A prospective study of the trajectories of clinical insight, affective symptoms, and cognitive ability in bipolar disorder.
A prospective study of the trajectories of clinical insight, affective symptoms, and cognitive ability in bipolar disorder.
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DOI：
10.1016/j.jad.2013.09.020
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发表时间：
2014-01
影响因子：
6.6
通讯作者：
Palmer, Barton W.
中科院分区：
文献类型：
--
作者：
Depp, Colin A.;Harmell, Alexandrea L.;Savla, Gauri N.;Mausbach, Brent T.;Jeste, Dilip V.;Palmer, Barton W.
双相情感障碍的临床洞察力与治疗依从性和心理社会结局有关。临床洞察力与症状和认知能力之间的短期动态尚不清楚。在一项前瞻性观察研究中，共有106名双相情感障碍I或II患者在基线、6周、12周和26周进行了评估。参与者接受了全面的神经心理测试，躁狂和抑郁症状严重程度的临床评级，以及自我报告的临床洞察力。滞后相关性和线性混合效应模型被用来确定症状和洞察力之间的时间关联，以及全局认知能力的缓和影响。在基线，自知力与躁狂症状的严重程度有一定的相关性，但与抑郁症状或认知能力无关。自知力和抑郁症状随着时间的推移波动到大致相同的程度。滞后相关性和滞后效应的混合效应模型都表明，躁狂症状的严重程度预示着在以后的评估中更差的自知力，而反之亦然。全球认知能力没有直接或缓和的影响。我们的样本量不大，包括精神状况相对稳定的门诊患者，并进行了六个月的跟踪调查。我们的结果可能不适用于长期随访的有明显症状的患者。在双相情感障碍患者中，临床洞察力随着时间的推移而变化很大。双相情感障碍的自知力受损更可能是紧随其后的，而不是躁狂症状的先兆。
Clinical insight in bipolar disorder is associated with treatment adherence and psychosocial outcome. The short-term dynamics of clinical insight in relationship to symptoms and cognitive abilities are unknown. In a prospective observational study, a total of 106 outpatients with bipolar disorder I or II were assessed at baseline, 6 weeks, 12 weeks, and 26 weeks. Participants were administered a comprehensive neuropsychological battery, clinical ratings of manic and depressive symptom severity, and self-reported clinical insight. Lagged correlations and linear mixed-effects models were used to determine the temporal associations between symptoms and insight, as well as the moderating influence of global cognitive abilities. At baseline, insight was modestly correlated with severity of manic symptoms, but not with depressive symptoms or cognitive abilities. Insight and depressive symptoms fluctuated to approximately the same extent over time. Both lagged correlations and mixed effects models with lagged effects indicated that the severity of manic symptoms predicted worse insight at later assessments, whereas the converse was not significant. There were no direct or moderating influences of global cognitive abilities. Our sample size was modest, and included relatively psychiatrically stable outpatients, followed for a six month period. Our results may not generalize to acutely symptomatic patients followed over a longer period. Clinical insight varies substantially over time within patients with bipolar disorder. Impaired insight in bipolar disorder is more likely to follow than to precede manic symptoms.
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