2026 ECNP Congress

PS03-3117

Mapping emotion dysregulation in bipolar disorder: links to cognition and functional impairment

Marta Bort — G. Fico, M. De Prisco, C. Sommerhoff, L. Montejo, V. Oliva, A. Montanari, L. Maitre, M.Y. Rivas, V. Ruiz, N. López, E. Vieta, A. Murru · Hospital Clinic de Barcelona, Bipolar and Depressive Disorders Unit, Barcelona, Spain

2026 ECNP Congress

Introduction

Emotion dysregulation (ED) is a core transdiagnostic feature in bipolar disorder (BD) [1]. However, its specific features have not been systematically examined in relation to psychosocial functioning and cognitive performance in euthymic patients.

Objectives

To investigate whether ED predicts cognitive performance and functional impairment in euthymic patients with BD.

Methods

Cross-sectional analysis of baseline data from the BEGIN (Bipolar Exposome-Gene Interaction Naturalistic), a 12-month prospective naturalistic cohort study, conducted at the Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona. A total of 111 euthymic BD patients were recruited between June 2023 and May 2025. ED was assessed with the brief version of Difficulties in Emotion Regulation Scale (DERS-S SF) [2], comprising five subscales: non-acceptance, lack of control, interference, inattention, and confusion. Functional impairment was measured with the Functioning Assessment Short Test (FAST) [3]. Cognitive performance was assessed across six domains (working memory, processing speed, attention, verbal memory, visual memory, and executive functioning) [4]. Two linear regression models were conducted examining DERS total score as a predictor of: (1) cognitive global score, and (2) FAST total score, both controlling for age, gender, and years of education. Additionally, a hierarchical blockwise linear regression was conducted, entering covariates (age, gender, years of education), lifetime affective episodes, DERS total score, and cognitive global score to predict functional impairment (FAST total score).

Results

A total of 80 BD patients were included in the analysis (59% female; 59% BD-I, 36% BD-II; mean age 49.97 ± 13.79 years). Mean FAST total score was 17.35 ± 11.28, indicating moderate functional impairment, and mean DERS total score was 2.46 ± 0.79. In the linear regression models, no significant association was found between DERS total score and cognitive global score (p > .05); DERS total score independently predicted FAST total score (B = 0.76, 95% CI [0.17, 1.35], p = .012), accounting for 19.4% of the variance. In the hierarchical blockwise regression, the addition of lifetime affective episodes did not significantly improve model fit beyond covariates (F(2,76) = 0.724, p = .488). The inclusion of DERS total score produced a significant improvement (F(1,75) = 7.821, p = .007), as did the subsequent addition of cognitive global score (F(1,74) = 6.120, p = .016). In the final model, DERS total score (B = 0.72, 95% CI [0.14, 1.30], p = .018) and cognitive global score (B = −6.83, 95% CI [−12.23, −1.42], p = .016) both significantly predicted FAST total score.

Conclusions

In euthymic BD, ED predicts functional impairment independently of cognitive performance, while ED remains dissociated from cognition. These findings highlight ED and cognition as distinct and clinically relevant targets for psychosocial interventions in BD. Future longitudinal studies should examine the directionality of these associations and whether changes in ED over time mediate improvements in functional outcome.

References

  1. De Prisco M, Oliva V, Fico G, Fornaro M, de Bartolomeis A, Serretti A, Vieta E, Murru A. Defining clinical characteristics of emotion dysregulation in bipolar disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2022 Nov;142:104914. doi: 10.1016/j.neubiorev.2022.104914. Epub 2022 Oct 13. PMID: 36243194.
  2. Navarro, O., Restrepo-Ochoa, D., Rommel, D., Ghalaret, J. M., & Fleury-Bahi, G. (2021). Validation of a brief version of the Difficulties in Emotion Regulation Scale with a Spanish speaking population (DERS-S SF). CES Psicología, 14(2), 71–88.
  3. Rosa, A. R., Sánchez-Moreno, J., Martínez-Aran, A., Salamero, M., Torrent, C., & Reinares, M. (2007). Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice and Epidemiology in Mental Health, 3, 1–8.
  4. Montejo, L., et al. (2022). Cognition in older adults with bipolar disorder: An ISBD task force systematic review and meta-analysis based on a comprehensive neuropsychological assessment. Bipolar Disorders, 24(2), 115–136.