Cognitive deficits in executive function and memory among individuals with bipolar disorder BD are well-documented; however, only recently have efforts begun to address whether such cognitive deficits can be ameliorated through cognitive training. This pilot study examined the effects of a top—down, cognitive reasoning training program in adults with BD on both brain and cognitive measures. Twenty-seven participants 11 males, 16 females , aged 21—70 years old, completed the study. The training delivered information processing strategies that were implemented and applicable to a variety of daily living contexts. We found a significant increase in resting cerebral blood flow CBF in left inferior frontal gyrus after cognitive training.
Recovery from Addiction is Possible. Bi polar training and texas are the consequences? Thirdly, we found a significant association between increased CBF in the right middle frontal gyrus MFG and improved complex abstraction. In sum, we propose that the increased health of the frontal B, as manifested by elevated CBF, could be a result of experience-driven neural plasticity where the concerted cognitive effort recruited and trainign the health of this neural system. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.
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The training program begins with multiple brainstorming sessions with the business Beer prostate deeply understand their requirements and expectations. All training must be coordinated through your local agency. Just about everyone has ups and downs from time to time, but for people like Katrina, these changes can be severe. Power BI Intermediate. A dedicated instructor from NetCom Learning Dallas customizes the delivery of the content according to the needs of the participants. Each patient and their family members will receive a treatment plan including medication management and family therapy focused on education, skill building, communication training, and problem-solving techniques. You can take extensive Microsoft Power BI training and certification courses in a range of learning modes including classroom, online, onsite, and instructor-led blended among other in custom schedules. Bi polar training and texas the "calmest" family will sometimes need outside help in dealing with the stress of a loved one who has continued symptoms. Some consequences of a manic episode can't be undone. In addition to providing business-to-business training, our courses are also taken by individuals with government training funds. The fact is that manic phases often turn destructive. What is Bipolar Disorder? So what's the problem? Suite HoustonBi polar training and texas Bipolar disorder, formerly Manic-Depressionis a condition involving significant, intense mood swings between the opposite poles of low and high mood.
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- Bipolar disorder, formerly Manic-Depression , is a condition involving significant, intense mood swings between the opposite poles of low and high mood.
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- Bipolar disorder also known as manic-depression is a serious but treatable medical illness.
You don't have to do this alone. DBSA offers in-person and online support groups for people living with a mood disorder as well as friends and family. Parents who have a child living with depression or bipolar can join the online community for parents, the Balanced Mind Parent Network.
Enter your zipcode to find an in-person support group near you. In order to thrive, all aspects of a person must be evaluated including physical health, lifestyle, education, employment status or career goals, relationships, etc.
For over twenty years, I have struggled with symptoms of mental illness. When I was only twelve, my father passed away Different people need different amounts of sleep to stay well. Learn about the importance of sleep in your wellness plan. Living Successfully with a Mood Disorder helps you understand mood disorders, and define what wellness means to you.
Using this app can help you better recognize potential health problems and mood triggers in your daily life. Depression and bipolar disorder can present challenges, but there are things you can do to manage your symptoms and stay well at work. Connecting to others is an important part of wellness. If you have had trouble in relationships with family and friends, you are not alone. Exercise is an important part of wellness, not only because it keeps our bodies healthy, but also because it benefits our brains!
Talk therapy can be an important part of treatment for depression, bipolar disorder or other mood disorders. If you need immediate assistance, call or go to the nearest hospital emergency room. First Name Email What is your question? Sign up for our newsletter. Find Support You don't have to do this alone. Miles: 5 10 20 30 40 50 October eUpdate. September eUpdate. August eUpdate. Thriving with Bipolar. Thriving with Bipolar Description. When I joined I felt isolated and in crisis. I found a supportive community of educated, helpful and kind parents who love their children very much.
I desperately needed to know that my son could find light at the end of the tunnel. I found optimism and helpful suggestions. Peer Stories. Eleora Han. Meet Maggie. Dana Parker-Mathis. Living Successfully with a Mood Disorder. Goal setting is an important part of wellness, no matter where you are on your journey.
Setting Goals. Wellness Tracker. At Work. Talk Therapy. View All Wellness Tools. DBSA Programs. Life Unlimited Empowering stories of individuals whose lives have been touched, but not limited by, a mood disorder. Young Adults The Young Adult section is to support young adults through challenges as well as help them connect to other young adult peers.
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Mania with fewer of the symptoms above may be called "hypomania", and might be diagnosed as "Bipolar Type II. There are many theories regarding the cause of bipolar disorder. It is likely a combination of biological and psychosocial factors. Neurotransmitters : Much of the research suggests there is an imbalance of specific neurotransmitters in the brain. Neurotransmitters are chemicals that facilitate information passing between nerve cells in the brain.
Scientists are unclear exactly how these neurotransmitters impact the development of bipolar disorder. However, medications that allow an increase or decrease in specific neurotransmitters help to reduce bipolar symptoms. Genetics : Twin and adoption studies indicate there is a strong genetic component to bipolar disorder.
Although biological factors clearly play a role, mood episodes have often been noted to follow stressfull life events such as change moving to college or loss death of loved ones, ending of relationships. Medication : Although there is no "cure" for bipolar disorder, medications can significantly reduce and manage symptoms and mood swings. People may continue to have residual symptoms, despite optimal medication treatment; however, their quality of life is frequently better.
Psychiatrists tend to use a combination of mood stabilizers and anti-depressant medications to prevent clients from rapidly shifting from one episode to another. Therapy : Psychotherapy can help the individual with bipolar disorder to stabilize daily routines, deal effectively with stress, be vigilant of encroaching symptoms, and to develop effective methods of communicating regarding their symptoms and behaviors.
Symptoms of bipolar disorder can often lead to damaged relationships, difficulty at work or school, and even suicide. People who are left untreated will continue to experience numerous shifts in mood. Learn about the importance of sleep in your wellness plan. Living Successfully with a Mood Disorder helps you understand mood disorders, and define what wellness means to you. Using this app can help you better recognize potential health problems and mood triggers in your daily life.
Depression and bipolar disorder can present challenges, but there are things you can do to manage your symptoms and stay well at work. Connecting to others is an important part of wellness. If you have had trouble in relationships with family and friends, you are not alone. Exercise is an important part of wellness, not only because it keeps our bodies healthy, but also because it benefits our brains! Talk therapy can be an important part of treatment for depression, bipolar disorder or other mood disorders.
If you need immediate assistance, call or go to the nearest hospital emergency room. First Name Email What is your question? Sign up for our newsletter. Find Support You don't have to do this alone. Miles: 5 10 20 30 40 50 October eUpdate.
September eUpdate. August eUpdate. Thriving with Bipolar In order to thrive, all aspects of a person must be evaluated including physical health, lifestyle, education, employment status or career goals, relationships, etc. Thriving with Bipolar Description. When I joined I felt isolated and in crisis. I found a supportive community of educated, helpful and kind parents who love their children very much.
I desperately needed to know that my son could find light at the end of the tunnel. I found optimism and helpful suggestions. Peer Stories. Eleora Han.
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Cognitive deficits in executive function and memory among individuals with bipolar disorder BD are well-documented; however, only recently have efforts begun to address whether such cognitive deficits can be ameliorated through cognitive training.
This pilot study examined the effects of a top—down, cognitive reasoning training program in adults with BD on both brain and cognitive measures. Twenty-seven participants 11 males, 16 females , aged 21—70 years old, completed the study. The training delivered information processing strategies that were implemented and applicable to a variety of daily living contexts.
We found a significant increase in resting cerebral blood flow CBF in left inferior frontal gyrus after cognitive training. We also found that resting CBF in the right frontal middle gyrus correlated positively with performance on the measure of complex abstraction. This feasibility study provides promising evidence that short-term reasoning training can enhance cognitive performance and brain health in adults with BD.
These data motivate further efforts to explore adjuvant therapeutics to improve cognitive performance and underlying brain systems in bipolar, as well as other psychiatric disorders.
Bipolar disorder BD , a mental illness with recurring episodes of mania and depression, can have far-reaching detrimental effects on the everyday function and living of those with the diagnosis. In addition to causing distressing shifts in mood and energy level, we now know that patients with BD experience cognitive deficits, not only during mood episodes but also in remission van Gorp et al.
A meta-analysis of cognitive deficits in adult euthymic patients with BD i. Imaging studies also reveal underlying neural abnormalities, including changes in brain blood flow and activation. Benabarre et al. Resting state functional imaging studies of individuals with BD demonstrate abnormal activation in the prefrontal and cingulate cortices Blumberg et al.
Other studies, including a quantitative meta-analysis review of functional magnetic resonance imaging studies in BD, extend previous evidence of attenuated activation of the left inferior frontal gurus IFG across emotional and cognitive tasks Phillips et al.
These approaches will continue to be a vital aspect of BD treatment; however, additive benefits may be derived from protocols that directly address the common cognitive sequelae. Previously reported studies have implemented cognitive training alone or in conjunction with other symptom management and therapeutic interventions e. The cognitive training portion of these studies targeted specific processing deficits in BD, such as memory, executive function, and attention. Studies by Deckersbach et al.
On the other hand, similarly well-constructed studies to address cognitive and psychosocial deficits in BD failed to find significant improvement in cognitive function Torrent et al. While cognitive gains were not reported, the Torrent et al. Based on this foundation of evidence that targeting specific cognitive processes may benefit individuals with BD, we were interested in testing whether a top—down strategy-based cognitive training of integrative processes could reap brain and cognitive gains as has been uncovered in other populations Gamino et al.
Evidence from a series of studies from our lab has found that strategy-based reasoning training described below improved cognitive functions in both primary and secondary measures across several different populations including individuals with mild cognitive impairment MCI , traumatic brain injury TBI , as well as healthy adults and teenagers Gamino et al.
A larger randomized trial in adults with TBI found similar improvements in measures of executive function, memory and daily function Vas et al. In this latter study, the reasoning training was shown to significantly improve psychological health with reduced depression and stress-related symptoms. A comparison of reasoning training versus a new learning intervention in adults with MCI also resulted in significant improvements in executive function and memory measures in the reasoning group Mudar et al.
Previous cognitive training approaches with BD have focused largely on targeting specific cognitive processes and measuring improvement through cognitive batteries alone. Additionally, previous training protocols e.
In contrast, strategy-based, integrative processes can be trained over a relatively short time-span with training in ways to incorporate strategies into daily life routines. Based on principles of experience-driven plasticity, the likelihood of increased usage throughout daily life may increase chances of achieving spill-over affects into other cognitive domains, maximizing treatment efforts.
For instance, in the aforementioned studies which trained reasoning, participants showed improvements in the primary outcome measure, as well as generalized cognitive benefits in other secondary outcome measures of memory and executive functioning skills Vas et al. To date, no known study has investigated the effectiveness of a reasoning training program in individuals with BD.
Additionally, of the cognitive trainings completed within the BD population, none have coupled neurocognitive and imaging measures.
Therefore, the current phase I pilot trial fills a void by providing preliminary evidence of cognitive and neural benefits from a cognitive training program in individuals with BD. The current study had three major objectives. First, we proposed that a reasoning program, Strategic Memory Advanced Reasoning Training SMART , would not only improve performance on the primary domain of complex abstraction, but would also show transfer effects to untrained domains of executive function and memory.
Our second major goal was to determine whether training induced neuroplasticity changes as measured by resting CBF using pseudo-continuous arterial spin labeling pCASL magnetic resonance imaging MRI.
Recent studies demonstrate that CBF is reflective of neuronal health Chen et al. Lastly, we were interested in whether the cognitive gains would be linked to specific brain blood flow changes to elucidate possible mechanisms of improvement. Participants were recruited at the University of Texas Southwestern Medical Center, through psychiatrist referral, flyers and website advertising.
Participants underwent a telephone screen with a research clinician, including a brief medical questionnaire covering their history, current medications and any pre-existing conditions. After the participant met the requirements covered by the phone screen, they were asked to complete a neurocognitive testing battery, including the Mini Mental State Exam MMSE.
The inclusion of partially in addition to fully remitted individuals served to confirm sufficient sample size and was based on evidence suggesting that residual affective symptoms have no major effects on objective cognitive function Burdick et al.
In addition, participants were administered a standard MRI prescreening form to assess the presence of contraindications for MRI compatibility e. Diagnosis of BD and euthymic state was confirmed with collaborating psychiatrist. When the participant was not a patient of the collaborating psychiatrist, written approval was obtained from the treating psychiatrist confirming the following: participant was between ages 21 and 70; participant had a diagnosis of BDI or BDII; participant was in a euthymic, rather than manic or depressive, state; participant had been stable on medications for at least 3 months; and participant was believed to be appropriate for the study.
This was a phase I, non-randomized, pilot intervention study examining the neurocognitive and brain changes from a reasoning training program, SMART, in euthymic individuals with BD. Outcome measures were administered at baseline pre-training, T1 and within 2 weeks after completing the training sessions post-training, T2. Groups were led by the same licensed speech-language pathologist. Groups met for 2 h once a week for 4 weeks total training of 8 h.
Groups were formed in order of enrollment and schedule alignment. Strategic Memory Advanced Reasoning Training equips participants with meta-cognitive strategies of Strategic Attention, Integrative Reasoning, and Innovation as a guide for engaging in deeper-level innovative thinking across real-life activities Chapman and Kirkland, Strategic Attention targets the ability to filter irrelevant information in order to focus on the important information.
Integrative Reasoning targets the ability to abstract meanings from specific key details be it from a book, medical or legal advice, a movie, conversation, meeting, or other daily interaction , and to interpret within a broader context of world knowledge to create global themes and take away messages that remain relevant to the information or task at hand.
At the end of each session, participants were given homework assignments that required use of the strategies. Homework was discussed in the initial portion of the following session, and each participant reported completing the assignments.
Exercises utilized a variety of materials, varying in complexity e. Emphasis was put on application of strategies to other contexts e. The three strategies were presented in sessions one and two, leaving sessions three and four for 1 participant demonstration of how they were incorporating the strategies in their daily lives, 2 participant-generated exercises that required implementation of the strategies exhibiting further understanding of material , and 3 feedback, questions, and broader conversations focusing on how to practically and independently implement the strategies in daily life, as this was the final goal.
A battery of neurocognitive measures was administered on a non-training day at two time periods, i. Cognitive assessment measures were completed in individual, face-to-face testing sessions. Brief description of outcome variables scaled scores used if not otherwise specified below. Complex abstraction is also referred to as gist reasoning. The TOSL is an assessment that has been previously utilized as a criterion-referenced measure of ability to abstract meaning from complex information in typically developing youth Chapman et al.
Recent evidence supports TOSL as both a sensitive and specific metric of complex abstraction ability Vas et al. Participants read a complex text approximately words.
To evaluate complex abstraction, participants are then instructed to generate a high-level summary of the text. Another subtest of TOSL assesses the ability to recall key facts from the text. The TOSL complex abstraction measure has a manualized objective scoring system where each abstracted idea in the summary receives one point and verbatim or paraphrased ideas do not receive any points, the final score then reflects the total number of accurately abstracted ideas from the text.
Different versions of the TOSL were administered at pre- and post- testing. Recall for details from TOSL text yields a maximum possible score of The QoL. BD scale is the only quality of life questionnaire specifically designed for individuals with BD. The full version has 56 questions within 10 basic domains: physical, sleep, mood, cognition, leisure, social, spirituality, finances, household, self-esteem, and two optional domains work and education.
A body coil was used for radiofrequency RF transmission and an 8-channel head coil with parallel imaging capability was used for signal reception. The MRI scans of participants were performed at rest with their eyes open and on a non-training day. The details of imaging parameters and their processing techniques are provided below. The difference image was then corrected for imaging slice delay time to yield CBF-weight image, which was normalized to the brain template from Montreal Neurological Institute MNI.
Each neurocognitive measure was considered a dependent variable in a standard linear model. We did not omit subjects whose baseline measures were not paired with their respective post-training measures from lack of follow-up. Thus, the intent-to-treat analyses necessitated the use of a mixed model with time as a within-subject fixed factor and subjects themselves as a random factor. Temporal contrasts, which estimated mean change across the two measurement times, were of primary interest; and all hypotheses were one-sided.
That is, we expected only improvements post-training. Given the inclusion of partially in addition to fully remitted individuals with BD, we included, in another set of models, the depression measure HAM-D as a covariate with possible interactions temporally. In these models temporal contrasts were conditional on the mean HAM-D estimate across subjects.
In addition, we included age as a covariate as well as indicators for the presence or absence of concurrent antipsychotic and anticonvulsive medications to assess any potential effects on the neurocognitive measures.
Finally, we applied the Benjamini-Hochberg method to control the false discovery rate FDR due to the large number of statistical tests on the neurocognitive battery. For the voxel-based imaging analyses, each subject had paired measurements pre- and post-training. Thus, voxel level analyses were paired t -tests.
At this threshold, contiguous clusters of voxels exceeding 1, 11, mm 3 in number volume were significant at a 0. All 27 participants completed 8 h of training.
Our primary measure of complex abstraction did show improvement from pre- to post-training, although not based on the FDR criterion. In a prior investigation, we had shown that such technique improves sensitivity of regional differences by reducing physiological variations Aslan et al.
Whole brain voxel-wise correlation analysis between complex abstraction i. Bipolar disorder group showed significant association between gains in regional CBF and behavioral measures. This feasibility study is the first known attempt to investigate both cognitive i. The novel aspects of this pilot trial are testing a cognitive training protocol SMART and brain measurement CBF that have previously shown promise in studies focused on harnessing cognitive and neural plasticity.
As stated above, SMART teaches top—down, metacognitive strategies that can be utilized in everyday life and its efficacy is supported by prior evidence of improved executive function and frontoparietal networks in other clinical and healthy populations Chapman et al. Additionally, recent technological advancements in resting state MRI allow measurement of neuroplasticity changes with CBF, which is beginning to show promise as one potential objective neural marker of enhanced brain health.