ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Neuropsychological impairment in bipolar disorder: the role of the Hypothalamic-Pituitary-Adrenal axis


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ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Neuropsychological impairment in bipolar disorder: the role of the Hypothalamic-Pituitary-Adrenal axis

Vol 1 - Iss 2 - Short Communication - Neuropsychological impairment in bipolar disorder: the role of the Hypothalamic-Pituitary-Adrenal axis #19

Neuropsychological impairment in bipolar disorder: the role of the
Hypothalamic-Pituitary-Adrenal axis

Lucy J. Robinson, B.A. (Hons) , Peter Gallagher, B.Sc. (Hons), M.Phil., Nicol Ferrier, F.R.C.P., M.D. (Hons), F.R.C.Psych.

Stanley Research Centre; School of Neurology, Neurobiology and Psychiatry; University of Newcastle upon Tyne, UK.

Correspondence and requests for reprints should be addressed to:
Professor IN Ferrier
School of Neurology, Neurobiology and Psychiatry;
University of Newcastle upon Tyne,
Leazes Wing (Psychiatry), Royal Victoria Infirmary,
Queen Victoria Road,
Newcastle upon Tyne,
NE1 4LP, UK.
Tel: +44 (0) 191 282 4336
Fax: +44 (0) 191 222 6162
E-mail: i.n.ferrier@ncl.ac.uk

Conflicts of Interest: None
Abstract

Bipolar disorder (BD) is a chronic and recurrent illness, with a lifetime incidence of approximately 1%. Although the illness is defined by mood disturbance, pronounced neurocognitive dysfunction is frequently described in symptomatic bipolar patients and there is increasing evidence of specific impairments which may persist in euthymia and therefore represent a relatively enduring abnormality. This is further supported by evidence of mild neurocognitive impairment in groups at high genetic risk, such as first degree relatives of bipolar probands. It has been suggested that abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function may cause or exacerbate both neurocognitive impairment and mood symptoms. HPA axis abnormalities, most likely at the level of the glucocorticoid receptor (GR), have been demonstrated in all illness phases in BD and their persistence in euthymia suggests they may also be a trait abnormality. Recent proof-of-concept studies have shown that the GR-antagonist mifepristone holds promise in the treatment of bipolar depression, particularly in ameliorating associated neurocognitive impairment. Therapies aimed at ameliorating glucocorticoid dysregulation may therefore be useful in BD, perhaps as adjuncts to other treatments and such research will increase our understanding of the neurobiological underpinnings of neurocognitive impairment in BD.
Key words: Bipolar disorder, neurocognitive function, executive function, Memory

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