CREST.BD Cognition & Bipolar Disorder Slides

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CREST.BDBipolar Wellness Center Webinars Connect. Learn. Engage.

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Bipolar Wellness Center Webinars Connect. Learn. Engage. CREST.BD

Cognition

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Bipolar Wellness Center Webinars Connect. Learn. Engage. CREST.BD CREST.BD

Featuring: Dr. Ivan TorresCREST.BD Member and Clinical Associate Professor, Department of Psychiatry, University of British Columbia

Cognition

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Defining cognition Cognition and BDWhy cognition is important to your QoLTools and resources

Webinar focus

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Defining cognitionRefers to thinking skills, eg., the ability to pay attention, remember, process information, solve problems and plan1

We’re all born with different cognitive capabilitiesCognitive skills can change over time, e.g.: • worsen with illness, injury or age• also be strengthened or improved

1 Medalia, A., Revheim, N. (2002). Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities. New York State Office of Mental Health.

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Cognition and BD BD can be associated with decreases in learning, verbal memory,

planning, decision-making and/or ability to focus attention2 Or, may not be associated with any cognitive problems at all3 Cognitive problems most obvious during mood episodes, especially severe depression or mania4 • can continue even when not experiencing mood symptoms Primary symptom of BD, not just related to mood symptoms1

1 Medalia, A., Revheim, N. (2002). Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities. New York State Office of Mental Health. 2Sole, B., Bonnin, C.M., Torrent, C et al. (2012). Neurocognitive impairment across the bipolar spectrum. CNC Neurosciences & Therapeutics, 18: 194-200.3Osuji, I.J., Cullum, C.M. (2005). Cognition in BD Psychiatr Clin North Am, 28(2): 427-414Torres, I.J., Malhi, G.S. (2010). Neurocognitive in BD. Chapter 8 in Yatham LN & Maj M (eds), BD: clinical and neurobiological foundations, 2010, John Wiley & Sons: 71.

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Age Recreational drugs, alcohol or substance misuse Medications Sleep problems

Cognition and BDFactors contributing to cognition in BD:

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Why is cognition important to QoL?Cognitive skills are necessary for success in many QoL areas, e.g.:

independent living and everyday functioning work and education leisure activitiesmaintaining social relationships and roles

Research has linked cognitive function to QoL in people with BD5

5 Mackala, S.A., Torres, I.J., Kozicky, J., Michalak, E.E., Yatham, L.N. (2014). Cognitive performance and QoL early in the course of BD. J Affect Disord. 2014 Jul 2, 168C: 119-124.

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How you can take actionPay attention to cognitive changes or problems

Track changes in memory, attention, alertness and thinkingBe vigilant for cognitive changes with different medications or mood phases1

Engage others, such as a family member or healthcare professionals to help track changes


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How you can take actionReport any changes to your doctor and healthcare team

Empowers you to work with your healthcare team to explore medication changes that could help Be open with your healthcare team about recreational substance use, other medications you’re taking or changes in the way you’re taking them

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Cognitive rehabilitation strategies Refers to activities that help restore cognition to a healthy state

Includes managing cognitive problems via 3 different methods1 1. Remediation techniques 2. Compensatory strategies 3. Adaptive approaches

An assessment by a healthcare professional can help you decide which unique approach may be most helpful


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Remediation techniques Research on remediation techniques is in its infancy, but shows promise for cognitive training in people with mood disorders, including some (but not all) people with BD6 While you may improve your results on the specific tasks you practice, it’s still uncertain how helpful this will be to your overall functioning7

Remediation techniques:• focus on improving thinking with drills and exercises (may involve computers, paper and pencil, or group activities) • don’t offer a quick fix: progress takes time and effort

6Bowie, C.R., Gupta, M., Holshausen, K. (2013). Cognitive remediation therapy for mood disorders: rationale, early evidence, and future directions. Canadian Journal of Psychiatry, 58: 319-325.7Owen, A., Hampshire, A., Grahn, J.A., Stenton, R., Dajani, S., Burns, A.S., Howard, R., Ballard, C.G. (2010). Putting Brain Training to the Test. Nature, 465(7299):775-55.

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Compensatory strategies

helping identify different ways to accomplish goals by ‘compensating’ for cognitive challengescognitive strengths can be used to override cognitive weaknesses e.g., can learn mnemonics (or ‘memory aids’) to help you remember things

Focus on:

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Adaptive approaches Focus on:

changes to your environment e.g., recording devices to help you keep track of important information, or reminders

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Final Tips Keep communication and activities simple, direct, shortKeep activities to one thing at a time; avoid multi-taskingRest; fatigue can make cognitive problems worseLimit distractionsBalance activities so that you have a blend of physical, mental and social activities to keep your interest up and prevent fatigueKeep activities and tasks structured and organized

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Tools and Resources

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Resources

CogniFitThis online cognitive training program provides tools to measure cognitive skills, and build on these skills through entertaining games and tracking one’s progress. Caveat: The efficacy of these resources has yet not been evaluated in people with BD

https://www.cognifit.com/

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Resources

LumosityThis is a similar online cognitive training website, using interactive games to “train memory and attention” through a “personalized training program.” Caveat: The efficacy of these resources has yet not been evaluated in people with BD

www.lumosity.com

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Resources

Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities A handbook for families and friends of individuals with psychiatric disorders, written by Alice Medalia, Ph.D.and Nadine Revheim, Ph.D.

https://www.omh.ny.gov/omhweb/cogdys_manual/CogDysHndbk.htm

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For more information and resources, visit our Bipolar Wellness Center at:

http://www.bdwellness.com/

To assess your quality of life, visit our QoL tool at:

http://www.bdqol.com/

http://www.bdwellness.com/

http://www.bdqol.com/

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Acknowledgments

CREST.BD Cognition & Bipolar Disorder Slides

Education

cognition cognition

cognitive changes

cognitive dysfunction

cognition important

cognitive function

cognitive performance

all3 cognitive problems

bipolar spectrum