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This thesis presents research investigating objectively and subjectively examined cognitive impairment in Bipolar Disorder (BD) in comparison to disorders with similar cognitive symptomatologies. First, a systematic review and meta-analyses compared the cognitive performance between BD and Mild Cognitive Impairment (MCI) or dementia. Studies included in this review and meta-analyses assessed cognitive performances using multiple objective cognitive assessments. Results from these meta-analyses found greater impairment in BD relative to MCI on motor initiative abilities. Additionally, there were similarities in cognitive deficits on delayed memory recall and visuoconstructional abilities between BD and MCI. For the comparison between BD and dementia, we analyzed the findings of studies comparing BD across different mood states with different types of dementia, where BD in acute mood episode demonstrated greater deficits in attention, working memory, verbal memory, and executive function than behavioral variant frontotemporal dementia (bvFTD). In contrast, overall cognitive functioning and verbal fluency was more impaired in Alzheimer’s disease (AD) in comparison to BD during euthymia. Next, we shifted the focus on examining subjective cognitive complaints in BD relative to Major Depressive Disorder (MDD). Our study is unique from previous literature with the same aim considering that it only involved patients recently diagnosed with BD, and subjective complaints were assessed with the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), an instrument specific to cognitive complaints detected in BD. The findings demonstrate higher subjective cognitive complaints in euthymic BD in comparison to euthymic MDD, suggesting greater self-perceived difficulties in BD, even in the beginning of the illness. Taken together, findings from the studies presented in this thesis highlight the importance of early detection and intervention of cognitive impairments in BD, with the aim of enhancing cognitive abilities, and prevention of further cognitive degradation with the progression of the disorder / Thesis / Master of Science (MSc)

Backpacks are used by more than 90% of schoolchildren worldwide and over 40 million students in the United States on a regular basis. The carriage of loaded backpacks is associated with kinematic and physiological changes, as well as complaints of neck and back pain. Since a history of backpain in childhood is the strongest predictor of having musculoskeletal discomfort and back pain as an adult, development of back pain due to backpack use is of prognostic concern. The purpose of this dissertation was to examine the effects of backpack weights (up to 20% body weight (BW)) on children’s posture, subjective complaints of pain and perceived exertion, and walking endurance. A secondary goal was to examine the data to identify and recommend a weight limit for backpacks carried by elementary school children based on the results. In Chapter 2, we performed a preliminary study designed to examine the effects of loaded backpacks on forward head posture in school children. The results of this study found that forward head posture increased with both backpack weight and condition. The greatest differences were noted at the 15% and 20%BW backpack loads with initial loading, but after 6 minutes of walking the forward head posture was similar for all backpack loads. In Chapter 3, we conducted a study to evaluate multiple postural angles and the subjective complaints of pain and perceived exertion/fatigue in children to determine the effects of both the weight and time spent carrying loaded backpacks up to 20%BW. Subjects showed significant changes in all measures including the Six Minute Walk Test (6MWT), OMNI Walk/Run Scale of perceived exertion/fatigue and subjective complaints of pain, as well as the postural angles of Craniovertebral Angle, Forward Trunk Lean, and Pelvic Tilt. Subjects demonstrated immediate and significant changes in forward head posture, forward trunk lean, and pelvic tilt while wearing backpacks weighing 10%, 15% and 20%BW, but the 10%BW backpack resulted in the least amount of change. This study also found that these postural angles changed additionally after walking 6 minutes while carrying the loaded backpacks. Subjects also demonstrated decreased 6MWT distances and increased reports of perceived exertion and pain after carrying backpacks weighing 10%, 15% and 20%BW. In Chapter 4, we discussed the clinical implications of this research. It was determined that backpack loads weighing 10%, 15% and 20%BW of a child’s body weight result in immediate changes in posture, which continue to increase after walking six minutes with the loaded backpack. The backpack loads significantly impacted the children’s walking endurance as well as their reports of perceived exertion/fatigue and regional pain. This study found that of the loads tested, the 10%BW resulted in the least amount of change in all outcome measures. However, the 10%BW load was not innocuous, as it still created significant changes in posture and subjective complaints. Backpack weight limit guidelines need to be written to protect children from carrying backpacks weighing more than 10% body weight.

Disertaciniame darbe nagrinėjama depresija sergančių asmenų savijauta ir subjektyvus gyvenimo vertinimas stacionarinio gydymo laikotarpiu, šių reiškinių sąsaja bei pokyčiai gydymo metu. Siekiama atskleisti subjektyvaus asmens savo ligos ir sveikatos vertinimo svarbą prognozuojant sveikimo nuo depresijos rezultatus. Darbe siekiama detaliai išanalizuoti depresija sergančių asmenų savijautos struktūrą, taip pat patikrinti prielaidą, kad subjektyvus gyvenimo vertinimas gali būti laikomas psichikos sveikatos išteklių rodikliu. Teorinėms darbo prielaidoms patikrinti gydymo pradžioje ir pabaigoje buvo ištirti 195 depresija sergantys asmenys besigydantys psichiatrijos stacionare, naudojant klausimyną depresijos pokyčiams vertinti (Pranckevičienė, Goštautas, 2007), Pasaulinės sveikatos organizacijos gyvenimo kokybės klausimyną (PSOGK – Trumpas) ir kitas papildomas metodikas. Statistinė rezultatų analizė atskleidė, kad depresija sergančių asmenų savijauta yra daugiakomponentė ir psichologinių bei somatinių savijautos komponentų išskyrimas yra naudingas analizuojant depresija sergančių asmenų sveikimą stacionarinio gydymo laikotarpiu. Subjektyvus gyvenimo vertinimas neprognozuoja gydymo rezultatų, tačiau yra tinkamas subjektyvus visuminės sveikatos matas, nes gerai parodo funkcines ir kognityvines depresijos pasekmes, t.y. pasikeitusį suvokimą. Tyrimas iliustruoja psichologinės pagalbos svarbą stacionarinio depresijos gydymo laikotarpiu. / The study analyses patients’ subjective complaints and subjective evaluation of life, and seeks to evaluate changes and relationships of these phenomena during inpatient treatment of depression, stressing the importance of subjective experience in understanding the burden of the illness, resources for recovery and treatment outcomes. The study seeks to analyze the structure of depressed patients’ subjective complaints, as well as to evaluate the utility of the subjective evaluation of life for treatment outcome evaluation. 195 depressed inpatients were assessed at the beginning of the treatment and at the time of discharge, using measures of subjective depressive complaints (Pranckevičienė, Goštautas, 2007), subjective quality of life (WHOQOL-Bref) and other clinical and social-demographic data. The results of the study show that additional attention to psychological and somatic components of patients’ subjective complaints is useful and compliments the analysis of depressed inpatients’ recovery process. The subjective evaluation of life should be interpreted as a more generic measure of consequences of depression, but not as a measure of depressed inpatient’s recovery resources. The results validate the need of psychological interventions during inpatient treatment.

The study analyses patients’ subjective complaints and subjective evaluation of life, and seeks to evaluate changes and relationships of these phenomena during inpatient treatment of depression, stressing the importance of subjective experience in understanding the burden of the illness, resources for recovery and treatment outcomes. The study seeks to analyze the structure of depressed patients’ subjective complaints, as well as to evaluate the utility of the subjective evaluation of life for treatment outcome evaluation. 195 depressed inpatients were assessed at the beginning of the treatment and at the time of discharge, using measures of subjective depressive complaints (Pranckevičienė, Goštautas, 2007), subjective quality of life (WHOQOL-Bref) and other clinical and social-demographic data. The results of the study show that additional attention to psychological and somatic components of patients’ subjective complaints is useful and compliments the analysis of depressed inpatients’ recovery process. The subjective evaluation of life should be interpreted as a more generic measure of consequences of depression, but not as a measure of depressed inpatient’s recovery resources. The results validate the need of psychological interventions during inpatient treatment. / Disertaciniame darbe nagrinėjama depresija sergančių asmenų savijauta ir subjektyvus gyvenimo vertinimas stacionarinio gydymo laikotarpiu, šių reiškinių sąsaja bei pokyčiai gydymo metu. Siekiama atskleisti subjektyvaus asmens savo ligos ir sveikatos vertinimo svarbą prognozuojant sveikimo nuo depresijos rezultatus. Darbe siekiama detaliai išanalizuoti depresija sergančių asmenų savijautos struktūrą, taip pat patikrinti prielaidą, kad subjektyvus gyvenimo vertinimas gali būti laikomas psichikos sveikatos išteklių rodikliu. Teorinėms darbo prielaidoms patikrinti gydymo pradžioje ir pabaigoje buvo ištirti 195 depresija sergantys asmenys besigydantys psichiatrijos stacionare, naudojant klausimyną depresijos pokyčiams vertinti (Pranckevičienė, Goštautas, 2007), Pasaulinės sveikatos organizacijos gyvenimo kokybės klausimyną (PSOGK – Trumpas) ir kitas papildomas metodikas. Statistinė rezultatų analizė atskleidė, kad depresija sergančių asmenų savijauta yra daugiakomponentė ir psichologinių bei somatinių savijautos komponentų išskyrimas yra naudingas analizuojant depresija sergančių asmenų sveikimą stacionarinio gydymo laikotarpiu. Subjektyvus gyvenimo vertinimas neprognozuoja gydymo rezultatų, tačiau yra tinkamas subjektyvus visuminės sveikatos matas, nes gerai parodo funkcines ir kognityvines depresijos pasekmes, t.y. pasikeitusį suvokimą. Tyrimas iliustruoja psichologinės pagalbos svarbą stacionarinio depresijos gydymo laikotarpiu.