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The Clinical Implications Of Cognitive Impairment and Allostatic Load in Bipolar Disorder

Published online by Cambridge University Press:  24 April 2012

E. Vieta ,
D. Popovic ,
A.R. Rosa ,
B. Solé ,
I. Grande ,
B.N. Frey ,
A. Martinez-Aran ,
J. Sanchez-Moreno ,
V. Balanzá-Martínez  and
R. Tabarés-Seisdedos
...Show all authors
E. Vieta*
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
D. Popovic
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Ospedale Santa Chiara, Via Roma 67, 56100Pisa, Italy
A.R. Rosa
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain Bipolar Disorders Program and INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Ramiro Barcelos, 2350 CEP 90035-003, Porto Alegre, RS, Brazil
B. Solé
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
I. Grande
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
B.N. Frey
Affiliation:
Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 2B4 and Montreal Neurological Institute, McGill University, Montreal, QC, Canada
A. Martinez-Aran
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
J. Sanchez-Moreno
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
V. Balanzá-Martínez
Affiliation:
Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Blasco-Ibáñez 17, 46010Valencia, Spain
R. Tabarés-Seisdedos
Affiliation:
Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Blasco-Ibáñez 17, 46010Valencia, Spain
F. Kapczinski
Affiliation:
Bipolar Disorders Program and INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Ramiro Barcelos, 2350 CEP 90035-003, Porto Alegre, RS, Brazil
*
⁎Corresponding author. Tel.: +34 93 2275401; fax: +34 932275795. E-mail addresses: evieta@clinic.ub.es, jose.sanchez.moreno@cibersam.es (E. Vieta).
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Abstract

Background

Allostatic load (AL) relates to the neural and bodily “wear and tear” that emerge in the context of chronic stress. This paper aims to provide clinicians with a comprehensive overview of the role of AL in patophysiology of bipolar disorder (BD) and its practical implications.

Methods

PubMed searches were conducted on English-language articles published from 1970 to June 2011 using the search terms allostatic load, oxidative stress, staging, and bipolar disorder cross-referenced with cognitive impairment, comorbidity, mediators, prevention.

Results

Progressive neural and physical dysfunction consequent to mood episodes in BD can be construed as a cumulative state of AL. The concept of AL can help to reconcile cognitive impairment and increased rates of clinical comorbidities that occur over the course of cumulative BD episodes.

Conclusions

Data on transduction of psychosocial stress into the neurobiology of mood episodes converges to the concept of AL. Mood episodes prevention would not only alleviate emotional suffering, but also arrest the cycle of AL, cognitive decline, physical morbidities and, eventually, related mortality. These objectives can be achieved by focusing on effective prophylaxis from the first stages of the disorder, providing mood-stabilizing agents and standardized psychoeducation and, potentially, addressing cognitive deficits by the means of specific medication and neuropsychological interventions.

Keywords

Bipolar disorderManiaDepressionCognitive impairmentProphylaxisAllostatic load
Type
Review
Information
European Psychiatry , Volume 28 , Issue 1 , January 2013 , pp. 21 - 29
Copyright
Copyright © European Psychiatric Association 2013

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