Intellectual Disability and Psychiatric Diagnoses of Children and Adolescents with a History of Stressful Events and Social Deprivation in Brazil: Preliminary Results. IQ, Depression and Stress

Abstract: Background: Studies have shown that stressful events in childhood are associated with impairments in cognitive functions and intellectual disability.Objective: Compare the intellectual functioning in groups of Brazilian children and adolescents with a history of stressful events with lifetime history of depression and without lifetime history of depression.Method: 30 children and adolescents underwent psychiatric evaluation and neuropsychological assessment of estimated intellectual quotient (EIQ), verbal knowledge, and visuospatial skills.Results: 15 patients (50%) had EIQ within the average and 6 had EIQ in the lower average (20%) for Brazilian standardized norms. The other part had at least some degree of intellectual disability and they were classified as: 2 mild mental retardation (6.7%) and 7 borderline (23.3%). Also, half of the sample had at least one lifetime depressive episode, and the performance in EIQ and visuospatial skills was worse in this group.Conclusion: 50% of the children and adolescents with a history of early stressful events and social deprivation had at least some degree of intellectual disability. In addition, a subgroup with history of depressive episodes had worse EIQ performance when compared to those without depression, possibly due to a greater impairment in visuospatial skills. The specific role of impaired right cerebral hemisphere, corpus callosum, and prefrontal cortex associated with depressive disorders and maltreatment should be investigated in further studies

Longitudinal Neuropsychological Assessment in Two Elderly Adults With Attention-Deficit/Hyperactivity Disorder: Case Report

The neuropsychological deficits in attention-deficit/hyperactivity disorder (ADHD) may present clinical features similar to mild and/or major neurocognitive disorder and may act as a confounding factor, making it difficult to detect cognitive decline. In this paper, we present the results of longitudinal neuropsychological evaluations in two elderly women with ADHD. Three neuropsychological assessments were performed in two women with ADHD (60 and 77 years old) between 2010 and 2013 at intervals varying from 12 to 15 months. We used structural magnetic resonance imaging to rule out significant abnormalities that could account for cognitive impairment. The results showed two different cognitive profiles with fluctuations in performance over these 2 years, sometimes with improvement and sometimes with decline of some functions such as attention, memory, inhibitory control, and reaction time. To minimize confounding aspects of these fluctuations in clinical practice, we used a longer follow-up with the application of a reliable change index and a minimum of three spaced assessments to provide a more consistent baseline cognitive profile. Our findings did not indicate a consistent cognitive decline, suggesting a less pessimistic perspective about cognitive impairments that could be a prodrome of ADHD-related dementia

Controlled Study of Executive Functions in Bipolar Disorder

Introdução: A literatura científica sugere que pacientes com Transtorno Bipolar apresentam dificuldades cognitivas, que parecem persistir mesmo após remissão dos sintomas afetivos. Os déficits encontrados se localizam basicamente nas funções executivas, porém, em amostras de pacientes bipolares eutímicos os resultados são inconsistentes e uma possível justificativa para isto reside na característica do grupo avaliado em relação ao regime medicamentoso, tempo de doença, número de episódios e de internações. Objetivo: O presente estudo teve como proposta investigar o funcionamento executivo de forma ampla em um grupo de pacientes bipolares eutímicos, comparando os resultados obtidos a um grupo de sujeitos controles. Método: Foi utilizada uma bateria de provas neuropsicológicas com a finalidade de avaliar as funções atencionais, memória de trabalho, bem como outros processos mnésticos, flexibilidade mental, habilidade de planejamento, capacidade de análise de situações sociais e de julgamento e crítica. Incluiu-se ainda um questionário auto-aplicativo sobre as habilidades sociais, sendo este o primeiro estudo na literatura a realizar este tipo de comparação. Foram avaliados 25 pacientes e 31 controles. Os grupos foram bem pareados quanto ao gênero, idade, escolaridade e nível intelectual. Resultados: Na avaliação das funções executivas foi observada uma diferença significativa na prova de fluência verbal, com menor produtividade para o grupo de pacientes. Não foram verificadas diferenças entre os grupos nas demais provas aplicadas. Foi encontrada associação entre o número de internações e a presença de sintomas psicóticos com os escores das provas que recrutavam análise visuoespacial, planejamento, velocidade no processamento da informação, controle inibitório e capacidade de julgamento e crítica. Nas habilidades sociais, os pacientes bipolares pontuaram menos nos itens que avaliavam as habilidades de \"conversação e desenvoltura social\" e, \"auto-exposição a desconhecidos e situações novas\". Conclusão: Dentre os componentes das funções executivas houve diferença apenas na prova de fluência verbal, resultado este consistente aos achados da literatura. Em desacordo com pesquisas anteriores, não encontramos diferenças entre os grupos nas seguintes funções cognitivas: atenção, memória, flexibilidade mental, planejamento e na capacidade de julgamento, crítica e análise de situações sociais. Em relação às habilidades sociais, os resultados sugerem um comportamento inibido e hipervigilante dos pacientes em relação ao meio ambiente nos períodos de eutimia quando comparados aos controlesIntroduction: The scientific literature suggests that patients with Bipolar Disorder present cognitive impairment, which seems to persist even after remission. The deficits are basically in the executive functions, however, in samples with euthymic bipolar patients, the results are inconsistent, and a possible explanation for this is the characteristic of the sample in relation to medication, duration of illness and number of hospitalizations. Objective: The present study had as primary objective the investigation of executive functioning in a comprehensive manner in a group of euthymic bipolar patients, comparing the results with a control group. Method: A battery of neuropsycological tests was used to assess attention, working memory and other memory process, mental flexibility, planning ability, judgment capacity and analysis of social situations. Furthermore we included a self- report questionnaire about social skills. This was the first study in the literature to undertake this comparison. Twenty five patients and 31 controls were assessed. Groups went matched as for the gender, age, education and intellectual level. Results: In the evaluation of executive functions a significant difference was observed in the verbal fluency, with a smaller productivity in the group of patients. Differences were not detected between the groups in the other tests. We found an association between the number of hospitalizations and the lifetime occurrence of psychotic symptoms, and the scores of the tests that required visuospatial analysis, information processing speed, planning, inhibitory control and capacity to express opinion about social events. Regarding social skills, bipolar patients scored less in the items that assessed \"Conversation and social self-confidence\" and \"Self-exposition to unknown people and new situations\". Conclusion: Among the components of the executive functions there was a difference only in the verbal fluency test, and this result is in accordance with the literature. In disagreement with previous descriptions, we did not find differences in attention, memory, mental flexibility, planning, judgment capacity, and analysis of social situations. In relation to social skills, the results suggest that bipolar patients showed an inhibited and hyper-attentive behavior in relation to the environment when compared to the control

Controlled Study of Executive Functions in Bipolar Disorder

Introdução: A literatura científica sugere que pacientes com Transtorno Bipolar apresentam dificuldades cognitivas, que parecem persistir mesmo após remissão dos sintomas afetivos. Os déficits encontrados se localizam basicamente nas funções executivas, porém, em amostras de pacientes bipolares eutímicos os resultados são inconsistentes e uma possível justificativa para isto reside na característica do grupo avaliado em relação ao regime medicamentoso, tempo de doença, número de episódios e de internações. Objetivo: O presente estudo teve como proposta investigar o funcionamento executivo de forma ampla em um grupo de pacientes bipolares eutímicos, comparando os resultados obtidos a um grupo de sujeitos controles. Método: Foi utilizada uma bateria de provas neuropsicológicas com a finalidade de avaliar as funções atencionais, memória de trabalho, bem como outros processos mnésticos, flexibilidade mental, habilidade de planejamento, capacidade de análise de situações sociais e de julgamento e crítica. Incluiu-se ainda um questionário auto-aplicativo sobre as habilidades sociais, sendo este o primeiro estudo na literatura a realizar este tipo de comparação. Foram avaliados 25 pacientes e 31 controles. Os grupos foram bem pareados quanto ao gênero, idade, escolaridade e nível intelectual. Resultados: Na avaliação das funções executivas foi observada uma diferença significativa na prova de fluência verbal, com menor produtividade para o grupo de pacientes. Não foram verificadas diferenças entre os grupos nas demais provas aplicadas. Foi encontrada associação entre o número de internações e a presença de sintomas psicóticos com os escores das provas que recrutavam análise visuoespacial, planejamento, velocidade no processamento da informação, controle inibitório e capacidade de julgamento e crítica. Nas habilidades sociais, os pacientes bipolares pontuaram menos nos itens que avaliavam as habilidades de \"conversação e desenvoltura social\" e, \"auto-exposição a desconhecidos e situações novas\". Conclusão: Dentre os componentes das funções executivas houve diferença apenas na prova de fluência verbal, resultado este consistente aos achados da literatura. Em desacordo com pesquisas anteriores, não encontramos diferenças entre os grupos nas seguintes funções cognitivas: atenção, memória, flexibilidade mental, planejamento e na capacidade de julgamento, crítica e análise de situações sociais. Em relação às habilidades sociais, os resultados sugerem um comportamento inibido e hipervigilante dos pacientes em relação ao meio ambiente nos períodos de eutimia quando comparados aos controlesIntroduction: The scientific literature suggests that patients with Bipolar Disorder present cognitive impairment, which seems to persist even after remission. The deficits are basically in the executive functions, however, in samples with euthymic bipolar patients, the results are inconsistent, and a possible explanation for this is the characteristic of the sample in relation to medication, duration of illness and number of hospitalizations. Objective: The present study had as primary objective the investigation of executive functioning in a comprehensive manner in a group of euthymic bipolar patients, comparing the results with a control group. Method: A battery of neuropsycological tests was used to assess attention, working memory and other memory process, mental flexibility, planning ability, judgment capacity and analysis of social situations. Furthermore we included a self- report questionnaire about social skills. This was the first study in the literature to undertake this comparison. Twenty five patients and 31 controls were assessed. Groups went matched as for the gender, age, education and intellectual level. Results: In the evaluation of executive functions a significant difference was observed in the verbal fluency, with a smaller productivity in the group of patients. Differences were not detected between the groups in the other tests. We found an association between the number of hospitalizations and the lifetime occurrence of psychotic symptoms, and the scores of the tests that required visuospatial analysis, information processing speed, planning, inhibitory control and capacity to express opinion about social events. Regarding social skills, bipolar patients scored less in the items that assessed \"Conversation and social self-confidence\" and \"Self-exposition to unknown people and new situations\". Conclusion: Among the components of the executive functions there was a difference only in the verbal fluency test, and this result is in accordance with the literature. In disagreement with previous descriptions, we did not find differences in attention, memory, mental flexibility, planning, judgment capacity, and analysis of social situations. In relation to social skills, the results suggest that bipolar patients showed an inhibited and hyper-attentive behavior in relation to the environment when compared to the control

Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial

Abstract Background Bipolar disorder (BD) is commonly associated with cognitive and functional impairments even during remission periods, and although a growing number of studies have demonstrated the benefits of psychotherapy as an add-on to pharmacological treatment, its effectiveness appears to be less compelling in severe presentations of the disorder. New interventions have attempted to improve cognitive functioning in BD patients, but results have been mixed. Methods The study consists of a clinical trial comparing a new structured group intervention, called “Cognitive-Behavioral Rehabilitation,” with treatment as usual (TAU) for bipolar patients. The new approach is a combination of cognitive behavioral strategies and cognitive remediation exercises, consisting of 12 weekly group sessions of 90 min each. To be included in the study, patients must be diagnosed with BD type I or II, aged 18–55 years, in full or partial remission, and have an IQ of at least 80. A comprehensive neuropsychological battery, followed by mood, social functioning, and quality of life assessments will occur in three moments: pre and post intervention and 12 months later. The primary outcome of the study is to compare the time, in weeks, that the first full mood episode appears in patients who participated in either group of the study. Secondary outcome will include improvement in cognitive functions. Discussion This is the first controlled trial assessing the validity and effectiveness of the new “Cognitive-Behavioral Rehabilitation” intervention in preventing new mood episodes and improving cognitive and functional impairments. Trial registration Clinicaltrial.gov, NCT02766361 . Registered on 2 May 2016