Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians

In the late 19th century, Emil Kraepelin popularized the dichotomy between chronic and episodic mental disorders. For Kraepelin, the condition we know today as bipolar disorder was a defining example of an episodic disorder, and this has since been part of the standard psychiatric dogma. Over a century later, by focusing on cognitive symptoms, the editors of and contributors to this book have produced a work that has the potential to both challenge this dichotomy and expand our conception of bipolar disorder and its treatments.

Research on cognitive dysfunction in neuropsychiatric diseases is not new. However, in recent years, there has been an explosion of interest in widening the scope of our knowledge. Disease processes such as schizophrenia, bipolar disorder, Parkinson's disease, multiple sclerosis, and epilepsy are all being reevaluated in light of new research in this area. Cognitive Dysfunction in Bipolar Disorder reviews this literature as it relates to bipolar disorder and provides a road map for future research. The target audience is clinicians, and the editors clearly made an effort to structure the book to address questions that may occur to clinicians as they try to integrate this recent research into the treatment of their patients.

Overall, I enjoyed this book. It lays out the evidence for cognitive dysfunction during pathological affective states as well as for dysfunction that remains constant, even in euthymia. Studies are reviewed that reveal deficits not only among patients but also among their parents and siblings. Next are chapters looking at worsening cognitive dysfunction that is caused by medications, as well as cognitive improvements that can occur during treatment. Finally there is a series of chapters devoted to looking at these deficits practically, by reviewing their likely impact on the patient's life and ability to engage in psychotherapy, as well as by giving advice on ways to engage with these deficits in treatment.

Although there is much to recommend this book, there are some aspects that might limit its appeal. I am not a fan of books with different authors for each chapter, because I find the content uneven and unnecessarily repetitive; this book does not completely escape that weakness. Also, this research literature is in its infancy. Despite the knowledge gained in recent years, there are still more questions than answers and still more recommendations of the type "theoretically this should work" than "this is the evidence that this works." This is not the fault of the authors, but anyone looking for evidence-based treatment recommendations may be disappointed. Also, there is much technical jargon regarding neuropsychological testing in this book. A brief attempt to introduce these terms and concepts can be found in the first chapter, but someone who is completely unfamiliar with this literature would probably do well to have a basic textbook close by for reference.

In summary I recommend this book to anyone who routinely treats patients who have bipolar disorder. The role of cognitive dysfunction in this patient population is still being explored, but the implications are exciting. As our field continues to seek new ways to improve the quality of life of these patients, books such as this provide useful ideas to help expand our conceptions of the disease as well as its treatment.