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Background The HOPE-BD was a naturalistic study established to follow individuals in Canada seeking treatment for bipolar disorder (BD). The study aimed to examine the course of BD and describe how clinical and sociodemographic factors are associated with outcomes. Methods Individuals with BD had their clinical data recorded at enrolment and were naturalistically treated. Participant were followed for up to four years, and visits occurred at least once every three months. We investigated the longitudinal outcomes with logistic, Cox, and quantile regressions. Results Among the 354 participants, 57.3% had BD type I. Depression as first episode, younger ages at onset and older ages of the first professional help predicted longer delays in correct diagnosis. Among the symptomatic patients at baseline, the median time to remission was 10.9 months. Comorbid alcohol use disorder and the severity of baseline depressive symptoms predicted longer times to remission. Among the euthymic participants, the median time to recurrence was 14.5 months. History of anxiety disorder and younger ages at onset predicted shorter times to recurrence. Baseline depression scores predicted recurrence in euthymic patients. Limitations We did not investigate the predictors of each polarity. Our findings may not apply to individuals followed in non-specialised outpatient services. Conclusion Our study reinforces the necessity of early diagnosis and interventions, as well as the importance of treating depressive symptoms and comorbidities.

Background Psychosis in bipolar I disorder (BDI) has been associated with increased cognitive dysfunction, which may relate to poorer functional outcomes. However, it is not known whether cognition differs between BDI patients with (BDP+) or without (BDP-) history of psychosis early in the disease course, or if it is impacted by the presence of mood congruent (MCP) versus incongruent (MIC) psychotic features. We compare cognition between these groups in BDI patients recently recovered from first episode of mania. Methods Attention, verbal learning/memory, processing speed and executive functioning were compared between: 1) all BDI patients (n = 73) and healthy controls (HC, n = 45), 2) BDP+ (n = 60) and BDP- (n = 13) patients and 3) MCP (n = 27) and MIC (n = 33) patients. Post-hoc analyses compared all patient groups with HC. Results While BDI patients performed worse than HC in all domains, there were no significant differences between BDP+ and BDP-, or MCP and MIC, patients. However, BDP+ and MIC groups demonstrated different patterns of impairment compared to HC then did BDP- or MCP. Executive functioning and cognitive flexibility in particular appeared to be a deficit area in BDP+ patients. Limitations This study may have been underpowered to detect differences in direct comparison between BDP+ and BDP- patients. Conclusion While replication in larger samples is required, these results suggest that subtle cognitive differences between BDP+ and BDP-, and between MIC and MCP, patients may be present shortly after disease onset. These patient subsets may therefore be of interest in examining early intensive strategies to preserve cognition.

Several studies have reported cognitive functioning as a significant predictor of quality of life (QoL) in patients with established bipolar disorder (BD), in addition to mood symptoms. However, it is unclear whether cognitive functioning predicts QoL early in the course of illness. The purpose of this study was therefore to evaluate the relationship between mood and neuropsychological variables and self-reported QoL early in the course of BD.Patients with BD-I (n=54) completed a neuropsychological battery and clinical assessment within 3 months of resolution of their first manic episode. QoL was assessed 6 months later using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Cognitive predictors of QoL were assessed through Pearson correlations and hierarchical multiple regression.After accounting for mood rating scores at the time of cognitive testing (ΔR²=.27, p.001), measures of sustained attention (ΔR²=.08, p.05), verbal memory (ΔR²=.09, p.01), working memory (ΔR²=.06, p.05), and executive functioning (ΔR²=.08, p.05) each predicted QoL when entered independently in separate regression models. When entered simultaneously, the cognitive domains explained 15% (R(2)=.42, p.05) of the variance in QoL beyond mood.Some aspects of QoL that are particularly important in BD may be missing as a result of using the Q-LES-Q, because the measure was not specifically developed to assess QoL in BD.In addition to mood symptoms, poorer cognitive functioning is a significant predictor of reduced QoL early in the course of BD. Recently diagnosed patients with BD may benefit from early cognitive-enhancing interventions to maintain or restore their QoL.

Background: Both bipolar disorder (BD) and childhood trauma are associated with cognitive impairment. People with BD have high rates of childhood trauma, which confer greater overall disease severity, but, it is unknown if childhood trauma is associated with greater neurocognitive impairment in BD patients early in the course of their illnesses. In this study, we investigated the impact of childhood trauma on specific cognitive dysfunction in patients who recently recovered from their first episode of mania. Methods: Data were available for 64 patients and 28 healthy subjects matched by age, gender and pre-morbid IQ, recruited from a large university medical center. History of childhood trauma was measured using the Childhood Trauma Questionnaire. Cognitive function was assessed through a comprehensive neuropsychological test battery. Results: Trauma was associated with poorer cognitive performance in patients on cognitive measures of IQ, auditory attention and verbal and working memory, and a different pattern was observed in healthy subjects. Limitations: We had a modest sample size, particularly in the group of healthy subjects with trauma. Conclusions: Childhood trauma was associated with poorer cognition in BD patients who recently recovered from a first episode of mania compared to healthy subjects. The results require replication, but suggest that the co-occurrence of trauma and bipolar disorder can affect those cognitive areas that are already more susceptible in patients with BD.