Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-15T11:34:23.923Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive remediation: potential novel brain-based treatment for bipolar disorder in children and adolescents

Published online by Cambridge University Press:  02 July 2015

Daniel P. Dickstein ,
Grace K. Cushman ,
Kerri L. Kim ,
Alexandra B. Weissman  and
Ezra Wegbreit
Daniel P. Dickstein*
Affiliation:
PediMIND Program, Bradley Hospital, East Providence, Rhode Island, USA; Division of Child Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island, USA
Grace K. Cushman
Affiliation:
PediMIND Program, Bradley Hospital, East Providence, Rhode Island, USA; Division of Child Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island, USA
Kerri L. Kim
Affiliation:
PediMIND Program, Bradley Hospital, East Providence, Rhode Island, USA; Division of Child Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island, USA
Alexandra B. Weissman
Affiliation:
PediMIND Program, Bradley Hospital, East Providence, Rhode Island, USA; Division of Child Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island, USA
Ezra Wegbreit
Affiliation:
PediMIND Program, Bradley Hospital, East Providence, Rhode Island, USA; Division of Child Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island, USA
*
*Address for correspondence: Daniel P. Dickstein, MD, Pediatric Mood, Imaging, & NeuroDevelopment (PediMIND) Program, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA.(Email: Daniel_Dickstein@Brown.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Bipolar disorder (BD) is among the most impairing psychiatric disorders affecting children and adolescents, despite our best psychopharmacological and psychotherapeutic treatments. Cognitive remediation, defined as a behavioral intervention designed to improve cognitive functions so as to reduce psychiatric illness, is an emerging brain-based treatment approach that has thus far not been studied in pediatric BD. The present article reviews the basic principles of cognitive remediation, describes what is known about cognitive remediation in psychiatric disorders, and delineates potential brain/behavior alterations implicated in pediatric BD that might be targets for cognitive remediation. Emerging data show that cognitive remediation may be useful in children and adults with schizophrenia, ADHD, and anxiety disorders, and in adults with BD. Potential targets for cognitive remediation in pediatric BD include face processing, response inhibition, frustration, and cognitive flexibility. Further study is warranted to determine if cognitive remediation for these targets, or others, may serve as a novel, brain-based treatment for pediatric BD.

Keywords

childrenadolescentsbipolar disorderinterventioncognition.
Type
Review Articles
Information
CNS Spectrums , Volume 20 , Special Issue 4: Pediatric Neuroimaging , August 2015 , pp. 382 - 390
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Blader, JC, Carlson, GA. Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996–2004. Biol Psychiatry. 2007; 62(2): 107–114.Google Scholar
2. Moreno, C, Laje, G, Blanco, C, Jiang, H, Schmidt, AB, Olfson, M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry. 2007; 64(9): 1032–1039.Google Scholar
3. Van Meter, AR, Moreira, AL, Youngstrom, EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. 2011; 72(9): 1250–1256.Google Scholar
4. Grant, BF, Stinson, FS, Hasin, DS, et al. Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005; 66(10): 1205–1215.Google Scholar
5. Dickstein, DP, Rich, BA, Binstock, AB, et al. Comorbid anxiety in phenotypes of pediatric bipolar disorder. J Child Adolesc Psychopharmacol. 2005; 15(4): 534–548.CrossRefGoogle ScholarPubMed
6. Birmaher, B, Axelson, D, Goldstein, B, et al. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiatry. 2009; 166(7): 795–804.Google Scholar
7. Goldstein, TR, Ha, W, Axelson, DA, et al. Predictors of prospectively examined suicide attempts among youth with bipolar disorder. Arch Gen Psychiatry. 2012; 69(11): 1113–1122.Google Scholar
8. Haas, M, DelBello, MP, Pandina, G, et al. Risperidone for the treatment of acute mania in children and adolescents with bipolar disorder: a randomized, double-blind, placebo-controlled study. Bipolar Disord. 2009; 11(7): 687–700.Google Scholar
9. Wagner, KD, Redden, L, Kowatch, RA, et al. A double-blind, randomized, placebo-controlled trial of divalproex extended-release in the treatment of bipolar disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2009; 48(5): 519–532.Google Scholar
10. Geller, B, Luby, JL, Joshi, P, et al. A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. Arch Gen Psychiatry. 2012; 69(5): 515–528.Google Scholar
11. Miklowitz, DJ, George, EL, Axelson, DA, et al. Family-focused treatment for adolescents with bipolar disorder. J Affect Disord. 2004; 82(Suppl 1): S113–S128.Google Scholar
12. Pavuluri, MN, Graczyk, PA, Henry, DB, Carbray, JA, Heidenreich, J, Miklowitz, DJ. Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: development and preliminary results. J Am Acad Child Adolesc Psychiatry. 2004; 43(5): 528–537.Google Scholar
13. Fristad, MA. Psychoeducational treatment for school-aged children with bipolar disorder. Dev Psychopathol. 2006; 18(4): 1289–1306.Google Scholar
14. Fristad, MA, Verducci, JS, Walters, K, Young, ME. Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders. Arch Gen Psychiatry. 2009; 66(9): 1013–1021.Google Scholar
15. Axelson, D, Birmaher, B, Strober, M, et al. Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry. 2006; 63(10): 1139–1148.Google Scholar
16. Berry, EA, Heaton, PT, Kelton, CM. National estimates of the inpatient burden of pediatric bipolar disorder in the United States. J Ment Health Policy Econ. 2011; 14(3): 115–123.Google Scholar
17. Correll, CU, Manu, P, Olshanskiy, V, Napolitano, B, Kane, JM, Malhotra, AK. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA. 2009; 302(16): 1765–1773.Google Scholar
18. Vinogradov, S, Fisher, M, Villers-Sidani, E. Cognitive training for impaired neural systems in neuropsychiatric illness. Neuropsychopharmacology. 2012; 37(1): 43–76.Google Scholar
19. Stern, Y, Zarahn, E, Hilton, HJ, Flynn, J, DeLaPaz, R, Rakitin, B. Exploring the neural basis of cognitive reserve. J Clin Exp Neuropsychol. 2003; 25(5): 691–701.Google Scholar
20. Kontis, D, Huddy, V, Reeder, C, Landau, S, Wykes, T. Effects of age and cognitive reserve on cognitive remediation therapy outcome in patients with schizophrenia. Am J Geriatr Psychiatry. 2013; 21(3): 218–230.Google Scholar
21. White, HA, Shah, P. Training attention-switching ability in adults with ADHD. J Atten Disord. 2006; 10(1): 44–53.Google Scholar
22. McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry. 2007; 164(12): 1791–1802.Google Scholar
23. Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. 2011; 168(5): 472–485.Google Scholar
24. Elgamal, S, McKinnon, MC, Ramakrishnan, K, Joffe, RT, MacQueen, G. Successful computer-assisted cognitive remediation therapy in patients with unipolar depression: a proof of principle study. Psychol Med. 2007; 37(9): 1229–1238.Google Scholar
25. Tchanturia, K, Davies, H, Campbell, IC. Cognitive remediation therapy for patients with anorexia nervosa: preliminary findings. Ann Gen Psychiatry. 2007; 6: 14.Google Scholar
26. Deckersbach, T, Nierenberg, AA, Kessler, R, et al. Cognitive rehabilitation for bipolar disorder: An open trial for employed patients with residual depressive symptoms. CNS Neurosci Ther. 2010; 16(5): 298–307.Google Scholar
27. Bowie, CR, Gupta, M, Holshausen, K. Cognitive remediation therapy for mood disorders: rationale, early evidence, and future directions. Can J Psychiatry. 2013; 58(6): 319–325.Google Scholar
28. Demant, KM, Almer, GM, Vinberg, M, Kessing, LV, Miskowiak, KW. Effects of cognitive remediation on cognitive dysfunction in partially or fully remitted patients with bipolar disorder: study protocol for a randomized controlled trial. Trials. 2013; 14: 378.Google Scholar
29. Solé, B, Bonnin, CM, Mayoral, M, et al. Functional remediation for patients with bipolar II disorder: improvement of functioning and subsyndromal symptoms. Eur Neuropsychopharmacol. 2015; 25(2): 257–264.Google Scholar
30. Correa, MS, da Silveira, EM, de Lima, DB, et al. The role of encoding strategies in contextual memory deficits in patients with bipolar disorder. Neuropsychol Rehabil. 2015; 25(1): 122–136.Google Scholar
31. Martínez-Arán, A, Vieta, E, Colom, F, et al. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord. 2004; 6(3): 224–232.Google Scholar
32. Cavedini, P, Zorzi, C, Bassi, T, et al. Decision-making functioning as a predictor of treatment outcome in anorexia nervosa. Psychiatry Res. 2006; 145(2–3): 179–187.Google Scholar
33. Garrido, G, Barrios, M, Penadés, R, et al. Computer-assisted cognitive remediation therapy: cognition, self-esteem and quality of life in schizophrenia. Schizophr Res. 2013; 150(2–3): 563–569.Google Scholar
34. McGurk, SR, Mueser, KT, DeRosa, TJ, Wolfe, R. Work recovery, and comorbidity in schizophrenia: a randomized controlled trial of cognitive remediation. Schizophr Bull. 2009; 35(2): 319–335.Google Scholar
35. Patel, A, Knapp, M, Romeo, R, et al. Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophr Res. 2010; 120(1–3): 217–224.Google Scholar
36. Puig, O, Penades, R, Baeza, I, et al. Cognitive remediation therapy in adolescents with early-onset schizophrenia: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2014; 53(8): 859–868.CrossRefGoogle ScholarPubMed
37. van der Oord, S, Ponsioen, AJ, Geurts, HM, Brink, EL, Prins, PJ. A pilot study of the efficacy of a computerized executive functioning remediation training with game elements for children with ADHD in an outpatient setting: outcome on parent- and teacher-rated executive functioning and ADHD behavior. J Atten Disord. 2014; 18(8): 699–712.Google Scholar
38. Green, CT, Long, DL, Green, D, et al. Will working memory training generalize to improve off-task behavior in children with attention-deficit/hyperactivity disorder? Neurotherapeutics. 2012; 9(3): 639–648.Google Scholar
39. Gray, SA, Chaban, P, Martinussen, R, et al. Effects of a computerized working memory training program on working memory, attention, and academics in adolescents with severe LD and comorbid ADHD: a randomized controlled trial. J Child Psychol Psychiatry. 2012; 53(12): 1277–1284.Google Scholar
40. Chacko, A, Bedard, AC, Marks, DJ, et al. A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. J Child Psychol Psychiatry. 2014; 55(3): 247–255.Google Scholar
41. Pelham, WE Jr, Gnagy, EM, Greenslade, KE, Milich, R. Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry. 1992; 31(2): 210–218.Google Scholar
42. Klingberg, T, Fernell, E, Olesen, PJ, et al. Computerized training of working memory in children with ADHD—a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2005; 44(2): 177–186.Google Scholar
43. Shalev, L, Tsal, Y, Mevorach, C. Computerized progressive attentional training (CPAT) program: effective direct intervention for children with ADHD. Child Neuropsychol. 2007; 13(4): 382–388.Google Scholar
44. Rapport, MD, Orban, SA, Kofler, MJ, Friedman, LM. Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clin Psychol Rev. 2013; 33(8): 1237–1252.Google Scholar
45. Dongen-Boomsma, M, Vollebregt, MA, Buitelaar, JK, Slaats-Willemse, D. Working memory training in young children with ADHD: a randomized placebo-controlled trial. J Child Psychol Psychiatry. 2014; 55(8): 886–896.Google Scholar
46. Davidson, RJ. Anxiety and affective style: role of prefrontal cortex and amygdala. Biol Psychiatry. 2002; 51(1): 68–80.Google Scholar
47. LeDoux, J. The emotional brain, fear, and the amygdala. Cell Mol Neurobiol. 2003; 23(4–5): 727–738.Google Scholar
48. Williams, MA, McGlone, F, Abbott, DF, Mattingley, JB. Differential amygdala responses to happy and fearful facial expressions depend on selective attention. Neuroimage. 2005; 24(2): 417–425.Google Scholar
49. McClure, EB, Monk, CS, Nelson, EE, et al. Abnormal attention modulation of fear circuit function in pediatric generalized anxiety disorder. Arch Gen Psychiatry. 2007; 64(1): 97–106.Google Scholar
50. Lindstrom, KM, Guyer, AE, Mogg, K, et al. Normative data on development of neural and behavioral mechanisms underlying attention orienting toward social-emotional stimuli: an exploratory study. Brain Res. 2009; 1292: 61–70.Google Scholar
51. Hardee, JE, Benson, BE, Bar-Haim, Y, et al. Patterns of neural connectivity during an attention bias task moderate associations between early childhood temperament and internalizing symptoms in young adulthood. Biol Psychiatry. 2013; 74(4): 273–279.Google Scholar
52. Eldar, S, Apter, A, Lotan, D, et al. Attention bias modification treatment for pediatric anxiety disorders: a randomized controlled trial. Am J Psychiatry. 2012; 169(2): 213–220.Google Scholar
53. Shechner, T, Rimon-Chakir, A, Britton, JC, et al. Attention bias modification treatment augmenting effects on cognitive behavioral therapy in children with anxiety: randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2014; 53(1): 61–71.Google Scholar
54. Yang, W, Ding, Z, Dai, T, Peng, F, Zhang, JX. Attention bias modification training in individuals with depressive symptoms: a randomized controlled trial. J Behav Ther Exp Psychiatry. In press. DOI: 10.1016/j.jbtep.2014.08.005.Google Scholar
55. Baert, S, De Raedt, R, Schacht, R, Koster, EH. Attentional bias training in depression: therapeutic effects depend on depression severity. J Behav Ther Exp Psychiatry. 2010; 41(3): 265–274.Google Scholar
56. Johnson, MH, Dziurawiec, S, Ellis, H, Morton, J. Newborns' preferential tracking of face-like stimuli and its subsequent decline. Cognition. 1991; 40(1–2): 1–19.Google Scholar
57. Farroni, T, Csibra, G, Simion, F, Johnson, MH. Eye contact detection in humans from birth. Proc Natl Acad Sci U S A. 2002; 99(14): 9602–9605.Google Scholar
58. Guyer, AE, McClure, EB, Adler, AD, et al. Specificity of facial expression labeling deficits in childhood psychopathology. J Child Psychol Psychiatry. 2007; 48(9): 863–871.Google Scholar
59. Seymour, KE, Pescosolido, MF, Reidy, BL, et al. Emotional face identification in youths with primary bipolar disorder or primary ADHD. J Am Acad Child Adolesc Psychiatry. 2013; 52(5): 537–546.Google Scholar
60. Brotman, MA, Guyer, AE, Lawson, ES, et al. Facial emotion labeling deficits in children and adolescents at risk for bipolar disorder. Am J Psychiatry. 2008; 165(3): 385–389.Google Scholar
61. Rich, BA, Vinton, DT, Roberson-Nay, R, et al. Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proc Natl Acad Sci U S A. 2006; 103(23): 8900–8905.Google Scholar
62. Pavuluri, MN, O'Connor, MM, Harral, E, Sweeney, JA. Affective neural circuitry during facial emotion processing in pediatric bipolar disorder. Biol Psychiatry. 2007; 62(2): 158–167.Google Scholar
63. Kalmar, JH, Wang, F, Chepenik, LG, et al. Relation between amygdala structure and function in adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2009; 48(6): 636–642.Google Scholar
64. Leibenluft, E, Charney, DS, Towbin, KE, Bhangoo, RK, Pine, DS. Defining clinical phenotypes of juvenile mania. Am J Psychiatry. 2003; 160(3): 430–437.Google Scholar
65. Rich, BA, Grimley, ME, Schmajuk, M, Blair, KS, Blair, RJ, Leibenluft, E. Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation. Dev Psychopathol. 2008; 20(2): 529–546.Google Scholar
66. Brotman, MA, Rich, BA, Guyer, AE, et al. Amygdala activation during emotion processing of neutral faces in children with severe mood dysregulation versus ADHD or bipolar disorder. Am J Psychiatry. 2010; 167(1): 61–69.Google Scholar
67. Thomas, LA, Kim, P, Bones, BL, Hinton, K, Milch, HS, Reynolds, RC, Adleman, N, Marsh, AA, Blair, RJR, Pine, DS, Leibenluft, E. Elevated amygdala responses to emotional faces in youths with chronic irritability or bipolar disorder. Neuroimage: Clinical. 2013; 2: 637–645.Google Scholar
68. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.Google Scholar
69. Mostofsky, SH, Simmonds, DJ. Response inhibition and response selection: two sides of the same coin. J Cogn Neurosci. 2008; 20(5): 751–761.Google Scholar
70. Verbruggen, F, Logan, GD. Automatic and controlled response inhibition: associative learning in the go/no-go and stop-signal paradigms. J Exp Psychol Gen. 2008; 137(4): 649–672.Google Scholar
71. Leibenluft, E, Rich, BA, Vinton, DT, et al. Neural circuitry engaged during unsuccessful motor inhibition in pediatric bipolar disorder. Am J Psychiatry. 2007; 164(1): 52–60.Google Scholar
72. Singh, MK, Chang, KD, Mazaika, P, et al. Neural correlates of response inhibition in pediatric bipolar disorder. J Child Adolesc Psychopharmacol. 2010; 20(1): 15–24.CrossRefGoogle ScholarPubMed
73. Blair, RJ, Cipolotti, L. Impaired social response reversal. a case of ‘acquired sociopathy’. Brain. 2000; 123(Pt 6): 1122–1141.Google Scholar
74. Blair, RJ. The roles of orbital frontal cortex in the modulation of antisocial behavior. Brain Cogn. 2004; 55(1): 198–208.Google Scholar
75. Blair, RJ. Psychopathy, frustration, and reactive aggression: the role of ventromedial prefrontal cortex. Br J Psychol. 2010; 101(Pt 3): 383–399.Google Scholar
76. Rich, BA, Schmajuk, M, Perez-Edgar, KE, Fox, NA, Pine, DS, Leibenluft, E. Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. Am J Psychiatry. 2007; 164(2): 309–317.Google Scholar
77. Rich, BA, Carver, FW, Holroyd, T, et al. Different neural pathways to negative affect in youth with pediatric bipolar disorder and severe mood dysregulation. J Psychiatr Res. 2011; 45(10): 1283–1294.Google Scholar
78. Cools, R, Clark, L, Owen, AM, Robbins, TW. Defining the neural mechanisms of probabilistic reversal learning using event-related functional magnetic resonance imaging. J Neurosci. 2002; 22(11): 4563–4567.Google Scholar
79. Dickstein, DP, Treland, JE, Snow, J, et al. Neuropsychological performance in pediatric bipolar disorder. Biol Psychiatry. 2004; 55(1): 32–39.Google Scholar
80. Gorrindo, T, Blair, RJ, Budhani, S, Dickstein, DP, Pine, DS, Leibenluft, E. Deficits on a probabilistic response-reversal task in patients with pediatric bipolar disorder. Am J Psychiatry. 2005; 162(10): 1975–1977.Google Scholar
81. Dickstein, DP, Nelson, EE, McClure, EB, et al. Cognitive flexibility in phenotypes of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2007; 46(3): 341–355.Google Scholar
82. Dickstein, DP, Finger, EC, Brotman, MA, et al. Impaired probabilistic reversal learning in youths with mood and anxiety disorders. Psychol Med. 2010; 40(7): 1089–1100.Google Scholar
83. Dickstein, DP, Finger, EC, Skup, M, Pine, DS, Blair, JR, Leibenluft, E. Altered neural function in pediatric bipolar disorder during reversal learning. Bipolar Disord. 2010; 12(7): 707–719.Google Scholar
84. Adleman, NE, Kayser, R, Dickstein, D, Blair, RJ, Pine, D, Leibenluft, E. Neural correlates of reversal learning in severe mood dysregulation and pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2011; 50(11): 1173–1185.Google Scholar