The long-term course of cognition in bipolar disorder: a systematic review and meta-analysis of patient-control differences in test-score changes

Samamé, C., Cattaneo, B. L., Richaud, M. C., Strejilevich, S., & Aprahamian, I. (2021). The long-term course of cognition in bipolar disorder: a systematic review and meta-analysis of patient-control differences in test-score changes. Psychological medicine, 1–12. Advance online publication.

  • “Neuropsychological impairment represents a key aspect of bipolar disorder (BD) that is evident even in early-course patients and is a strong predictor of functional outcomes among those affected. Previous meta-analyses of longitudinal studies suggest that BD-related cognitive deficits may not progress along the course of the disorder. However, short test-retest periods were used in most primary studies and comparisons with healthy controls were limited.”
  • “The aim of this review was to synthesize the findings of research reports comparing long-term neurocognitive trajectories between BD patients and healthy individuals. PubMed, PsycINFO, and Scopus databases were searched from inception through July 2021. Publications were considered for inclusion if they reported cognitive test scores of BD patients and healthy controls at two different time points, with a minimum test-retest interval of 5 years.”
  • “No significant differences were found between patients and controls regarding long-term cognitive outcomes. These findings are consistent with previous shorter-term longitudinal meta-analyses and do not provide evidence for progressive cognitive deterioration in most bipolar individuals. Future studies should address the longitudinal course of cognition in different subgroups of BD patients and its prognostic and therapeutic value.”

What not to use in bipolar disorders: a systematic review of non-recommended treatments in clinical practice guidelines

Gomes, F. A., Cerqueira, R. O., Lee, Y., Mansur, R. B., Kapczinski, F., McIntyre, R. S., Yatham, L. N., Berk, M., Milev, R., & Brietzke, E. (2021). What not to use in bipolar disorders: a systematic review of non-recommended treatments in clinical practice guidelines. Journal of affective disorders, S0165–0327(21)01225–8. Advance online publication. https://doi.org/10.1016/j.jad.2021.11.007

  • “Clinical practice guidelines (CPG) are an important tool for implementation of evidence-based clinical care. Despite clinical trials showing lack of efficacy of some agents in bipolar disorder (BD), they are still frequently prescribed in clinical practice. The objective of this study was to systematically review the CPG recommendations on pharmacological interventions with evidence against their use due to lack of efficacy data and/or due to serious safety concerns.”
  • “A systematic literature search identified 29 guidelines published by national and international organizations during the 1994–2020 period. Information was extracted regarding how the recommendations framed non-use of treatments in particular clinical situations as well as the actual recommendation in the guideline.”
  • “Twenty-three guidelines (79%) mentioned at least one non-recommended treatment. The terms used to qualify recommendations varied amongst guidelines and included: “not recommended” “no recommendation” and “negative evidence”. Lamotrigine, topiramate and gabapentin were commonly cited as non-recommended treatments for mania and most CPG did not recommend monotherapy with antidepressants, aripiprazole, risperidone, and ziprasidone for treatment of acute bipolar depression. Most guidelines made recommendations about lack of efficacy data or potential harm in treatments for BD but there is a significant variation in the way this information is conveyed to the reader.”
  • “Limitations: Non-recommended treatments were based on their use for BD episodes or maintenance but specific medications may benefit patients when treating comorbid conditions.”
  • “Conclusions: The absence of a uniform language and recommendations in current guidelines may be an additional complicating factor in the implementation of evidence-based treatments in BD.”

Affective lability as a prospective predictor of subsequent bipolar disorder diagnosis: a systematic review

Taylor, R. H., Ulrichsen, A., Young, A. H., & Strawbridge, R. (2021). Affective lability as a prospective predictor of subsequent bipolar disorder diagnosis: a systematic review. International journal of bipolar disorders, 9(1), 33. https://doi.org/10.1186/s40345-021-00237-1

  • “Objectives: The early pathogenesis and precursors of Bipolar Disorder (BD) are poorly understood. There is some cross-sectional and retrospective evidence of affective lability as a predictor of BD, but this is subject to recall biases. The present review synthesises the prospective evidence examining affective lability and the subsequent development of BD at follow-up.
  • “Methods: The authors performed a systematic search of PubMed, PsycInfo and Embase (1960-June 2020) and conducted hand searches to identify studies assessing affective lability (according to a conceptually-inclusive definition) at baseline assessment in individuals without a BD diagnosis, and a longitudinal follow-up assessment of bipolar (spectrum) disorders. Results are reported according to the PRISMA guidelines, and the synthesis without meta-analysis (SWiM) reporting guidelines were used to strengthen the narrative synthesis. The Newcastle-Ottawa Scale was used to assess risk of bias (ROB).”
  • “Results: 11 articles describing 10 studies were included. Being identified as having affective lability at baseline was associated with an increased rate of bipolar diagnoses at follow-up; this association was statistically significant in six of eight studies assessing BD type I/II at follow-up and in all four studies assessing for bipolar spectrum disorder (BSD) criteria. Most studies received a ‘fair’ or ‘poor’ ROB grade.”
  • “Conclusions: Despite a paucity of studies, an overall association between prospectively-identified affective lability and a later diagnosis of BD or BSD is apparent with relative consistency between studies. This association and further longitudinal studies could inform future clinical screening of those who may be at risk of BD, with the potential to improve diagnostic accuracy and facilitate early intervention.”

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