Psychiatry Research EG

This book is an example of an original idea to transform MD and Phd theses into books. This work was initiated by ‘Lap Lambert Academic Publishing’ in order to make use of the effort and time spent to prepare such research with the enthusiastic young researchers. The first part of the book is a review of the literature of bipolar spectrum, cognitive functions, cognitive functions of bipolar disorder, and neurological soft signs (NSS). Chapter 1 discusses the concept of a bipolar spectrum: The concept of a broad bipolar spectrum provided by Akiskal is based mainly on Kraepelin’s unitary theory about the manic-depressive continuum. Kraepelin stated that there are many patients who begin with depression and end up with mania and vice versa; other depressives may go as far as hypomania but not beyond. There were also patients who have a cyclical course without excited episodes but who are temperamentally similar to manicdepressive patients. Some authors have documented that the classical figure of 0.4–1.6% for bipolar disorder is too conservative, and that at least 5% of the community manifests bipolarity. The most common mental disorders that co-occur with bipolar disorder in community studies include anxiety, substance use, and conduct disorders. Disorders of eating, sexual behavior, attention-deficit/hyperactivity, and impulse control as well as autism spectrum disorders and Tourette’s disorder co-occur with bipolar disorder in clinical samples. Chapter 2 describes the cognitive functions in general: Most theories describe cognition as the ability to recognize and process complex tasks adequately. It depends on the function of a complex interrelated and distributed neuronal network. Neuropsychological test batteries are designed to examine various domains of cognition, such as memory, attention, vigilance, visuospatial ability, language and verbal function, concept formation, problem solving, and executive functions. Examples of cognitive functions are as follows: (a) global cognitive function; (b) executive functions; (c) memory functions; (d) attention and vigilance; (e) concept formation; (f) verbal functions; (g) visuospatial functions; and (h) psychomotor speed. Cognitive dysfunction in bipolar disorder is discussed in chapter 3. Kraeplin differentiated manic-depressive illness (bipolar affective disorder) from dementia praecox (schizophrenia) on the basis that those with the former tended to experience full remission, whereas the latter did not. However, with reference to manic-depressive illness, in 1913, he added: ‘usually, all morbid manifestations disappear; but where that is exceptionally not the case only rather slight peculiar a psychic weakness develops’. Although there may be qualitative differences in the remission state of these two conditions, there is accumulating evidence that recovery in bipolar disorder is not complete. Cognitive deficits have been measured in bipolar patients in euthymic or asymptomatic states as well as in acute disorder. Persistent psychosocial difficulties and cognitive deficits are common in patients with bipolar disorder even in the euthymic or the asymptomatic state. Although several studies have confirmed a good outcome for bipolar patients, a subgroup of 5–34% has consistently been described as having a poor social outcome, poor response to treatment, or even intellectual impairment that persisted after clinical recovery.