Factors influencing self-assessment of cognition and functioning in bipolar disorder: a preliminary study

Introduction. Self-assessment deficits are common in schizophrenia and span multiple aspects of functioning, including awareness of symptoms, and the ability to assess objective levels of cognitive deficits and everyday functioning. Whereas impaired awareness of illness in bipolar disorder during symptomatic periods is well understood, awareness of disability and cognitive deficits has been less well studied. Methods. In this pilot study, 30 patients with a lifetime history of bipolar I disorder and current bipolar depression completed performance-based tests of cognition and functional capacity and self-reported their opinions of their cognitive abilities, everyday functioning and symptoms. High contact clinicians also provided impressions of the patients' cognitive performance and everyday functioning. Results. Clinician impressions of cognition and everyday functioning were correlated with the results of the performance-based assessments, whereas the patient self-reports of cognition and functioning were uncorrelated both with their own performance and with the clinician impressions. However, severity of depressive symptoms was correlated with self-reports of functioning in cognitive and functional domains, but not with either performance-based data or clinician impressions of cognition or functioning. Conclusions. Depression appears to be a factor affecting self-assessment in bipolar disorder and reports of cognition and functioning were minimally related to objective information and clinician impressions. Symptoms of mania were minimal and not correlated with performance-based assessments or clinician impressions.