Bipolar on the brain

Professor Benincio Frey began the session with an exploration of cognitive impairment in mood disorders, presenting data linking impaired cognitive functioning with mental disorders such as bipolar I disorder. With further data he demonstrated the association of these conditions to negative outcomes in patients, including poor responses to pharmacological and psychological treatments.

Prof Frey finished by making the important point that that cognitive impairment in the context of bipolar disorder can occur not just during acute episodes, but during remission as well, highlighting the need for continuous monitoring and treatment in this group of patients.

It’s in the biology

Next to take the stage was Professor Michael Berk with some fascinating insights into the link between neurobiology and therapeutic outcomes in bipolar disorder, in his talk – Clinical Assessment of Neurocognition: The Basis for Improved Clinical Outcomes. Prof Berk presented a model of neuroprogression in bipolar disorder, describing the process as a “toxic soup” of neurological changes that begins with a series of malfunctions in the brain at a genetic level, and ends in complete functional and cognitive decline.

The professor believed that a new understanding of bipolar using this model “opens up the scenario for us to intervene to disrupt the toxic process”, recommending that the most effective time for intervention is early on, around the time of a patient’s first episode.

He also suggested that stage-specific approach could have great potential in the future treatment of bipolar disorder.

Quality vs. quantity

Professor Serge Beulieu from Canada wrapped up the symposium with his presentation on the relationship between cognitive impairment, functional outcomes and quality of life in patients with bipolar disorder, with a focus on treating patients lives, rather than just their symptoms or the number of episodes.

He proposed cognitive interventions as useful tools in improving quality of life, especially in recently diagnosed bipolar patients, and presented the following treatment recommendations:

• Aggressive treatment of subsyndromal symptoms (especially depressive symptoms)
• Psychotherapy to help enhance coping skills
• Cognitive-enhancing strategies
• Treatment of comorbid disorders

Everything’s connected

Prof Frey ended the session with an insightful thought when asked during question time about the nature of the brain and which of its areas are involved in mental disorders – “when we affect one [neural network], we affect all of them, which is why we know so much and so little at the same time”.