Cognitive problems have historically been the last to be recognized and treated in the clinical setting.
View the slides in PDF format. Also see: 7 Components of Depression Evaluation.
Cognitive problems have historically been the last to be recognized and treated. Scroll through the slides for a deeper dive into concepts covering cognitive disorders, with links to respective articles in this collection. View the slides in PDF format. Also see: 7 Components of Depression Evaluation.
Psychiatrists traditionally warn patients about effects on attention, alertness, and motor function. Rarely, if ever, do we discuss in detail any negative effects on cognition. The only notable exception to this oversight involves the effects of ECT on memory. The purpose of this Special Report on cognition and cognitive disorders is to raise the consciousness of mental health clinicians to less obvious, but important, effects that illness and treatment have on cognition. With additional research and knowledge, we can strengthen our partnership with patients in shared decision-making and make further advancements in quality of life for people with mental illness. For details, see: Introduction: Cognition, Rarely Discussed.
In clinical practice, functional mood stability-which can on occasion be achieved with optimum lithium therapy-is the gold standard that both clinicians and patients strive to attain. To facilitate this endeavor, guidelines on lithium therapy have become increasingly sophisticated; they not only provide therapeutic indications and plasma levels with respect to efficacy, but also inform practitioners about how potential adverse effects can be minimized or avoided. The above schematic displays the indicated plasma concentrations in mmol/L for initiation of treatment, as well as treatment during acute episodes of mania and depression in bipolar disorder and during the maintenance phase of treatment. For a mobile-friendly view of the schematic, click here. For details, see Lithium Therapy, Bipolar Disorder-and Neurocognition.
To map the neurocognitive changes that occur in patients with bipolar disorder who undergo lithium treatment, the authors proposed that clinicians use the Lithium Battery–Clinical to assess the neurocognitive effects of lithium [see reference 13 here]. This tool allows clinical complaints to be correlated with changes to the illness profile and, in particular, to changes in treatment. The adoption of such a tool automatically enhances the attention paid to neurocognition in clinical settings and provides a richer understanding of contributing factors in patient illness. See more at Lithium Therapy, Bipolar Disorder-and Neurocognition. For a mobile-friendly view of the Figure, click here.
SIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST: Neurocognition is an important aspect of global functioning, and psychiatrists may consider how mental disorders and their treatments affect neurocognitive functioning. For a mobile-friendly view of the Monarch notes, click here.
Cognitive enhancement is often characterized by attempts to increase the performance of cognitive functions, such as attention or memory, in healthy individuals. While humans and other species have consistently made efforts to improve from an evolutionary standpoint, what is relatively new is the impact of medications and technological advances in enhancing such efforts. Although personal enhancements such as cosmetic surgery have gained societal acceptance, interventions such as cognitive enhancement continue to be a matter of significant ethical, philosophical, and sociopolitical debate. For details, see: Cognitive Enhancers in Children and Adolescents: What Psychiatrists Need to Know.
SIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST. Unlike other “self-enhancement” strategies, the legitimacy of cognitive enhancement raises questions in ethical, legal, and medical domains. While cognition-enhancing agents may be useful in professions in which one must maintain prolonged concentration, the risk of abuse-as well as cardiac risks and excessive weight loss-in otherwise healthy individuals may outweigh the benefits. For a mobile-friendly view of the Monarch notes, click here. For a mobile-friendly view of the Monarch notes, click here.
Editor's note: This slideshow was originally published on February 10, 2017 and has since been updated.