HealthlineHow Does a Person with Bipolar Disorder Think?

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Bipolar disorder significantly affects cognitive function during both manic and depressive episodes, impacting thought patterns, memory retention, and decision-making abilities. Understanding these cognitive manifestations enables clinicians to better recognize episode characteristics and implement targeted interventions.

Key Points:

• Manic episodes present with racing thoughts, heightened mental energy, concentration difficulties, and impulsivity, while depressive episodes manifest as reduced mental energy, impaired concentration, and compromised decision-making abilities
• Research indicates specific memory impairments: delayed memory during manic episodes, reduced working memory between episodes, and diminished prospective memory, particularly in severe cases
• Cognitive distortions during depressive episodes include all-or-nothing thinking, catastrophizing, emotional reasoning, and overgeneralization, which can compound feelings of hopelessness
• Psychosis, particularly during severe manic episodes, can impair memory formation and recall, with studies showing a correlation between poor working memory and auditory verbal hallucinations
• Substance use disorder comorbidity significantly impacts verbal memory function in bipolar patients compared to those without SUD

HCN Medical Memo
Clinicians should routinely assess cognitive function in bipolar patients, particularly memory and executive function, as these impairments persist beyond mood episodes and affect treatment adherence and functional outcomes.

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