Association of subthreshold manic symptoms and cognitive impairments in euthymic patients with bipolar disorder I
Abstract
Cognitive impairments exist during the euthymic period of bipolar disorder (BD). However, the impact of clinical factors (e.g., subthreshold symptoms and body mass index) on cognitive function in euthymic patients with bipolar disorder I is inconsistent. This cross-sectional study included 83 patients with euthymic BD I and 115 healthy controls. The Repeatable Battery for the Assessment of Neuropsychological Status indices were used to assess cognitive function. We assessed the relationship between cognitive function and clinical impact factors. Performance in language abilities, attention, and immediate memory was worse in euthymic BD I. Spearman's correlation revealed that indices for immediate memory and attention were negatively correlated with subthreshold manic symptoms, and indices for delayed memory were positively correlated with years of education. Linear regressions indicated that subthreshold manic symptoms were the best predictors of immediate memory and attention. Years of education predicted performance in most cognitive domains, except immediate memory. Individuals with euthymic BD I exhibited cognitive deficits in language learning, attention, and immediate memory. Our study highlights the importance of the effect of subthreshold manic symptoms on cognitive function in remitted BD; these symptoms should receive more attention and be targeted in personalized clinical therapeutic interventions.
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Subclinical symptoms are associated with neurobiological and cognitive abnormalities.
“associated with neurobiological and cognitive abnormalities [15–18]”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [18]
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817 · see citing works
Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative
Merikangas, K. R., Jin, R., He, J.-P., Kessler, R. C., Lee, S., Sampson, N. A., Viana, M. C., Andrade, L. H., Hu, C., Karam, E. G., et al. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.12 · Cited by 2,627 · see citing works
Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998) · Journal of Clinical and Experimental Neuropsychology · doi:10.1076/jcen.20.3.310.823 · Cited by 2,519 · see citing works
Merikangas, K. R., Akiskal, H. S., Angst, J., Greenberg, P. E., Hirschfeld, R. M. A., Petukhova, M., & Kessler, R. C. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.5.543 · Cited by 2,399 · see citing works
Cognitive Function Across Manic or Hypomanic, Depressed, and Euthymic States in Bipolar Disorder
Martínez‐Arán, A., Vieta, E., Reinares, M., Colom, F., Torrent, C., Sánchez‐Moreno, J., Benabarre, A., Goikolea, J. M., Comes, M., & Salamero, M. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.2.262 · Cited by 1,106 · see citing works
Bora, E., Yücel, M., & Pantelis, C. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.06.009 · Cited by 1,021 · see citing works
A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder
Robinson, L. J., Thompson, J. M., Gallagher, P., Goswami, U., Young, A. H., Ferrier, I. N., & Moore, P. B. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.02.016 · Cited by 962 · see citing works
Neuropsychological functioning in euthymic bipolar disorder: a meta‐analysis
Torres, I. J., Boudreau, V. G., & Yatham, L. N. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.01055.x · Cited by 622 · see citing works
Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome
Martínez‐Arán, A., Vieta, E., Colom, F., Torrent, C., Sánchez‐Moreno, J., Reinares, M., Benabarre, A., Goikolea, J. M., Brugué, E., Daban, C., et al. (2004) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00111.x · Cited by 587 · see citing works
Sustained attention deficit in bipolar disorder
Clark, L., Iversen, S. D., & Goodwin, G. M. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.180.4.313 · Cited by 539 · see citing works
Kurtz, M. M., & Gerraty, R. T. (2009) · Neuropsychology · doi:10.1037/a0016277 · Cited by 433 · see citing works
Neuropsychological function in euthymic patients with bipolar disorder
Ferrier, I. N., Stanton, B. R., Kelly, T. P., & Scott, J. L. (1999) · The British Journal of Psychiatry · doi:10.1192/bjp.175.3.246 · Cited by 426 · see citing works
Cognitive Impairment in Euthymic Bipolar Patients With and Without Prior Alcohol Dependence
van Gorp, W. G., Altshuler, L. L., Theberge, D. C., Wilkins, J. N., & Dixon, W. J. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.1.41 · Cited by 413 · see citing works
The Bech‐Rafaelsen Mania Scale and the Hamilton Depression Scale
Bech, P., Bolwig, T. G., Kramp, P., & Rafaelsen, O. J. (1979) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1979.tb04484.x · Cited by 405 · see citing works
Depp, C. A., Mausbach, B. T., Harmell, A. L., Savla, G. N., Bowie, C. R., Harvey, P. D., & Patterson, T. L. (2012) · Bipolar Disorders · doi:10.1111/j.1399-5618.2012.01011.x · Cited by 342 · see citing works
Cognitive impairment in remission in bipolar affective disorder
Rubinsztein, J. S., Michael, A., Paykel, E. S., & Sahakian, B. J. (2000) · Psychological Medicine · doi:10.1017/s0033291799002664 · Cited by 289 · see citing works
Cavanagh, J., Beck, M. V., Muir, W., & Blackwood, D. (2002) · The British journal of psychiatry : the journal of mental science · doi:10.1192/bjp.180.4.320 · Cited by 277 · see citing works
Subclinical symptoms in mood disorders: pathophysiological and therapeutic implications
FAVA, G. A. (1999) · Psychological Medicine · doi:10.1017/s0033291798007429 · Cited by 258 · see citing works
Cognitive deficits in bipolar disorders: Implications for emotion
Lima, I. M. M., Peckham, A. D., & Johnson, S. L. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.11.006 · Cited by 250 · see citing works
Cognitive Dysfunctions in Bipolar Disorder: Evidence of Neuropsychological Disturbances
Martínez‐Arán, A., Vieta, E., Colom, F., Reinares, M., Benabarre, A., Gastó, C., & Salamero, M. (1999) · Psychotherapy and Psychosomatics · doi:10.1159/000012361 · Cited by 238 · see citing works
A new validation of the Hamilton Rating Scale for depression
Ramos-Brieva, J. A., & Cordero-Villafafila, A. (1988) · Journal of Psychiatric Research · doi:10.1016/0022-3956(88)90024-6 · Cited by 238 · see citing works
López‐Jaramillo, C., Lopera-Vásquez, J. P., Gallo, A., Ospina‐Duque, J., Bell, V., Torrent, C., Martínez‐Arán, A., & Vieta, E. (2010) · Bipolar Disorders · doi:10.1111/j.1399-5618.2010.00835.x · Cited by 223 · see citing works
Deckersbach, T., Nierenberg, A. A., Kessler, R., Lund, H. G., Ametrano, R. M., Sachs, G., Rauch, S. L., & Dougherty, D. (2010) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2009.00110.x · Cited by 204 · see citing works
Subthreshold symptoms in bipolar disorder: Impact on neurocognition, quality of life and disability
Bonnín, C. M., Sánchez-Moreno, J., Martínez-Arán, A., Solé, B., Reinares, M., Rosa, A. R., Goikolea, J. M., Benabarre, A., Ayuso-Mateos, J. L., Ferrer, M., et al. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.10.012 · Cited by 190 · see citing works
Strakowski, S. M., Eliassen, J. C., Lamy, M., Cerullo, M. A., Allendorfer, J. B., Madore, M. R., Lee, J. H., Welge, J. A., DelBello, M. P., Fleck, D. E., et al. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.09.019 · Cited by 143 · see citing works
Diagnostic Features, Prevalence, and Impact of Bipolar Disorder
Ketter, T. A. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.8125tx11c · Cited by 142 · see citing works
The effect of previous psychotic mood episodes on cognitive impairment in euthymic bipolar patients
Bora, E., Vahip, S., Akdeniz, F., Gönül, A. S., Eryavuz, A., Ogut, M., & Alkan, M. (2007) · Bipolar Disorders · doi:10.1111/j.1399-5618.2007.00469.x · Cited by 132 · see citing works
Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder
Samalin, L., de Chazeron, I., Vieta, E., Bellivier, F., & Llorca, P. (2016) · Bipolar Disorders · doi:10.1111/bdi.12376 · Cited by 127 · see citing works
The effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder
Yim, C. Y., Soczynska, J. K., Kennedy, S. H., Woldeyohannes, H. O., Brietzke, E. M., & McIntyre, R. S. (2011) · European Psychiatry · doi:10.1016/j.eurpsy.2011.02.004 · Cited by 110 · see citing works
Cognitive functioning in euthymic bipolar I and bipolar II patients
Dittmann, S., Hennig‐Fast, K., Gerber, S., Seemüller, F., Riedel, M. J., Severus, W. E., Langosch, J. M., Engel, R. R., Möller, H., & Grunze, H. (2008) · Bipolar Disorders · doi:10.1111/j.1399-5618.2008.00640.x · Cited by 105 · see citing works
A quantitative review of neurocognition in euthymic late‐life bipolar disorder
Samamé, C., Martino, D. J., & Strejilevich, S. (2013) · Bipolar Disorders · doi:10.1111/bdi.12077 · Cited by 104 · see citing works
Sánchez‐Moreno, J., Martínez‐Arán, A., Colom, F., Scott, J. L., Tabarés‐Seisdedos, R., Sugranyes, G., Torrent, C., Daban, C., Benabarre, A., Goikolea, J. M., et al. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.08m04302 · Cited by 76 · see citing works
Cárdenas, S. A., Kassem, L., Brotman, M. A., Leibenluft, E., & McMahon, F. J. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.08.002 · Cited by 76 · see citing works
Cognitive impairment in manic bipolar patients: important, understated, significant aspects
Vrabie, M., Marinescu, V., Talasman, A., Tautu, O.-F., Drima, E. P., & Micluția, I. (2015) · Annals of General Psychiatry · doi:10.1186/s12991-015-0080-0 · Cited by 73 · see citing works
Dittmann, S., Seemüller, F., Schwarz, M., Kleindienst, N., Stampfer, R., Zach, J., Born, C., Bernhard, B., Fast, K., Grunze, H., et al. (2007) · Bipolar Disorders · doi:10.1111/j.1399-5618.2007.00412.x · Cited by 66 · see citing works
The predictive significance of neurocognitive factors for functional outcome in bipolar disorder
Andreou, C., & Bozikas, V. P. (2012) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32835a2acf · Cited by 62 · see citing works
Relationship between neurocognitive functioning and episode recurrences in bipolar disorder
Martino, D. J., Strejilevich, S., Marengo, E. B., Igoa, A., Fassi, G., Teitelbaum, J., & Caravotta, P. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.11.037 · Cited by 55 · see citing works
Roux, P., Raust, A., Cannavo, A.-S., Aubin, V., Aouizerate, B., Azorin, J., Bellivier, F., Belzeaux-R, R., Bougerol, T., Cussac, I., et al. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.117.201335 · Cited by 43 · see citing works
Samalin, L., Llorca, P., Giordana, B., Milhiet, V., Yon, L., El‐Hage, W., Courtet, P., Hacques, E., Bedira, N., Filipovics, A., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.02.023 · Cited by 42 · see citing works
The Impact of Obesity on Cognitive Functioning in Euthymic Bipolar Patients
Mora, E., Portella, M. J., Martínez‐Alonso, M., Teres, M., Forcada, I., Vieta, E., & Mur, M. (2017) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.16m10968 · Cited by 41 · see citing works
McIntyre, R. S., Mansur, R. B., Lee, Y. L., Japiassú, L., Chen, K., Lu, R., Lu, W., Chen, X., Li, T., Xu, G., et al. (2017) · Bipolar Disorders · doi:10.1111/bdi.12491 · Cited by 34 · see citing works
Konstantakopoulos, G., Ioannidi, N., Typaldou, M., Sakkas, D., & Oulis, P. (2016) · Psychiatriki · doi:10.22365/jpsych.2016.273.182 · Cited by 27 · see citing works
Papachristou, E., Oldehinkel, A. J., Ormel, J., Raven, D., Hartman, C. A., Frangou, S., & Reichenberg, A. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.01.038 · Cited by 23 · see citing works
Okasha, T. A., Sheikh, M. M. E., El-Missiry, A., Missiry, M. A. G. E., El-Serafi, D., Kholy, S. E., & Aziz, K. A. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.051 · Cited by 18 · see citing works
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1 of the 46 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Zhang, H., Chen, J., & Fang, Y. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s427617 · Cited by 12 · see citing works
Self-citationYu, H., Wang, C., Wu, Y. Y., He, C., & Zou, S. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1574391 · Cited by 4 · see citing works
Hirsig, A., Häfeli, X. A., & Schmidt, S. J. (2024) · Trials · doi:10.1186/s13063-024-08241-3 · Cited by 2 · see citing works
“Subclinical symptoms are highly prevalent in adolescence [13, 14], associated with neurobiological and cognitive abnormalities [15–18], and enhance the risk of developing a mental disorder later on [19–21].”
BackgroundZhang, X., Cheng, X., Chen, J., Sun, J., Yang, X., Li, W., Chen, L., Mao, Y., Liu, Y., Zeng, X., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.04.063 · Cited by 2 · see citing works
Self-citationHuang, Y., Gong, W., Song, M., Zou, H., Zhai, Q., Shen, A., Shi, K., Yan, R., Hua, L., Yao, Z., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120396 · Cited by 1 · see citing works
GÖKÇEİMAM, P. Ş., Selma Filiz, Y. A. R., & Kumsar, N. A. (2022) · Çukurova medical journal (Online)/Çukurova medical journal · doi:10.17826/cumj.1176773 · Cited by 1 · see citing works
Troubles neurocognitifs dans les troubles bipolaires de l'humeur
Roux, P., Brunet-Gouet, É., & Passerieux, C. (2023) · Elsevier eBooks · doi:10.1016/b978-2-294-77180-4.00040-8
Vidal, N., Brunet-Gouet, É., Frileux, S., Belzeaux-R, R., Courtet, P., d’Amato, T., Dubertret, C., Étain, B., Haffen, É., Januel, D., et al. (2026) · International Journal of Bipolar Disorders · doi:10.1186/s40345-026-00420-2
- Authors
- Zhang, X., Cheng, X., Chen, J., Zhang, B., Wu, Q., Deng, W., Li, X., Lin, Y., Yang, C., & Cao, L.
- Affiliations
- Guangzhou Medical University (CN)
- Shenzhen Children's Hospital (CN)
- Corresponding author
- Yang, Chanjuan
- Cao, Liping
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2019-08
- Volume
- 278
- Pages
- 303-308
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2949176705
- Cited by
- 9
- References
- 46
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1
- FWCI
- 0.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81771466)
- Natural Science Foundation of Guangdong Province (2018A030313283)
- Science and Technology Planning Project of Guangdong Province (2017ZC0419, 2013B021800074)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar I disorder, euthymia, cognitive impairment, immediate memory, attention, language skills, delayed memory, years of schooling, body mass index, neuropsychological performance
- MeSH terms
- Adult, Attention, Bipolar Disorder, Cognition, Cross-Sectional Studies, Cyclothymic Disorder, Female, Humans, Male, Memory, Short-Term, Middle Aged, Neuropsychological Tests, Body Mass Index, Linear Models, Cognitive Dysfunction
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