For bipolar disorder patients, longer admission to hospital is associated with more severe executive functioning deficits at discharge, the results of a US study indicate.

A more severe disease course in bipolar disorder is associated with greater cognitive impairments, with cognitive deficits in euthymic patients predicted by a greater number and longer duration of mood episodes.

To determine whether length of hospitalization to stabilize from an acute episode of mood disturbance is linked to cognitive functioning, Boaz Levy, from Harvard Medical School in Boston, Massachusetts, and colleagues studied 41 patients with bipolar disorder.

In all, 20 patients had a hospital stay that lasted longer than the median stay of 12 days, while the remaining 21 patients had a shorter stay. The participants were administered a neuropsychological battery at discharge and group differences in clinical data and test performance were analyzed.

There were no significant differences between long- and short-stay patients in terms of age at onset of bipolar disorder, previous number of psychiatric admissions, number of psychiatric medications taken on the day of testing or diagnostic subtype on admission. There were also no differences in depressive or manic symptoms, gender, marital status, age, or years of education.

Patients with longer hospital stays had significantly worse performance than those with a short hospital stay on immediate recall and recognition of the figure’s parts on the Rey Complex Figure Test, as well as marginally significant impairment of delayed recall and significant impairments in overall verbal memory.

In addition, performance on tests of executive functioning was significantly worse for patients with longer hospital stay compared with those with a short stay, specifically on the Stroop, Wisconsin Card Sorting Test, and Controlled Oral Word Association Test. There were no significant differences in attention, working memory, and IQ.

The team concludes in the journal Comprehensive Psychiatry: “The current data indicate that longer duration of hospital stay is correlated with more severe deficits in executive functioning during the phase of early remission.

“These results illuminate the challenges patients with bipolar disorder may face after discharge from a long inpatient admission and underscore the need to develop better care for their outpatient recovery.”

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