Insight and neurocognitive functioning in bipolar subjects.
Insight and neurocognitive functioning in bipolar subjects.
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双相情感障碍受试者的洞察力和神经认知功能。
DOI：
10.1016/j.comppsych.2014.04.016
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发表时间：
2015
影响因子：
7.3
通讯作者：
Goldstein,Gerald
中科院分区：
文献类型：
--
作者：
Shad,MujeebU;Prasad,Konasale;Forman,StevenD;Haas,GretchenL;Walker,JonD;Pisarov,LiubomirA;Goldstein,Gerald
背景有关精神疾病的洞察力已被发现影响治疗的结果和有效性。它主要在精神分裂症领域进行研究，很少有研究涉及其他疾病。本研究使用评估精神障碍意识缺失的量表（SUMD）评估双相情感障碍患者的自知力，该量表是一种用于评估疾病意识和症状归因的综合性访谈。该假说认为，在双相情感障碍中，意识水平可能与许多因素有关，包括神经认知功能、通过MRI评估的额叶和海马结构变化、神经认知状态、躁狂和其他精神症状的严重程度以及共病酒精中毒。给予SUMD和许多其他程序，包括定量MRI测量额叶和海马体的体积，简短的神经认知测试，简明精神病评定量表和青年躁狂评定量表。通过使用t检验和线性多元回归比较这些程序中有和没有酗酒的参与者来分析数据，与SUMD等级的意识和归因作为因变量和变量集从其他程序管理作为多变量individualvariables.ResultsThe中位数得分从SUMD获得的当前意识是在一个范围之间的充分意识和不确定性有关的精神存在disorder.对于归因，中位数分数表明归因通常是疾病本身。有无共病酒精中毒的参与者之间的差异无显着的SUMD意识和归因评分，神经认知或MRI变量。多元回归分析仅显示SUMD意识评分与Young躁狂评定量表之间存在显著相关性（r2= 0.632，p <0.05）。逐步分析表明，项目评估程度的洞察力，烦躁不安，睡眠障碍符合进入回归方程的标准。没有回归分析的SUMD归因item是显着的。ConclusionsApparently不同的情况下，精神分裂症，大多数的参与者，他们都有双相情感障碍，都知道他们的症状，并正确地将它们与精神疾病。关于无意识程度和可能的贡献者之间的关系，包括共病酗酒，认知功能障碍和额叶区和海马灰质结构减少的假设，与无意识程度无关，但躁狂症状显着相关。这一结果的明显原因是样本获得了1或2的SUMD模态意识得分，反映了完全意识和对精神障碍的不确定性之间的区域。没有一个参与者被评为5分，反映了他/她没有精神障碍的信念。
BackgroundInsight concerning having a mental illness has been found to influence outcome and effectiveness of treatment. It has been studied mainly in the area of schizophrenia with few studies addressing other disorders. This study evaluates insight in individuals with bipolar disorder using the Scale to Assess Unawareness of Mental Disorder (SUMD), a comprehensive interview for evaluation of awareness of illness and attribution of symptoms. The hypothesis was that in bipolar disorder level of awareness may be associated with numerous factors including neurocognitive function, structural changes in the frontal lobes and hippocampus evaluated by MRI, neurocognitive status, severity of mania and other psychiatric symptoms and comorbid alcoholism.MethodIn order to evaluate this hypothesis 33 individuals with DSM-IV diagnosed bipolar disorder, some with and some without comorbid alcoholism, were administered the SUMD and a number of other procedures including a quantitative MRI measuring volume of the frontal lobes and hippocampus, a brief battery of neurocognitive tests, the Brief Psychiatric Rating Scale, and the Young Mania Rating Scale. The data were analyzed by comparing participants with and without alcoholism on these procedures using t tests and by linear multiple regression, with SUMD ratings of awareness and attribution as the dependent variables and variable sets from the other procedures administered as multivariate independent variables.ResultsThe median score obtained from the SUMD for current awareness was in a range between full awareness and uncertainty concerning presence of a mental disorder. For attribution, the median score indicated that attribution was usually made to the illness itself. None of the differences between participants with and without comorbid alcoholism were significant for the SUMD awareness and attribution scores, neurocognitive or MRI variables. The multiple regression analyses only showed a significant degree of association between the SUMD awareness score and the Young Mania Rating Scale (r2= .632, p < .05). A stepwise analysis indicated that items assessing degree of insight, irritability, and sleep disturbance met criteria for entry into the regression equation. None of the regression analyses for the SUMD attribution item were significant.ConclusionsApparently unlike the case for schizophrenia, most of the participants, all of whom had bipolar disorder, were aware of their symptoms and correctly related them to a mental disorder. Hypotheses concerning the relationships between degree of unawareness and possible contributors to its development including comorbid alcoholism, cognitive dysfunction and structural reduction of gray matter in the frontal region and hippocampus, were not associated with degree of unawareness but symptoms of mania were significantly associated. The apparent reason for this result is that the sample obtained a SUMD modal awareness score of 1 or 2, reflecting the area between full awareness and uncertainty about having a mental disorder. None of the participants were rated as having a 5 response reflecting the belief that s/he does not have a mental disorder.