Efficacy of cognitive remediation in bipolar disorder: systematic review and meta-analysis of randomized controlled trials

Cecilia Samamé; Paula Durante; Brenda Cattaneo; Ivan Aprahamian; Sergio Strejilevich

doi:10.1017/S0033291723001897

Efficacy of cognitive remediation in bipolar disorder: systematic review and meta-analysis of randomized controlled trials

Published online by Cambridge University Press: 24 July 2023

Ivan Aprahamian and

Cecilia Samamé*: Affiliation:
Universidad Católica del Uruguay, Montevideo, Uruguay Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
Paula Durante: Affiliation:
Universidad Favaloro, Buenos Aires, Argentina
Brenda Cattaneo: Affiliation:
Universidad Favaloro, Buenos Aires, Argentina
Ivan Aprahamian: Affiliation:
Faculdade de Medicina de Jundiaí, Departamento de Medicina Interna, Divisão de Geriatria, Grupo de Investigação sobre Multimorbidade e Saúde Mental no Envelhecimento, Jundiaí SP, Brasil Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Sergio Strejilevich: Affiliation:
ÁREA, Asistencia e Investigación en Trastornos del Ánimo, Buenos Aires, Argentina
*: Corresponding author: Cecilia Samamé; Email: ceciliasamame@gmail.com

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Abstract

A significant percentage of people with bipolar disorder (BD) exhibit suboptimal functional adjustment, even when appropriately treated and after symptomatic recovery is achieved. Given that cognitive impairment is one of the strongest correlates of socio-occupational outcomes and quality of life in BD, cognitive remediation (CR) is currently acknowledged as a promising treatment that could help bridge the gap between symptomatic and full functional recovery. The aim of this review was to explore the efficacy of CR approaches in improving cognitive and functional outcomes in BD patients. PubMed, PsycINFO, and CENTRAL were searched from inception to November 2022. Randomized controlled trials exploring the effects of CR on cognition and/or functional adjustment in adult BD patients were eligible. Ten studies based on seven independent trials (n = 586) were included. Change-score effect sizes (Hedges' g) were obtained for efficacy outcome measures and combined by means of meta-analytic procedures. Small but significant overall effects were observed for working memory (g = 0.32, 95% CI 0.11–0.52), planning (g = 0.30, 95% CI 0.03–0.56), and verbal learning (g = 0.40, 95% CI 0.15–0.66). However, CR was not found to exert any significant effects on functional outcomes at treatment completion or at follow-up assessment. Although CR may modestly enhance the cognitive performance of BD patients, this effect does not translate into an improvement at the functional level. The current data do not support the inclusion of CR as a treatment recommendation in clinical practice guidelines for the management of BD.

Keywords

Bipolar disorder cognitive remediation efficacy meta-analysis systematic review

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Type: Review Article
Information: Psychological Medicine , Volume 53 , Issue 12 , September 2023 , pp. 5361 - 5373

DOI: https://doi.org/10.1017/S0033291723001897 [Opens in a new window]
Copyright: Copyright © The Author(s), 2023. Published by Cambridge University Press

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