust and efficient, predictors of treatment response, including potential subdiagnostic differences and cognitive endophenotypes within [bipolar disorder], should be identified,” the investigators concluded.