Processos cognitivos controlados e automatizados no transtorno afetivo bipolar: ampliando a compreensão da relação entre cognição e manifestações clínicas

Abstract

INTRODUCTION: Bipolar is a highly disabling disorder. Although there are evidencedbased treatment approaches available, relapse rates and dysfunctionality remain high. Cognition and emotional processing problems occur even in euthymic states of the disorder; therefore they are in the mainstream to elucidate underlying mechanisms for bipolar vulnerability. The major aim of this study was to describe possible interactions between cognition and emotional processing and discuss their implications upon treatments. METHODS: This major study was divided into three smaller ones. The first was a review that aimed to unfold the up-to-date research in cognition and emotionality, as well as their possible interactions. Study two aimed to test some of cognition-emotion interaction in a Brazilian bipolar sample and their relatives. Study three considered the hierarchical complex dynamic of cognitive-emotional processing and discussed how automatic levels of emotional responses can be associated to bipolar symptomatology and clinical outcomes. RESULTS: It was observed that, in emotional contexts, specific cognitive aspects are related to dysfunctional responses, such as executive functioning -more specifically, inhibitory control. Bipolar relatives Inhibitory control may foster traumatic childhood experiences in patients. Patients who have experienced high levels of emotional abuse and who present low levels of inhibitory control are more vulnerable to attempt suicide recurrently. Increased emotional reactivity is observed even in basic levels of emotional cognitive processing, such as eye fixation time (measured in milliseconds). DISCUSSION: It is possible that high emotional contexts require greater inhibitory control capacity to deal with them in a functional way. However, in bipolar patients, inhibitory control is specially compromised in these contexts, leading to dysfunctional outcomes such as higher incidence of history of suicide attempts. Furthermore, treatment approaches designed to improve clinical outcomes need to consider that the emotional reactivity observed in this population occur in automatic levels of emotional-cognitive processing. Although cognition and emotional processing are traditionally described as separate topics, their overlap is an important aspect to be taken into account to promote realistic treatment outcomes expectations.Key-words: Bipolar Disorder, Cognition, Emotion, Attentional bias.