Search

Impaired time perception is considered to be a relatively unusual and poorly understood consequence of brain injury. This paper presents a case study of altered time perception in JB, a 50-year-old woman who in 2011 had a small thalamic stroke affecting the right anteromedian region. We report on her subjective experience and present results from studies of retrospective timing (i.e., estimating how much time has passed and the clock time) and prospective timing (i.e., producing and reproducing intervals). The results showed that relative to neurologically healthy and brain-injured controls, JB had impaired retrospective timing and impaired prospective time reproduction. However, her prospective time production did not differ significantly from either of the control groups. We interpret this to mean that JB’s essential timing functions are intact, and that rather, her time perception impairment stems from a problem in anterograde memory for time intervals. Further, we argue that unlike other cognitive domains, time perception alteration is neither anticipated nor evaluated in most patients, yet these impairments can have a remarkably serious impact on daily life. We encourage further investigation of this topic.

Background: Cognitive remediation therapy (CRT) may benefit people with bipolar disorders but randomised trials of evidenced therapy programmes for those with bipolar type I and II are lacking. The Cognitive Remediation in Bipolar (CRiB) study aimed to determine whether an established CRT programme is feasible and acceptable for people with bipolar disorders. Methods: This proof-of-concept, single-blind randomised trial recruited participants from the community, primary and secondary care to one centre in London, UK. Participants were aged 18-65 with bipolar disorder, not currently experiencing an episode. They were 1:1 block randomised to treatment-as-usual (TAU) with or without individual CRT for 12 weeks. The partly-computerised CRT programme ("CIRCuiTS") was therapist-led and evidence-based. Data were collected and analysed by investigators blinded to group allocation. The main outcomes (week 13 and 25) examined participant retention, intervention feasibility and putative effects of CRT on cognitive and psychosocial functioning via intention-to-treat analyses. Trial registration: ISRCTN ID32290525. Findings: 60 participants were recruited (02/2016-06/2018) and randomised to CRT (n=29) or TAU (n=31). Trial withdrawals were equivalent (CRT n=2/29; TAU n=5/31). CRT satisfaction indicated high acceptability. Intention-to-treat analyses (N=60) demonstrated greater improvements for CRT- than TAU-randomised participants: at both week 13 and 25, CIRCuiTS participants showed larger improvements in IQ (SES=0·71, 95% CI [0·29,1·13]), working memory (SES=0·70, 95% CI [0·31,1·10]), executive function (SES=0·93, 95% CI [0·33,1·54]), psychosocial functioning (SES=0·49, 95% CI [0·18,0·80]) and goal attainment (SES=2·02, 95% CI [0·89,3·14]). No serious adverse events were reported. Interpretation: CRT is feasible for individuals with bipolar disorders and may enhance cognition and functioning. The reported effect sizes from this proof-of-concept trial encourages further investigation in a definitive trial. Trial Registration Number: ISRCTN ID32290525. Funding: National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-0614-34075) and NIHR Maudsley Biomedical Research Centre. Declaration of Interest: TW and CR were involved with the CIRCuiTs programme development; however, neither author had any involvement with undertaking or supervising any assessment procedures or data analysis, or data collection. AHY has received payment for lectures and advisory boards membership from AstraZenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, and Janssen and reports no shareholdings in pharmaceutical companies. He is the lead investigator for the Embolden Study (AZ), BCI Neuroplasticity Sudy, and Aripiprazole Mania Study, and has led investigator-initiated studies from AstraZeneca, Eli Lilly, Lundbeck, Wyeth, and Janssen. RS has received an honorarium for speaking at a Lundbeck-sponsored event. The remaining authors declare no competing interests (DT, JH, TM, NY, PM, JB, KM, MC, JF). Ethical Approval: The trial protocol contains full details of the study methodology as approved by a UK NHS Research Ethics Committee (16/10/2015, reference 15/LO/1557).

This chapter examines various attempts to enhance the natural recovery of attentional processes, or to better manage the consequences of impairment, following brain injury acquired in adulthood. The results reviewed give grounds for cautious optimism. However, rehabilitation is about working with patients to achieve functional goals in everyday life. If the promising findings showing changes on neuropsychological tests are to usefully filter through to clinical care, the extent to which these translate into meaningful functional improvements must be evaluated.