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Processing efficiency and sustained attention in bipolar disorder

Published online by Cambridge University Press:  28 January 2005

DAVID E. FLECK ,
PAULA K. SHEAR  and
STEPHEN M. STRAKOWSKI
DAVID E. FLECK
Affiliation:
Center for Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati
PAULA K. SHEAR
Affiliation:
Center for Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati Department of Psychology, University of Cincinnati, Cincinnati
STEPHEN M. STRAKOWSKI
Affiliation:
Center for Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati Department of Psychology, University of Cincinnati, Cincinnati
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Abstract

We hypothesized that patterns of sustained attention performance in bipolar disorder were consistent with processing efficiency theory—a theory of the relationship between central processing capacity and performance. We predicted (1) sustained attention deficits during mania because symptoms interfere with limited-capacity executive control processes resulting in decreased performance effectiveness; and (2) decreased processing efficiency during euthymia, as indicated by speed/accuracy tradeoffs, consistent with a stable phenotypic abnormality. Twenty-five manic bipolar, 23 euthymic bipolar, and 28 healthy comparison participants were compared on a continuous performance task and administered symptom-rating scales. The manic group was significantly impaired on overall perceptual sensitivity and demonstrated a significant linear decrease in performance over time, consistent with impaired sustained attention. The euthymic group evidenced significantly slower overall hit reaction time (RT), but when RT was controlled they performed similarly to the healthy group over time. Two discriminant functions combined to separate the groups on manic symptom severity and on-task effort/strategy use. These findings are consistent with processing efficiency theory. They suggest that euthymic patients sustain attention through effortful control at the expense of processing efficiency, while acute mania reduces the capacity for control and impairs sustained attention. Problems with processing efficiency are viewed as trait characteristics of bipolar disorder that may be overlooked by traditional error-based assessments. (JINS, 2005, 11, 49–57.)

Keywords

Bipolar disorderManiaProcessing efficiency theorySustained attentionContinuous performance test
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 11 , Issue 1 , January 2005 , pp. 49 - 57
Copyright
© 2005 The International Neuropsychological Society

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