For in-depth reviews, the reader is referred to refs 7, 8, and 13. Attention Attention refers to our ability to selectively and flexibly process some of the information in the environment, at the expense of other information. The attcntional system of the human brain can be decomposed into several distinct, mechanisms, including those responsible for selective attention, attentional shifting, and sustained attention.14 The former two processes have considerable overlap with executive function, and will

be considered in the following section. Sustained attention has been widely studied in bipolar disorder, Inhibitors,research,lifescience,medical and relates to the capacity to maintain selective processing over prolonged periods of time (“vigilance”). Sustained attention can be measured with continuous performance tests (CPTs) including

the Rapid Visual Information Processing task in the Cambridge Neuropsychological Automated Testing Battery (CANTAB) assessment.15 In these tasks, the Inhibitors,research,lifescience,medical subject, Inhibitors,research,lifescience,medical must, monitor a stream of stimuli (eg, digits) for click here target stimuli that are specified by the experimenter. The target, stimuli occur infrequently and unpredictably, and healthy subjects typically show a deterioration in target detection as the task progresses. CPT target, detection is reliably impaired during the manic state,16,17 and was one of the strongest predictors of the manic state across a wide-ranging neuropsychological assessment.16 As well as deficits in target detection, manic patients also committed more Inhibitors,research,lifescience,medical false alarms – responses to nontargct stimuli.16,18 This is likely to reflect clinical symptoms of impulsivity and disinhibition in the manic state. The deficit, in target, detection (but not impulsive Inhibitors,research,lifescience,medical errors) was shown to persist, in

remitted patients with bipolar disorder, albeit at, a somewhat, less severe level compared with mania.5,19-21 The deficit, in euthymic patients was unrelated to subclinical symptoms,19,22 which are common in remitted patients and may impact, upon functional capacity and cognitive performance. In fact, after controlling for subclinical symptoms, target detection was the only variable to remain significantly impaired in euthymic cases across a wide-ranging neuropsychological assessment. Target detection impairment, was present in below a subset, of patients who were early in the illness course, but, also correlated with disease duration and number of episodes.19 The sustained attention deficit, in euthymic cases was also present, regardless of the working memory load of the CPT.23 It, is likely that, the deficit is also exacerbated during depressed states,24 although, as discussed below, there are currently limited data in bipolar depression.