Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-30T20:11:18.976Z Has data issue: false hasContentIssue false
  • English
  • Français

A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder

Published online by Cambridge University Press:  01 June 2004

STEPHANIE E. MEYER ,
GABRIELLE A. CARLSON ,
EDYTHE A. WIGGS ,
PEDRO E. MARTINEZ ,
DONNA S. RONSAVILLE ,
BONNIE KLIMES–DOUGAN ,
PHILIP W. GOLD  and
MARIAN RADKE–YARROW
STEPHANIE E. MEYER
Affiliation:
University of Minnesota National Institute of Mental Health UCLA Neuropsychiatric Institute and Hospital
GABRIELLE A. CARLSON
Affiliation:
State University of New York, Stony Brook
EDYTHE A. WIGGS
Affiliation:
National Institute of Mental Health
PEDRO E. MARTINEZ
Affiliation:
National Institute of Mental Health
DONNA S. RONSAVILLE
Affiliation:
National Institute of Mental Health
BONNIE KLIMES–DOUGAN
Affiliation:
Catholic University of America
PHILIP W. GOLD
Affiliation:
National Institute of Mental Health
MARIAN RADKE–YARROW
Affiliation:
National Institute of Mental Health
Get access Rights & Permissions [Opens in a new window]

Abstract

Studies of adults who have been diagnosed with, and treated for, bipolar disorder have shown that these patients exhibit impairment on measures of executive functioning. However, it is unclear whether executive dysfunction precedes the diagnosis of bipolar illness, or develops subsequent to its onset. Moreover, investigators have failed to control for the effects of premorbid attentional problems on cognitive performance in these patients. The present authors explored these questions using data from a longitudinal prospective study of individuals at risk for major mood disorder. Results revealed that 67% of participants who met criteria for bipolar disorder in young adulthood showed impairment on the Wisconsin Card Sorting Test (WCST) when they were assessed during adolescence, as compared with 17% of individuals with no major mood diagnosis, and 19% with unipolar depression. This association between performance on the WCST and bipolar illness was not accounted for by high rates of premorbid attentional disturbance. In fact, among participants with early attentional problems, only those who ultimately developed bipolar disorder exhibited impairment on the WCST. Early attentional problems that preceded unipolar depression or no mood disorder were not associated with executive dysfunction.The findings presented in this paper come from the doctoral dissertation of the first author, which was funded by an NIMH Intramural Research Training Award. The authors are enormously grateful to Roger E. Meyer for his comments on earlier drafts of this paper and to Anne Mayfield, without whom this project would not have been possible. We are deeply indebted to Ann S. Masten, W. Andrew Collins, L. Alan Sroufe, Monica Luciana, and Carrie Borchardt, who provided invaluable guidance throughout all stages of this project, as well as Robert Asarnow, who was an important mentor during the review process. In addition, we acknowledge the contributions of Gail Inoff–Germain, who administered diagnostic interviews and neuropsychological measures at adolescent follow-up; Rula B. Garside, who undertook the painstaking job of establishing interrater reliability; Erika Sundstrom, who devoted many hours to data organization and quality assurance; and Sara Avery Torvik and Patricia Kasdan, whose combined gifts of organization and warmth created a comfortable atmosphere for study participants. Finally, we thank the extraordinary research participants of the NIMH Childrearing Study, who have shown enormous bravery and dedication by sharing with us 23 years of their lives.

Type
Research Article
Information
Development and Psychopathology , Volume 16 , Issue 2 , June 2004 , pp. 461 - 476
Copyright
© 2004 Cambridge University Press

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

REFERENCES

Achenbach, T., & Edelbrock, C. S. (1981). Behavioral Problems and Competencies Reported by Parents of Normal and Disturbed Children Aged Four through Sixteen. Chicago: University of Chicago Press.
Al-Mousawi, A. H., Evans, N., Ebmeier, K. P., Roeda, D., Chaloner, F., & Ashcroft, G. W. (1996). Limbic dysfunction in schizophrenia and mania: A study using 18F-labeled fluorodeoxyglucose and positron emission tomography. British Journal of Psychiatry 169, 509–516.CrossRefGoogle Scholar
Anderson, S. W., Damasio, H., Jones, R. D., & Tranel, D. (1991). Wisconsin Card Sorting Test performance as a measure of frontal lobe damage. Journal of Clinical and Experimental Neuropsychology 13, 909–922.CrossRefGoogle Scholar
Barkley, R. A., Grodzinsky, G., & DuPaul, G. J. (1992). Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report. Journal of Abnormal Child Psychology 20, 163–188.CrossRefGoogle Scholar
Berman, K. F., Ostrem, J. L., Randolph, C., Gold, J., Goldberg, T. E., Coppola, R., Carson, R. E., Herscovitch, P., & Weinberger, D. R. (1995). Physiological activation of a cortical network during performance of the Wisconsin Card Sorting Test: A positron emission tomography study. Neuropsychologia 33, 1027–1046.CrossRefGoogle Scholar
Borchardt, C. M., Bernstein, G. A., & Crosby, R. D. (1995). Psychopathology in the families of inpatient affective disordered adolescents. Child Psychiatry and Human Development 26, 71–84.CrossRefGoogle Scholar
Borkowska, A., & Rybakowski, J. K. (2001). Neuropsychological frontal lobe tests indicate that bipolar depressed patients are more impaired than unipolar. Bipolar Disorders 3, 88–94.CrossRefGoogle Scholar
Carlson, G. A., Bromet, E. J., Driessens, C., Mojtabai, R., & Schwartz, J. E. (2002). Age at onset, childhood psychopathology, and 2-year outcome in psychotic bipolar disorder. American Journal of Psychiatry 159, 307–309.CrossRefGoogle Scholar
Carlson, G. A., Bromet, E. J., & Sievers, S. (2000). Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. American Journal of Psychiatry 157, 213–219.CrossRefGoogle Scholar
Carlson, G. A., & Weintraub, S. (1993). Childhood behavior problems and bipolar disorder: Relationship or coincidence? Journal of Affective Disorders 28, 143–153.Google Scholar
Coll, P. G., & Bland, R. (1979). Manic depressive illness in adolescence and childhood: Review and case report. Canadian Journal of Psychiatry 24, 255–263.CrossRefGoogle Scholar
Dvoredsky, A. E., & Stewart, M. A. (1981). Hyperactivity followed by manic-depressive disorder: Two case reports. Journal of Clinical Psychiatry 42, 212–214.Google Scholar
Endicott, J., & Spitzer, R. L. (1978). A diagnostic interview: The schedule for affective disorders and schizophrenia. Archives of General Psychiatry 35, 837–844.CrossRefGoogle Scholar
Faraone, S. V. (2000). Genetics of childhood disorders: XX. ADHD, part 4: Is ADHD genetically heterogeneous? Journal of the American Academy of Child and Adolescent Psychiatry 39, 1455–1457.Google Scholar
Faraone, S. V., Biederman, J., Wozniak, J., Mundy, E., Mennin, D., & O'Donnell, D. (1997). Is comorbidity with ADHD a marker for juvenile-onset mania? Journal of the American Academy of Child and Adolescent Psychiatry 36, 1046–1055.Google Scholar
Ferrier, I. N., MacMillan, I. C., & Young, A. H. (2001). The search for the wandering thymostat: A review of some developments in bipolar disorder research. British Journal of Psychiatry, 178 (Suppl. 141), S103–S106.CrossRefGoogle Scholar
Ferrier, I. N., Stanton, B. R., Kelly, T. P., & Scott, J. (1999). Neuropsychological function in euthymic patients with bipolar disorder. British Journal of Psychiatry 175, 246–251.CrossRefGoogle Scholar
Ferrier, I. N., & Thompson, J. M. (2002). Cognitive impairment in bipolar affective disorder: Implications for the bipolar diathesis. British Journal of Psychiatry 180, 293–295.CrossRefGoogle Scholar
First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (1996). User's guide for the structured clinical interview for DSM-IV axis I disorders—research version (Version 2.0). Washington, DC: American Psychiatric Press.
Gourovitch, M. L., Torrey, E. F., Gold, J. M., Randolph, C., Weinberger, D. R., & Goldberg, T. E. (1999). Neuropsychological performance of monozygotic twins discordant for bipolar disorder. Biological Psychiatry 45, 639–646.CrossRefGoogle Scholar
Grant, D. A., & Berg, E. A. (1948). A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem. Journal of General Psychology 38, 404–411.CrossRefGoogle Scholar
Hawkins, K. A., Hoffman, R. E., Quinlan, D. M., Rakfeldt, J., Docherty, N. M., & Sledge, W. H. (1997). Cognition, negative symptoms, and diagnosis: A comparison of schizophrenic, bipolar and control samples. Journal of Neuropsychiatry and Clinical Neurosciences 9, 81–89.Google Scholar
Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin Card Sorting Test Manual—Revised and Expanded. Odessa, FL: Psychological Assessment Resources.
Herjanic, B., & Reich, W. (1982). Development of a structured psychiatric interview for children: Agreement between child and parent on individual symptoms. Journal of Abnormal Child Psychology 10, 307–324.CrossRefGoogle Scholar
Hodges, K., McKnew, D., Cytryn, L., Stern, L., & Kline, J. (1982). The Child Assessment Schedule (CAS) diagnostic interview: A report on reliability and validity. Journal of the American Academy of Child Psychiatry 21, 468–473.CrossRefGoogle Scholar
Jacobvitz, D., & Sroufe, L. A. (1987). The early caregiver–child relationship and attention-deficit disorder with hyperactivity in kindergarten: A prospective study. Child Development 58, 1496–1504.Google Scholar
Lezak, M. D. (1995). Neuropsychological assessment. New York: Oxford University Press.
Loong, J. (1989). The Wisconsin Card Sorting Task (Version 1.0). San Luis Obisbo, CA: Wang Neuropsychological Laboratory.
Martínez–Arán, A., Penadés, R., Vieta, E., Colom, F., Reinares, M., Benabarre, A., Salamero, M., & Gastró, C. (2002). Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome. Psychotherapy and Psychosomatics 71, 39–46.Google Scholar
Mendlewicz, J. (1988). Population and family studies in depression and mania. British Journal of Psychiatry, 153 (Suppl. 3), 16–25.Google Scholar
Mendlewicz, J., & Rainer, J. D. (1977). Adoption study supporting genetic transmission in manic depressive illness. Nature 268, 327–329.CrossRefGoogle Scholar
Michie, P. T., Kent, A., Stienstra, R., Castine, R., Johnston, J., Dedman, K., Wichmann, H., Box, J., Rock, D., Rutherford, E., & Jablensky, A. (2000). Phenotypic markers as risk factors in schizophrenia: Neurocognitive functions. Australian and New Zealand Journal of Psychiatry 34, S74–S85.CrossRefGoogle Scholar
Morice, R. (1990). Cognitive inflexibility and pre-frontal dysfunction in schizophrenia and mania. British Journal of Psychiatry 157, 50–54.CrossRefGoogle Scholar
Mountain, M. A., & Snow, W. G. (1993). Wisconsin Card Sorting Test as a measure of frontal pathology: A review. Clinical Neuropsychologist 7, 108–118.CrossRefGoogle Scholar
Nagahama, Y., Fukuyama, H., Yamauchi, H., Matsuzaki, S., Konishi, J., Shibasaki, H., & Kimura, J. (1996). Cerebral activation during performance of a card sorting task. Brain 119, 1667–1675.CrossRefGoogle Scholar
Öngür, D., Drevets, W. C., & Price, J. L. (1998). Glial reduction in the subgenual prefrontal cortex in mood disorders. Proceedings of the National Academy of Sciences of the United States of America 95, 13290–13295.CrossRefGoogle Scholar
Pineda, D., Ardila, A., Rosseli, M., Cadavid, C., Manchedo, S., & Mejia, S. (1998). Executive dysfunctions in children with attention deficit hyperactivity disorder. International Journal of Neuroscience 96, 177–196.CrossRefGoogle Scholar
Radke–Yarrow, M. (1998). Children of depressed mothers: From early childhood to maturity. New York: Cambridge University Press.
Rajkowska, G., Halaris, A., & Selemon, L. D. (2001). Reductions in neuronal and glial density characterize the dorsolateral prefrontal cortex in bipolar disorder. Biological Psychiatry, 49, 741–752.CrossRefGoogle Scholar
Reitan, R. M., & Wolfson, D. (1995). Category Test and Trail Making Test as measures of frontal lobe functions. Clinical Neuropsychologist 9, 50–56.CrossRefGoogle Scholar
Rezai, K., Andreasen, N. C., Alliger, R., Cohen, G., Swayze, V., & O'Leary, D. S. (1993). The neuropsychology of the prefrontal cortex. Archives of Neurology 50, 636–642.CrossRefGoogle Scholar
Richters, J. E. (1992). Depressed mothers as informants about their children: A critical review of the evidence of distortion. Psychological Bulletin 112, 485–499.CrossRefGoogle Scholar
Sachs, G. S., Baldassano, C. F., Truman, C. J., & Guille, C. (2000). Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder. American Journal of Psychiatry 157, 466–468.CrossRefGoogle Scholar
Seidman, L. J., Biederman, J., Faraone, S. V., Weber, W., & Ouellette, C. (1997). Toward defining a neuropsychology of attention deficit-hyperactivity disorder: Performance of children and adolescents from a large clinically referred sample. Journal of Consulting and Clinical Psychology 65, 150–160.CrossRefGoogle Scholar
Sergeant, J. A., Geurts, H., & Oosterlaan, J. (2002). How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder? Behavioural Brain Research 130, 3–28.Google Scholar
Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1992). The structured clinical interview for DSM-III-R (SCID). 1. History, rationale, and description. Archives of General Psychiatry 49, 624–629.CrossRefGoogle Scholar
Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests: Administration, norms, and commentary. New York: Oxford University Press.
SPSS. (2000). SPSS 10.0 for Macintosh (Release 10.0.7a.2000). Chicago: Author.
Strakowski, S. M., Delbello, M. P., Adler, C., Cecil, K. M., & Sax, K. W. (2000). Neuroimaging in bipolar disorder. Bipolar Disorders 2, 148–164.CrossRefGoogle Scholar
Stuss, D. T., & Alexander, M. P. (2000). Executive functions and the frontal lobes: A conceptual view. Psychological Research 63, 289–298.CrossRefGoogle Scholar
Stuss, D. T., & Benson, D. F. (1986). The frontal lobes. New York: Raven Press.
Stuss, D. T., Levine, B., Alexander, M. P., Hong, J., Palumbo, C., Hamer, L., Murphy, K. J., & Izukawa, D. (2000). Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: Effects of lesion location and test structure on separable cognitive processes. Neuropsychologia 38, 388–402.CrossRefGoogle Scholar
Sylvester, C. E., Burke, P. M., McCauley, E. A., & Clark, C. J. (1984). Manic psychosis in childhood: Report of two cases. Journal of Nervous and Mental Disease 172, 12–15.CrossRefGoogle Scholar
Tannock, R., & Schachar, R. (1992). Methylphenidate and cognitive perseveration in hyperactive children. Journal of Child Psychology and Psychiatry and Allied Disciplines 33, 1217–1228.CrossRefGoogle Scholar
Tarullo, L. B., Richardson, D. T., Radke–Yarrow, M., & Martinez, P. E. (1995). Multiple sources in child diagnosis: Parent–child concordance in affectively ill and well families. Journal of Clinical Child Psychology 24, 173–183.CrossRefGoogle Scholar
Toren, P., Sadeh, M., Wolmer, L., Eldar, S., Koren, S., Weizman, R., & Laor, N. (2000). Neurocognitive correlates of anxiety disorders in children: A preliminary report. Journal of Anxiety Disorders 14, 239–247.CrossRefGoogle Scholar
Verdoux, H., & Liraud, F. (2000). Neuropsychological function in subjects with psychotic and affective disorders. Relationship to diagnostic category and duration of illness. European Psychiatry 15, 236–243.Google Scholar
Wechsler, D. (1974). Manual for the Wechsler intelligence scale for children—Revised. New York: Psychological Corporation.
Weinberger, D. R., Berman, K. F., & Zec, R. F. (1986). Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. 1. Regional cerebral blood-flow evidence. Archives of General Psychiatry 43, 114–124.Google Scholar
Winokur, G., Coryell, W., Endicott, J., & Akiskal, H. (1993). Further distinctions between manic depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression). American Journal of Psychiatry 150, 1176–1181.Google Scholar
Wolf, L. E., Cornblatt, B. A., Roberts, S. A., Maminski Shapiro, B., & Erlenmeyer–Kimling, L. (2002). Wisconsin card sorting deficits in the offspring of schizophrenics in the New York High Risk Project. Schizophrenia Research 57, 173–182.CrossRefGoogle Scholar
Yurgellun–Todd, D. A., Gruber, S. A., Killgore, W. D. S., & Tohen, M. (2000). Neuropsychological performance in first episode bipolar disorder. International Journal of Neuropsychopharmacology, 3, S333.Google Scholar
Zubieta, J. K., Huguelet, P., O'Neill, R. L., & Giordani, B. J. (2001). Cognitive function in euthymic Bipolar I Disorder. Psychiatry Research 102, 9–20.CrossRefGoogle Scholar