Acta Psychiatrica Scandinavica最新文献

{"title":"Internet-Based Cognitive Assessments During Remission in Bipolar Disorder: Subjective Cognitive Function and Clinical Severity","authors":"Kristin Svee,&nbsp;Gunnar Morken,&nbsp;Tor Ivar Hansen,&nbsp;Anne Engum","doi":"10.1111/acps.70031","DOIUrl":"10.1111/acps.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cognitive impairment is well-established in bipolar disorder and significantly impacts daily functioning. However, the relationship between self-evaluated cognitive functions and objective cognitive tests is inconsistent. This heterogeneity in cognitive function necessitates flexible and accessible testing methods. An Internet-based test platform can address this need. This study examines cognitive function in individuals with bipolar disorder in full or partial remission using an Internet-based test platform. It explores associations with subjective cognitive function and clinical severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, the Memoro Internet-based cognitive test platform was used to assess objective cognitive functions. We recruited 84 participants with bipolar disorder type I or II in full or partial remission at the time of assessment, aged 18 to 65 years, from a bipolar outpatient clinic at a university hospital. We examined the completion rates of cognitive tests, reported technical issues, and differences between cognitively normal and impaired groups. Subjective cognition was measured using Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 84 participants completed the Memoro assessment of objective cognitive performance. No significant differences were observed in the completion rates of cognitive subtests or reported technical issues across groups. Of the participants, 61.9% were classified as cognitively normal, while 38.1% had cognitive impairments. 86.9% reported cognitive complaints. Correlation analysis indicated relationships between cognitive complaints (COBRA), symptoms of anxiety, and verbal memory. Multiple regression analyses identify symptoms of anxiety and age as significant predictors of verbal immediate recall and cognitive complaints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Objective measurements showed fewer cognitive problems than subjective reports. Additionally, anxiety symptoms may contribute to overreporting cognitive complaints.</p>\u0000 \u0000 <p>\u0000 <b>Clinical Registration:</b> ClinicalTrials.gov identifier: NCT04454073.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"515-524"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Maltreatment and Cognitive Performance in Bipolar Disorder: The Potential Role of Inflammation","authors":"Marzieh Majd,&nbsp;Jennifer Nicoloro-SantaBarbara,&nbsp;Katharine Burns,&nbsp;Maura De Laney,&nbsp;Emma V. Galante,&nbsp;Julia Lebovitz,&nbsp;Megan Shanahan,&nbsp;Katherine E. Burdick","doi":"10.1111/acps.70033","DOIUrl":"10.1111/acps.70033","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Cognitive deficits are common in individuals with bipolar disorder (BD), but there is considerable variability in cognitive functioning. Childhood maltreatment (CM), which is frequently reported in BD, has been linked to poorer cognitive performance, potentially through mechanisms such as inflammation. However, the relationship between CM and global cognition and the mediating role of inflammation in BD warrant further investigation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study sample consisted of 112 BD individuals and 83 healthy controls (HCs). Participants completed the MATRICS Consensus Cognitive Battery (MCCB), the Wisconsin Card Sorting Test, and the Childhood Trauma Questionnaire (CTQ). A composite inflammation index was created using blood levels of C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α, and was used in primary analyses.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The BD group, compared to HC, showed higher levels of inflammation and CM. Across the entire sample, higher total CM was associated with poorer global cognitive performance, with a medium effect size, even after accounting for diagnostic status. The associations were evident across all CM subscales. Specific cognitive domains affected included speed of processing, working memory, visual learning, and reasoning and problem solving. The association between CM and poorer global cognitive performance was partially mediated by inflammation (indirect effect: &lt;i&gt;β&lt;/i&gt; = −0.048, CI = −0.10, −0.009). Within the BD group, higher total CM was similarly associated with worse global cognitive performance. The associations were evident across all CM subscales, except for physical neglect. Significant associations were observed between total CM and MCCB domains of speed of processing, attention and vigilance, working memory, visual learning, reasoning and problem solving, as well as cognitive flexibility. Within the HC group, only emotional neglect and physical neglect were associated with poorer global cognition.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study provides evidence that total CM and its subscales are associated with poorer global cognitive performance in a sample of individuals with BD and HC, with stronger associations found within the BD group. In addition, inflammation partially mediated the relationship between CM and global cognition. These findings highlight the importance of trauma-informed and cognition-focused interventions aimed at enhancing cognitive outcomes and slowing cognitive decline in individuals with BD who have a history of CM. Furthermor","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"500-514"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Sex and Diagnosis on Clinical Variables and Neurocognitive Performance in Severe Mental Illness. Results From the PsyCourse Study","authors":"Maria Serra-Navarro,&nbsp;Maria Heilbronner,&nbsp;Brisa Solé,&nbsp;Roger Borràs,&nbsp;Anabel Martinez-Arán,&nbsp;Kristina Adorjan,&nbsp;Alba Navarro-Flores,&nbsp;Mojtaba Oraki Kohshour,&nbsp;Daniela Reich-Erkelenz,&nbsp;Eva C. Schulte,&nbsp;Fanny Senner,&nbsp;Ion-George Anghelescu,&nbsp;Volker Arolt,&nbsp;Bernhard T. Baune,&nbsp;Udo Dannlowski,&nbsp;Detlef E. Dietrich,&nbsp;Andreas J. Fallgatter,&nbsp;Christian Figge,&nbsp;Markus Jäger,&nbsp;Georg Juckel,&nbsp;Carsten Konrad,&nbsp;Jens Reimer,&nbsp;Eva Z. Reininghaus,&nbsp;Max Schmauß,&nbsp;Andrea Schmitt,&nbsp;Carsten Spitzer,&nbsp;Jens Wiltfang,&nbsp;Jörg Zimmermann,&nbsp;Sergi Papiol,&nbsp;Urs Heilbronner,&nbsp;Peter Falkai,&nbsp;Thomas G. Schulze,&nbsp;Eduard Vieta,&nbsp;Carla Torrent,&nbsp;Monika Budde,&nbsp;Silvia Amoretti","doi":"10.1111/acps.70026","DOIUrl":"10.1111/acps.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) and schizophrenia (SZ) are serious mental illnesses (SMI) with overlapping symptoms but distinct differences in onset and course. Sex differences are an area of growing interest in SMI. This study aims to examine potential interactions between sex and diagnosis across a broad range of variables, to compare males and females within SZ and BD, and to investigate sex-specific group differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 1516 individuals were included in a cross-sectional study using baseline data from the multicenter PsyCourse Study, including BD (<i>n</i> = 543), SZ (<i>n</i> = 517), and healthy controls (HC) (<i>n</i> = 456). Sociodemographic characteristics, clinical symptoms, psychosocial functioning, quality of life, neurocognitive performance, and somatic comorbidities were assessed. Generalized linear models were used to analyze differences between groups and sexes. False Discovery Rate (FDR) and Bonferroni post hoc comparisons were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant interactions were identified in age (<i>p</i> = 0.001), age at treatment (<i>p</i> = 0.05), illness duration (<i>p</i> = 0.03), illicit drug use (<i>p</i> = 0.01), and smoking (<i>p</i> = 0.05). Differences in substance use were observed across groups and sexes, with the highest rates found in males with SZ. The BD group showed better functioning and neurocognitive performance compared with the SZ group. Within the BD group, females reported better performance in verbal memory (<i>p</i> = 0.003) and psychomotor speed (<i>p</i> &lt; 0.001) than males. Moreover, both females and males with SMI showed higher rates of thyroid alterations compared with HC (<i>p</i> = 0.01 for females and <i>p</i> = 0.002 for males).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Significant sex differences were observed in substance use and somatic comorbidities. Interactions between diagnosis and sex underscore the importance of considering both factors in clinical assessments. These findings highlight the need to tailor sex-specific treatment for each patient. Further research is needed to explore the role of sex hormones and other biological and societal factors in the presentation and course of these disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"449-467"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Inflammatory Markers and Cognitive Function in Adults With Bipolar Disorder: A Systematic Review","authors":"David R. A. Coelho,&nbsp;Jennifer Nicoloro Santabarbara,&nbsp;Marzieh Majd,&nbsp;Willians Fernando Vieira,&nbsp;Maura De Laney,&nbsp;Melis Lydston,&nbsp;Olindo Assis Martins-Filho,&nbsp;Lilian Maria Garcia Bahia-Oliveira,&nbsp;Joshua D. Salvi,&nbsp;Paolo Cassano,&nbsp;Katherine E. Burdick","doi":"10.1111/acps.13824","DOIUrl":"10.1111/acps.13824","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) is frequently associated with cognitive dysfunction, which can significantly impact the quality of life and functional recovery of affected individuals. Growing evidence suggests that inflammation may contribute to the cognitive dysfunction observed in BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review following PRISMA guidelines, searching six databases on March 23, 2023 (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, and ClinicalTrials.gov), with the aim of identifying studies that examined the relationship between peripheral or central inflammatory markers and cognitive function in adults with BD. Studies involving animals, abstracts, protocols, reviews, and non-English publications were excluded. The quality of included studies was assessed using the Risk of Bias in Non-Randomized Studies—of Exposure (ROBINS-E). A narrative synthesis was completed, stratifying results based on the associations between inflammatory markers and cognitive domains in BD. The review protocol was pre-registered in PROSPERO (CRD42023415437).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 2680 identified records, 25 studies involving 3567 adults with BD (mean age: 43.6 years; 1839 females and 1728 males) met the inclusion criteria. Seventeen studies were classified as low risk of bias, seven as having some concerns, and one as high risk. Elevated levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 receptor antagonist (IL-1Ra) were most commonly associated with cognitive dysfunction in domains such as executive function, processing speed, and memory. Findings for other inflammatory markers were less consistent. Most studies relied on cross-sectional designs, which limit causal interpretations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review found a consistent association between inflammation and cognitive dysfunction in BD, particularly involving CRP, TNF-α, IL-6, and IL-1RA in areas such as executive function, processing speed, and memory. Targeting inflammation may offer a promising approach to mitigating these cognitive challenges. Future studies should prioritize longitudinal designs, standardized cognitive assessments, and the exploration of central inflammatory markers to better understand the neurobiological processes underlying cognitive dysfunction in BD. These findings may help inform the development of adjunctive anti-inflammatory strategies to support cognitive health in individuals with BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"339-373"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognition in Psychiatry: Treatment Targets, Mechanisms, and Assessment Innovations","authors":"Kamilla W. Miskowiak,&nbsp;Katherine E. Burdick","doi":"10.1111/acps.70015","DOIUrl":"10.1111/acps.70015","url":null,"abstract":"&lt;p&gt;Over the past two decades, psychiatry has undergone a paradigm shift from focusing solely on symptom remission - such as reducing hallucinations and delusions in psychosis or depressive or mania symptoms in mood disorders - to a broader emphasis on functional recovery and quality of life. Patients do not just want to feel well; they want to do well in order to be well [&lt;span&gt;1&lt;/span&gt;]. This shift has placed cognition at the center of psychiatric research and treatment because cognitive function is a key determinant of real-world outcomes, including social integration, employment, and independent living.&lt;/p&gt;&lt;p&gt;Cognitive impairment is a core feature across major psychiatric disorders, including major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ), often persisting even in remission. The cognitive deficits significantly contribute to disability, reduced treatment adherence, and greater relapse and psychiatric hospitalization risk [&lt;span&gt;2-4&lt;/span&gt;]. Despite growing recognition of the role of cognition in mental health, treatments with robust, replicable efficacy remain scarce [&lt;span&gt;5&lt;/span&gt;]. This is due to several challenges in cognition research, including (I) incomplete understanding of the neurobiological origins of cognitive impairments and their interaction with early-life adversity, (II) methodological limitations in assessment and intervention, and (III) the lack of objective biomarkers to guide treatment development [&lt;span&gt;5, 6&lt;/span&gt;]. This Special Issue of Acta Psychiatrica Scandinavica explores these challenges and presents novel research addressing key gaps in the field.&lt;/p&gt;&lt;p&gt;Evidence indicates considerable heterogeneity in cognitive trajectories among individuals with major psychiatric disorders. While some experience marked decline following illness onset, others remain resilient to these changes [&lt;span&gt;7&lt;/span&gt;]. Biological contributors to cognitive impairment include neuroinflammation, impaired neuroplasticity, and genetic factors, while environmental influences, such as early-life adversity, sleep, diet, and physical activity, further modulate outcomes. Identifying sensitive and specific biomarkers and physiological indicators to predict and monitor cognitive change is essential for developing and targeting effective interventions to those at most risk.&lt;/p&gt;&lt;p&gt;This Special Issue includes several papers that examine these mechanisms: One study leverages a twin-based design, allowing the authors to differentiate the aspects of cognitive impairment and cognitive decline that are related to familial risk for illness from those that are more directly linked to disease expression [&lt;span&gt;8&lt;/span&gt;]. Other included studies investigated sex differences in key clinical, cognitive, and functional outcomes [&lt;span&gt;9&lt;/span&gt;]; the importance of considering premorbid status when determining the extent of deficit after onset [&lt;span&gt;10&lt;/span&gt;]; and the impact of inflammation [&lt;span&gt;11, 12&lt;/span&gt;]; physical activity [&lt;spa","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"311-314"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Cognitive Functions and Subsequent Mood Disorder Prognosis in Low-Risk, High-Risk and Affected Monozygotic Twins: A Seven-Year Follow-Up Study","authors":"Kamilla Miskowiak,&nbsp;Hanne Lie Kjærstad,&nbsp;Stella Lystlund,&nbsp;Anjali Sankar,&nbsp;Lars Kessing,&nbsp;Maj Vinberg","doi":"10.1111/acps.70025","DOIUrl":"10.1111/acps.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Aberrant cognition is common among individuals at familial risk for mood disorders (MD) and those already affected. However, long-term prospective studies are needed to determine whether specific cognitive features predict illness onset and relapse; and whether cognitive impairments reflect neurodevelopmental traits or neuroprogressive decline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This seven-year prospective study examined the relationship between cognition and illness progression in monozygotic twins with mood disorders, their healthy high-risk monozygotic co-twins, and low-risk twins without a family history. Emotional and non-emotional cognition was assessed at baseline (<i>n</i> = 204) and follow-up (<i>n</i> = 124). Cox regression models tested whether baseline cognition predicted future illness onset in unaffected individuals (<i>n</i> = 89) or relapse in affected ones (<i>n</i> = 112). Longitudinal cognitive changes were analyzed using mixed models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Greater attentional vigilance toward consciously processed happy faces at baseline was associated with a reduced risk of both illness onset (Exp(B) = 0.995, CI [0.990; 1.000], <i>p</i> = 0.03) and relapse (Exp(B) = 0.997, CI [0.995; 0.999], <i>p</i> = 0.003). Paradoxically, better verbal fluency at baseline was linked to an increased risk of illness onset (Exp(B) = 1.589, CI [1.204; 2.097], <i>p</i> &lt; 0.001). Over time, onset was associated with increasing avoidance of subliminal fearful faces (group-by-time interaction, <i>p</i> &lt; 0.001), whereas avoidance decreased in those who remained well. Verbal fluency declined in twins who developed a mood disorder (<i>p</i> = 0.02) but remained stable in those who stayed unaffected. No significant longitudinal cognitive differences emerged between affected twins with and without relapse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Positive attentional biases may protect against illness onset and relapse, while greater baseline verbal fluency may unexpectedly signal vulnerability. Verbal fluency decline after illness onset likely reflects scar effects. The findings underscore the importance of early identification of cognitive-emotional vulnerabilities and suggest targets for preventive interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"432-448"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Response to Pro-Cognitive Interventions in Mood Disorders: A Systematic Review by the International Society for Bipolar Disorders Targeting Cognition Task Force","authors":"Dimosthenis Tsapekos,&nbsp;Michail Kalfas,&nbsp;Johanna M. Schandorff,&nbsp;Caterina del Mar Bonnin,&nbsp;Christopher R. Bowie,&nbsp;Vicent Balanzá-Martínez,&nbsp;Katherine E. Burdick,&nbsp;Andre F. Carvalho,&nbsp;Annemieke Dols,&nbsp;Katie Douglas,&nbsp;Peter Gallagher,&nbsp;Gregor Hasler,&nbsp;Lars V. Kessing,&nbsp;Hanne L. Kjærstad,&nbsp;Beny Lafer,&nbsp;Kathryn E. Lewandowski,&nbsp;Carlos López-Jaramillo,&nbsp;Anabel Martinez-Aran,&nbsp;Roger S. McIntyre,&nbsp;Richard J. Porter,&nbsp;Scot E. Purdon,&nbsp;Ayal Schaffer,&nbsp;Paul R. A. Stokes,&nbsp;Tomiki Sumiyoshi,&nbsp;Ivan J. Torres,&nbsp;Tamsyn E. Van Rheenen,&nbsp;Lakshmi N. Yatham,&nbsp;Jeff Zarp,&nbsp;Allan H. Young,&nbsp;Eduard Vieta,&nbsp;Kamilla W. Miskowiak","doi":"10.1111/acps.70038","DOIUrl":"10.1111/acps.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Major depressive disorder (MDD) and bipolar disorder (BD) are often associated with persistent cognitive deficits that impair psychosocial functioning. While pro-cognitive interventions show promise, trial findings are inconsistent, potentially due to baseline factors influencing treatment response. This systematic review summarizes evidence on pre-treatment characteristics associated with cognitive improvement and offers methodological recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in PubMed/MEDLINE, EMBASE, PsycINFO, and Cochrane Library from inception to February 28, 2025. Eligible studies included primary or secondary analyses of randomized controlled trials (RCTs) investigating predictors of cognitive response to pro-cognitive interventions in MDD and/or BD. Two researchers independently conducted study selection and risk of bias assessments. Findings were synthesized qualitatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty studies (<i>N</i> = 3864) were identified, covering pharmacological treatments (k = 20; <i>N</i> = 2299), psychological therapies (k = 16; <i>N</i> = 1165), brain stimulation (k = 2; <i>N</i> = 168), and physical activity (k = 2; <i>N</i> = 232). Poorer baseline cognitive performance was the most consistent predictor of greater cognitive improvement, though the direction of the effect was not entirely uniform across all studies. Baseline depression severity showed no significant association with cognitive outcomes. Age, education, sex, IQ, diagnosis, and medication status were similarly non-predictive. Risk of bias was high in 77% of studies, mainly due to deviations from specified outcomes, poor randomization processes, and inconsistent handling of missing data. Considerable heterogeneity in interventions, outcome measures, and sample characteristics limited replicability and precluded meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Poorer baseline cognition emerged as the most reliable predictor of greater cognitive improvement across interventions. More rigorous, well-powered studies are needed to replicate these findings and identify robust predictors to guide personalized pro-cognitive treatment approaches in mood disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"374-401"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Associations Between Affective and Non-Affective Cognitive Domains in Mood Disorders and Healthy Controls Using Network Analysis","authors":"Hanne Lie Kjærstad,&nbsp;Astrid Endrup Iversen,&nbsp;Maj Vinberg,&nbsp;Lars Vedel Kessing,&nbsp;Jeff Zarp,&nbsp;Kamilla Woznica Miskowiak","doi":"10.1111/acps.70084","DOIUrl":"10.1111/acps.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cognitive impairment is a core feature of mood disorders that contributes to reduced functioning and poorer prognosis, thereby emerging as an important treatment target. Persistent trait-related impairments present within both affective and non-affective cognition. Nevertheless, the relationship between affective and non-affective cognitive domains remains unclear, including whether impairments in emotion regulation and facial expression recognition are secondary to deficits in non-affective cognition. Mapping out the hierarchical structure of affective and non-affective cognitive domains may elucidate core cognitive impairments that represent the most relevant treatment targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Network analysis was employed to explore the associations between affective and non-affective cognitive domains in individuals with mood disorders (<i>N</i> = 380) and healthy controls (HC; <i>N</i> = 225) pooled from two previous studies. Partial correlation networks were constructed separately for individuals with mood disorders and HC comprising measures of non-affective cognition (working memory and executive function, attention and processing speed, verbal learning, and verbal memory) and affective cognition (emotion regulation success, facial expression recognition speed and accuracy).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For both mood disorders and HC, ‘working memory and executive function’ and ‘attention and processing speed’ emerged as central cognitive domains. Emotion regulation showed a significantly weaker association with ‘working memory and executive function’ in mood disorders relative to HC. Additionally, facial expression recognition speed was associated with ‘attention and processing speed’ across both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that working memory, executive function, attention, and processing speed are core cognitive domains in mood disorders. Further, the weak association between executive function and emotion regulation in mood disorders may indicate a reduced reliance on cognitive control processes during emotion regulation. These findings underscore the importance of targeting both affective and non-affective cognition in pro-cognitive interventions to improve emotion regulation and potentially mitigate the risk of mood episodes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"534-543"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Cognitive Impairment in Bipolar Disorder: Should We Account for Premorbid IQ?","authors":"Dimosthenis Tsapekos,&nbsp;Michail Kalfas,&nbsp;Rebecca Strawbridge,&nbsp;Samuel Swidzinski,&nbsp;Katherine E. Burdick,&nbsp;Allan H. Young","doi":"10.1111/acps.70000","DOIUrl":"10.1111/acps.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cognitive impairment estimations traditionally rely on the deviation of current cognitive performance from population norms (normative approach). Since bipolar disorder (BD) has been associated with above-average premorbid cognitive functioning in some studies, this approach might underestimate the extent of cognitive impairment in a proportion of patients. We examined whether intraindividual deviation of cognitive performance from premorbid estimates (idiographic approach) would more accurately estimate impairment in BD and assessed the functional relevance of this approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study pooled euthymic patients with BD (<i>N</i> = 257) taking part in two cognitive remediation trials with comparable eligibility criteria and measures. All participants underwent a baseline assessment including measures of current cognition, premorbid IQ, psychosocial functioning and mood symptom severity. We estimated and compared the prevalence of normative versus idiographic impairment and examined the association of the idiographic approach with functioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>According to normative standards, 13%–31% of our euthymic sample was classified as cognitively impaired depending on the adopted cut-off. After accounting for premorbid IQ, idiographic impairment rates increased to 37%–64%. The difference between the two approaches was significant for each cut-off considered (0.5 and 1 SD). Idiographic cognitive impairment was significantly associated with psychosocial functioning, even after controlling for residual mood symptoms and demographic/clinical variables and functional impairment classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Common practices for characterising cognitive impairment using a normative approach may underestimate the extent of impairment for a substantial proportion of euthymic patients with BD. Considering idiographic impairment provides an alternative, functionally relevant approach for cognition trials and clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"468-476"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Maltreatment and Cognitive Functioning in Bipolar Disorder: A Systematic Review and Meta-Analysis","authors":"Natalia E. Fares-Otero,&nbsp;Anaid Pérez-Ramos,&nbsp;Ricardo Lopez-Escribano,&nbsp;Sara Martin-Parra,&nbsp;Luis Alameda,&nbsp;Sarah L. Halligan,&nbsp;Kamilla Woznica Miskowiak,&nbsp;Eduard Vieta","doi":"10.1111/acps.13813","DOIUrl":"10.1111/acps.13813","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Characterising the association between childhood maltreatment (CM) and cognitive functioning in bipolar disorder (BD) is crucial for improving the understanding of how early environmental risk factors impact the presentation of the disorder. We conducted a systematic review and meta-analysis to estimate associations between overall and subtypes of CM, global cognition/IQ, and five cognitive domains in BD (attention/processing speed, verbal memory/learning, working memory, executive functions/verbal fluency, and social cognition), and to explore moderators/mediators in these associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was performed on 24 June 2024 to identify published peer-reviewed articles in six databases (PROSPERO-CRD42023468641).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 780 identified records, 20 studies were included, comprising 2457 individuals with BD (M ± SD, age in years = 39.5 ± 9.7; 41.3% males; BD type I = 81.2%); 152 effect sizes were pooled in random-effect meta-analyses. Overall CM was negatively associated with global cognition/IQ, attention/processing speed, and verbal memory/learning (<i>r</i> = −0.14 to −0.18, <i>p</i> = 0.002 to &lt; 0.001). Sexual/physical abuse and physical neglect were negatively associated with global cognition/IQ, working memory, and executive functions/verbal fluency (<i>r</i> = −0.07 to −0.18, <i>p</i> = 0.037 to &lt; 0.001). Emotional abuse was negatively associated with working memory (<i>r</i> = −0.12, <i>p</i> = 0.002). Emotional neglect was unrelated to cognitive functions. CM (overall/subtypes) was unrelated to social cognition. Meta-regressions did not identify any consistent moderators. Narrative synthesis identified possible moderators/mediators. Associations were of small magnitude, and a limited number of studies assessing CM subtypes and cognitive functions are available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CM exposure is associated with worse cognitive performance in people with BD, an effect observed across multiple maltreatment types and cognitive domains. Besides trauma-informed interventions, those with BD and CM require cognitive assessment and therapies to rehabilitate cognitive functioning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"153 5","pages":"315-338"},"PeriodicalIF":5.0,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}