Cognitive Remediation Journal 2022, 11(1):1-5 | DOI: 10.5507/crj.2022.001

The Ecological Cognitive training program (ECo) for bipolar disorders: a case report.

Isaac C.1, Castillo M.-C.1, Andrianisaina P.2, Durand F.1, Moulier V.1, Januel D.1
1 Unité de Recherche Clinique, Secteur G03, EPS de Ville-Evrard (202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France)
2 Laboratoire de Psychopathologie et de Neuropsychologie, Université Paris 8 Vincennes Saint-Denis (2 Rue de la Liberté, 93526 Saint-Denis, France)

Objective: Cognitive deficits remain underdiagnosed and difficult to treat in bipolar disorders. Cognitive remediation programs should take more into account the specificities of these illnesses, such as potential mood variations during cognitive training. We report on the design of a new ecological cognitive remediation program for mood disorders (called “ECo”) that we administered to a patient suffering from a type II bipolar disorder.

Methods: Before and after administering this 28-session program, we assessed the patient’s cognitive and functional abilities, using standardized neuropsychological tests and clinical scales and questionnaires.

Results: After the therapy, we observed major improvements in executive functions, moderate improvements in attentional processes, and mixed results for verbal memory. Improvements occurred despite a worsening of the patient’s symptomatology during the last month of therapy. The conventional assumption that cognitive remediation should only apply to patients with minimal residual symptoms raises ethical concerns regarding the exclusion of patients with more serious symptoms. Furthermore, this assumption may not be applicable to patients with bipolar disorders, as these patients frequently experience mood variations, even during periods of remission.

Conclusions and Implications for Practice: The flexibility of the ECo program may represent an asset in multiple clinical contexts, or places where treatment is provided, or when treating patients at different stages of the recovery process.

Keywords: Bipolar Disorder; Cognitive Impairments; Cognitive Remediation; Rehabilitation

Objective: Cognitive deficits remain underdiagnosed and difficult to treat in bipolar disorders. Cognitive remediation programs should take more into account the specificities of these illnesses, such as potential mood variations during cognitive training. We report on the design of a new ecological cognitive remediation program for mood disorders (called “ECo”) that we administered to a patient suffering from a type II bipolar disorder.

Methods: Before and after administering this 28-session program, we assessed the patient’s cognitive and functional abilities, using standardized neuropsychological tests and clinical scales and questionnaires.

Results: After the therapy, we observed major improvements in executive functions, moderate improvements in attentional processes, and mixed results for verbal memory. Improvements occurred despite a worsening of the patient’s symptomatology during the last month of therapy. The conventional assumption that cognitive remediation should only apply to patients with minimal residual symptoms raises ethical concerns regarding the exclusion of patients with more serious symptoms. Furthermore, this assumption may not be applicable to patients with bipolar disorders, as these patients frequently experience mood variations, even during periods of remission.

Conclusions and Implications for Practice: The flexibility of the ECo program may represent an asset in multiple clinical contexts, or places where treatment is provided, or when treating patients at different stages of the recovery process.

Published: March 31, 2022  Show citation

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Isaac C, M.-C. C, Andrianisaina P, Durand F, Moulier V, Januel D. The Ecological Cognitive training program (ECo) for bipolar disorders: a case report. Cogn. Remediat. J. 2022;11(1):1-5. doi: 10.5507/crj.2022.001.
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    References

    1. Bora, E., Yucel, M., & Pantelis, C. (2009). Cognitive endophenotypes of bipolar disorder : A meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders, 113(1‑2), 1‑20. https://doi.org/10.1016/j.jad.2008.06.009 Go to original source...
    2. Crowne, D. P., & Marlowe, D. (1960). A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology, 24, 349‑354. Go to original source...
    3. Cullen, B., Ward, J., Graham, N. A., Deary, I. J., Pell, J. P., Smith, D. J., & Evans, J. J. (2016). Prevalence and correlates of cognitive impairment in euthymic adults with bipolar disorder : A systematic review. Journal of affective disorders, 205, 165‑181. Go to original source...
    4. Deckersbach, T., Nierenberg, A. A., Kessler, R., Lund, H. G., Ametrano, R. M., Sachs, G., & …. (2010). Cognitive Rehabilitation for Bipolar Disorder : An open Trial for Employed Patients with Residual Depressive Symptoms. CNS Neuroscience & Therapeutics, 16, 298‑307. Go to original source...
    5. Demant, K. M., Vinberg, M., Kessing, L. V., & Miskowiak, K. W. (2015). Effects of short-term cognitive remediation on cognitive dysfunction in partially or fully remitted individuals with bipolar disorder : Results of a randomised controlled trial. PLoS One, 10, 0127955‑10. Go to original source...
    6. Favre, S., Aubry, J. M., Gex-Fabry, M., Ragama-Pardos, E., McQuillan, A., & Bertschy, G. (2003). Translation and validation of a French version. of the Young Mania Rating Scale (YMRS). L'Encephale, 29, 499‑505.
    7. Fitapelli, B., & Lindenmayer, J. P. (2022). Advances in Cognitive Remediation Training in Schizophrenia: A Review. Brain Sciences, 12(2), 129. doi : 10.3390/brainsci12020129. Go to original source...
    8. Godefroy, O., & Roussel-Pieronne, M. (2007). La batterie GREFEX : Données normatives. Fonctions exécutives et Pathologies Neurologiques et psychiatriques. Solal, Marseille, 231‑252.
    9. Guelfi, J. D. (1993). L'échelle de dépression de Hamilton. Dans L'évaluation Clinique Standardisée en Psychiatrie. Boulogne : Editions Médicales Pierre Fabre, 1, 187‑194.
    10. Isaac, C., & Januel, D. (2016). Neural correlates of cognitive improvements following cognitive remediation in schizophrenia : A systematic review of randomized trials. Socioaffective neuroscience & psychology, 6, 30054‑10. Go to original source...
    11. Isaac, Clémence. (2018). Elaboration d'un programme de remédiation cognitive au profit des patients bipolaires-Approche clinique et neuropsychologique [Thèse de Doctorat]. Paris 8.
    12. Ives-Deliperi, V. L., Howells, F., Stein, D. J., Meintjes, E. M., & Horn, N. (2013). The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: a controlled functional MRI investigation. Journal of affective disorders, 150(3), 1152-1157. doi: 10.1016/j.jad.2013.05.074. Go to original source...
    13. Lahera, G., Benito, A., Montes, J. M., Fernandez-Liria, A., Olbert, C. M., & Penn, D. L. (2013). Social cognition and interaction training (SCIT) for outpatients with bipolar disorder. Journal of affective disorders, 146, 132‑136. Go to original source...
    14. Latalova, K., Prasko, J., Diveky, T., & Velartova, H. (2011). Cognitive impairment in bipolar disorder. Biomedical papers of the Medical Faculty of the University. Palacký, Olomouc, Czechoslovakia, 155, 19‑26. Go to original source...
    15. Lengvenyte, A., Coppola, F., Jaussent, I., Courtet, P., & Olié, E. (2020). Improved functioning following computerized working memory training (COGMED®) in euthymic patients with bipolar disorder and cognitive complaints: An exploratory study. Journal of Affective Disorders, 262, 414-421. doi: 10.1016/j.jad.2019.11.062. Go to original source...
    16. Lewandowski, K. E., Sperry, S. H., Cohen, B. M., Norris, L. A., Fitzmaurice, G. M., Ongur, D., & Keshavan, M. S. (2017). Treatment to Enhance Cognition in Bipolar Disorder (TREC-BD) : Efficacy of a Randomized Controlled Trial of Cognitive Remediation Versus Active Control. Journal of Clinical Psychiatry, 78, 1242‑1249. Go to original source...
    17. Maddux, J. E., & Meier, L. J. (1995). Self-efficacy and depression. In Self-efficacy, adaptation, and adjustment : Theory, research, and application (p. 143‑169). Plenum Press. https://doi.org/10.1007/978-1-4419-6868-5_5 Go to original source...
    18. Marks, K. A., Fastenau, P. S., Lysaker, P. H., & Bond, G. R. (2000). Self-Appraisal of Illness Questionnaire (SAIQ) : Relationship to researcher-rated insight and neuropsychological function in schizophrenia. Schizophrenia research, 45, 203‑211. Go to original source...
    19. Martínez-Arán, A., Torrent, C., Solé, B., Bonnín, C. M., Rosa, A. R., Sánchez-Moreno, J., & Vieta, E. (2011). Functional remediation for bipolar disorder. Clinical practice and epidemiology in mental health: CP & EMH, 7, 112. Go to original source...
    20. Martínez-Arán, A., Vieta, E., Colom, F., Torrent, C., Sánchez-Moreno, J., Reinares, M., & M …Salamero. (2004). Cognitive impairment in euthymic bipolar patients : Implication for clinical and functional outcome. Bipolar Disorders, 6, 224‑232. Go to original source...
    21. Medalia, A., & Choi, J. (2009). Cognitive remediation in schizophrenia. Neuropsychology Review, 19, 353‑364. Go to original source...
    22. Ott, C. V., Macoveanu, J., Bowie, C. R., Fisher, P. M., Knudsen, G. M., Kessing, L. V., & Miskowiak, K. W. (2021). Change in prefrontal activity and executive functions after action-based cognitive remediation in bipolar disorder: a randomized controlled trial. Neuropsychopharmacology, 46(6), 1113-1121. doi: 10.1038/s41386-020-00901-7. Go to original source...
    23. Pattanayak, R. D., Sagar, R., & Mehta, M. (2011). Cognitive dysfunction as a trait marker for Bipolar Disorder : A critical Review. Disponible en ligne (accédé le 14/03/2018) : goo.gl/LeCycK. Journal of Mental Health and Human Behaviour, 16, 18‑28.
    24. Prouteau, A. (2011). Neuropsychologie clinique de la schizophrénie : Enjeux et débats. Dunod. Go to original source...
    25. Rey, A., & Vanier, M. (1991). Test d'apprentissage auditivo-verbal de Rey-Taylor AVLT (Centre de recherche, Institut de réadaptation de Montréal).
    26. Samamé, C., Martino, D. J., & Strejilevich, S. A. (2012). Social cognition in euthymic bipolar disorder : Systematic review and meta-analytic approach. Acta Psychiatrica Scandinavica, 125, 266‑280. Go to original source...
    27. ©kobrtal, P., Novotný, M., & Novotný, M. (2019). The Effectiveness of the Cognitive Training Via the Internet. Cognitive Remediation Journal, 8(1), 4-8. doi: 10.5507/crj.2019.001 Go to original source...
    28. Solé, B., Bonnin, C. M., Mayoral, M., Amann, B. L., Torres, I., & González-Pinto, A. (2015). Functional remediation for patients with bipolar II disorder : Improvement of functioning and subsyndromal symptoms. European Neuropsychopharmacology, 25, 257‑264. Go to original source...
    29. Sparding, T., Silander, K., Pålsson, E., Östlind, J., Sellgren, C., & Ekman, C. J. (2015). Cognitive functioning in clinically stable patients with bipolar disorder. I and II. PloS one, 10, 0115562‑10. Go to original source...
    30. Strawbridge, R., Tsapekos, D., Hodsoll, J., Mantingh, T., Yalin, N., McCrone, P., ... & Young, A. H. (2021). Cognitive remediation therapy for patients with bipolar disorder: A randomised proof-of-concept trial. Bipolar Disorders, 23(2), 196-208. doi: 10.1111/bdi.12968. Go to original source...
    31. Tiihonen, J., Haukka, J., Henriksson, M., Cannon, M., Kieseppä, T., Laaksonen, I., & Lönnqvist, J. (2005). Premorbid intellectual functioning in bipolar disorder and schizophrenia : Results from a cohort study of male conscripts. American Journal of Psychiatry, 162, 1904‑1910. Go to original source...
    32. Veeh, J., Kopf, J., Kittel-Schneider, S., Deckert, J., & Reif, A. (2017). Cognitive remediation for bipolar patients with objective cognitive impairment: a naturalistic study. International journal of bipolar disorders, 5(1), 1-13. doi: 10.1186/s40345-017-0079-3. Go to original source...
    33. Vianin, P. (2007). Remédiation cognitive de la schizophrénie. Présentation du programme RECOS. Annales Médico-psychologiques, revue psychiatrique, 165(3), 200‑205. Go to original source...
    34. Voráèková, V., ©paniel, F., Mohr, P., & Rodriguez, M. (2016). EEG-biofeedback u pacientù se schizofrenií: dal¹í mo¾nost ovlivnìní kognitivního deficitu?. Cognitive Remediation Journal, 5(1), 3-15. doi: 10.5507/crj.2016.001 Go to original source...
    35. Ware, J. E., Kosinski, M., & Keller, S. (1994). SF-36 physical and mental health summary scales : A user's manual. Health Assessment Lab.
    36. Wechsler, D. (2011). WAIS-IV Echelle d'intelligence de Wechsler pour adultes : Manuel d'administration et de cotation (4e édition). Coédition ECPA.
    37. Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). BADS : Behavioural assessment of the dysexecutive syndrome.
    38. Wykes, T., & Spaulding, W. D. (2011). Thinking about the future cognitive remediation therapy - What works and could we do better. Schizophrenia Bulletin, 37, 80‑90. Go to original source...
    39. Young, A. W., Perrett, D., Calder, A., Sprengelmeyer, R., & Ekman, P. (2002). Facial expressions of emotion : Stimuli and tests (FEEST). Bury St. Edmunds: Thames Valley Test Company.

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