Executive function, mood state and impulsive spending in bipolar disorder: an empirical study, systematic review and meta-analysis

Abstract

The roles of executive function and mood state in bipolar disorder are investigated in this thesis, with exploration of their relationship with impulsive spending. The first chapter includes a systematic literature review and meta-analysis examining whether set-shifting ability varies according to mood state in bipolar disorder. Twenty studies contributed to the review, with data from 16 used in the meta-analysis. The evidence suggested a difference in set-shifting ability according to mood state, with poorer set-shifting in affective states compared to euthymia. The second chapter details an empirical study, with a longitudinal design, investigating the relationship between executive functioning and impulsive spending behaviours in a bipolar disorder population. One hundred and nineteen participants took part in the study at baseline, and 82 completed follow-up measures four weeks later. Methods of statistical analysis, including hierarchical regression, were used to investigate whether scores on computerised performance-based measures of executive function were predictive of compulsive buying, gambling or level of debt. Main findings suggested specific measures of planning and inhibition predicted compulsive buying behaviours.
The findings of both chapters have implications for future research and intervention. Recommendations are made for standardised approaches to mood state definitions and measurement of set-shifting. Further research regarding the role of executive function in expressed behaviours during mood states is needed, in addition to determining the efficacy of incorporating tailored cognitive rehabilitation in intervention. Methods of screening for vulnerability to impulsive spending, with a view to implement preventative measures, require further investigation.

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Identifiers

ORCID for Thomas Richardson: orcid.org/0000-0002-5357-4281

ORCID for Warren Dunger: orcid.org/0000-0002-3213-5175

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