Neuropsychological status of bipolar I disorder: impact of psychosis
Neuropsychological status of bipolar I disorder: impact of psychosis
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DOI：
10.1192/bjp.bp.108.052001
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发表时间：
2009-03
影响因子：
10.5
通讯作者：
J. Savitz;L. van der Merwe;D. Stein;M. Solms;R. Ramesar
中科院分区：
文献类型：
--
作者：
J. Savitz;L. van der Merwe;D. Stein;M. Solms;R. Ramesar
背景：一些双相情感障碍患者存在典型的人格特征，同时有精神病性特征病史的患者与无精神病性特征病史的患者相比，认知功能障碍更严重，这引起了人们对双相情感障碍伴精神病性特征和不伴精神病性特征的双相情感障碍之间疾病分类学关系的质疑。目的测试DSM-IV定义的精神病史对双相情感障碍参与者神经心理状态的影响，同时统计控制混杂因素，如情绪，药物，酒精滥用/依赖和儿童虐待，并评估非典型人格特征对（因此可能易患精神病）对双相情感障碍患者及其健康亲属的认知表现的影响。方法对25例有精神病史的I型双相情感障碍患者、24例无精神病史的I型双相情感障碍患者和61例无精神病史的I型双相情感障碍患者的亲属进行神经心理学检查。用分裂型人格量表（STA）测量分裂型特征。儿童期创伤采用儿童期创伤问卷进行测量。结果有精神病史组在言语工作记忆、认知灵活性和陈述性记忆方面的成绩显著差于健康亲属。然而，两个双相情感障碍组在任何认知测量上彼此没有显著差异。STA得分与言语工作和陈述性记忆呈负相关，但与视觉回忆记忆呈正相关。结论：双相情感障碍的“精神病性”和“非精神病性”亚型可能存在于一个疾病分类连续体上，最清楚的定义是言语记忆障碍。
Background The presence of schizotypal personality traits in some people with bipolar disorder, together with reports of greater cognitive dysfunction in patients with a history of psychotic features compared with patients without such a history, raises questions about the nosological relationship between bipolar disorder with psychotic features and bipolar disorder without psychotic features. Aims To test the impact of a history of DSM–IV-defined psychosis on the neuropsychological status of participants with bipolar disorder while statistically controlling for confounding factors such as mood, medication, alcohol misuse/dependence and childhood abuse, and to evaluate the impact of schizotypal personality traits (and thus potential vulnerability to psychotic illness) on the cognitive performance of people with bipolar disorder and their healthy relatives. Method Neuropsychological data were obtained for 25 participants with type I bipolar disorder and a history of psychosis, 24 with type I bipolar disorder but no history of psychosis and 61 unaffected relatives. Schizotypal traits were measured with the Schizotypal Personality Scale (STA). Childhood trauma was measured with the Childhood Trauma Questionnaire. Results The group with a history of psychosis performed significantly worse than the healthy relatives on measures of verbal working memory, cognitive flexibility and declarative memory. Nevertheless, the two bipolar disorder groups did not differ significantly from each other on any cognitive measure. Scores on the STA were negatively associated with verbal working and declarative memory, but positively associated with visual recall memory. Conclusions ‘Psychotic’ and ‘non-psychotic’ subtypes of bipolar disorder may lie on a nosological continuum that is most clearly defined by verbal memory impairment.