The role of Executive Attention in the association between obsessive-compulsive symptoms and relapses in Major Depressive and Bipolar Disorder

Abstract

Introduction Major Depressive (MDD) and Bipolar Disorder (BD) are chronic relapsing condition in which mood episodes are interspersed with periods of euthymia. Impairments in Executive Attention (EA) are a trait characteristic of mood disorder that persists also during remission. Similarly prefrontal dysfunctions are crucial in the genesis and maintenance of Obsessive-Compulsive Symptoms (OCS), which are highly comorbid in both MDD and BD. Objectives The aim of this study is to test a model in which deficits in EA mediate the relationship between the OCS and the relapse in a cohort of patients with MDD and BD. Methods Sixty-four euthymic subjects with BD and MDD performed the Attentional Network Task Revised (ANT-R), that gauges EA in a standard conflict task. Here we adopted a drift diffusion model to measure the task efficiency as the drift rate in incongruent trials. Patients also completed at baseline the YBOCS, a questionnaire that evaluate the severity of OCS. All the participants have been followed-up for up to 5 years and relapses have been recorded. Results The association between OCS and time in euthymia was fully mediated by the EA so that greater OCS were associated with poorer executive functions (beta=-0.341; p=0.006) that in turn predicted a sooner relapse (beta=0.349; p=0.005). This held true even when controlling for classic predictors of recurrence such as previous episode distance, the duration of illness and medications. Conclusions Treatment targeting executive functions could hence be crucial in preventing relapses in subjects with mood disorders experiencing obsessive compulsive-symptoms. Disclosure No significant relationships.

Keywords

• bipolar disorder
• Obsessive-compulsive symptoms
• Executive Attention
• major depressive disorder