4.3 Article

The effect of concomitant benzodiazepine use on neurocognition in stable, long-term patients with bipolar disorder

Journal

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY
Volume 55, Issue 10, Pages 1005-1016

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/0004867420969819

Keywords

Bipolar disorder; euthymia; cognition; benzodiazepines; cognitive impairment

Categories

Funding

  1. Carlos III Health Institute [PI18/01352, JR17/00003, PI16/01770]
  2. Carlos III Health Institute (Spanish Ministry of Economy and Innovation) `Rio Hortega' fellowship [CM19/00078]
  3. National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowships [APP1059660, APP1156072]
  4. European Development Regional Fund 'A way to achieve Europe'

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The study found that individuals with bipolar disorder, regardless of benzodiazepine treatment, exhibit impairments in memory and processing speed, but those using benzodiazepines showed additional impairments in executive functioning.
Objective: Neurocognitive dysfunction is a common feature of bipolar disorder even in euthymia, and psychopharmacological treatment could have an effect on cognition. Long-term prescription of benzodiazepines in bipolar disorder is a common practice, and their effect on neurocognition has not been well studied in this population. The aim of this study was to evaluate the impact of concomitant benzodiazepine long-term use on neurocognitive function in stable euthymic bipolar disorder patients. Methods: Seventy-three euthymic bipolar disorder outpatients and 40 healthy individuals were assessed using a neurocognitive battery. Patients were classified in two groups according to the presence of benzodiazepines in their treatment: the benzodiazepine group (n = 34) and the non- benzodiazepine group (n = 39). Neurocognitive performance was compared between the groups using a multivariate analysis of covariance, considering age, number of depressive episodes, adjuvant antipsychotic drugs, Young Mania Rating Scale score and Hamilton Depression Rating Scale score as covariates. Results: Both bipolar disorder groups (benzodiazepine and non-benzodiazepine) showed an impairment in memory domains (Immediate Visual Memory [p = 0.013], Working Memory [p < 0.001], and Letter-Number Sequence [p < 0.001] from the Wechsler Memory Scale-Revised-III) and slower processing speed functions (Stroop Colour [p < 0.001]) relative to the control group. Nevertheless, the benzodiazepine group showed a greater impairment in executive functions (Conceptual Level Responses [p = 0.024] from the Wisconsin Card Sorting Test and Frontal Assessment Battery [p = 0.042]). Conclusion: Although memory and processing speed impairments were found in bipolar disorder, regardless of their benzodiazepine treatment, benzodiazepine users presented additional neurocognitive impairments in terms of executive functioning. These findings support restricted prescription of benzodiazepines in individuals with bipolar disorder.

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