Let’s Talk About Cognition

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.