中华精神科杂志
中華精神科雜誌
중화정신과잡지
CHINESE JOURNA OF PSYCHIATRY
2013年
6期
325-329
,共5页
朱玥%马燕桃%石川%张磊%于欣
硃玥%馬燕桃%石川%張磊%于訢
주모%마연도%석천%장뢰%우흔
双相情感障碍%精神分裂症%认知
雙相情感障礙%精神分裂癥%認知
쌍상정감장애%정신분렬증%인지
Bipolar disorder%Schizophrenia%Cognition
目的 比较双相Ⅰ型抑郁(bipolar depression type Ⅰ)、复发单相抑郁(recurrent unipolardepression)及精神分裂症(schizophrenia)患者神经认知功能特点,探讨双相Ⅰ型抑郁认知功能与临床特征的关系.方法 2010年9月至201 1年4月于北京大学第六医院门诊及病房连续入组双相抑郁组(29例)、复发单相抑郁组(25例)、精神分裂症组(30例),及社区来源的健康对照组30名.经《美国精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)轴Ⅰ精神障碍定式临床检查表病人版(SCID-I/P)诊断,比较4组研究对象的总体认知功能以及在持续注意、学习、记忆、精细动作、社会认知、执行功能和信息处理速度7项认知领域的表现,分析BD认知功能与临床特征的相关性.结果 精神分裂症组几乎所有认知变量均达重度损害(ES=-0.81 ～-1.76),双相抑郁组及复发单相抑郁组损害多为轻到中度(ES=0.5～0.8).精神分裂症组在持续注意(40.4±7.9比49.8±7.4,P=0.001)、学习(37.8±10.7比47.1±10.1,P=0.007)与记忆(40.6±11.9比48.6 ±9.3,P=0.035)、执行功能(40.5±7.1比45.9±5.2,P=0.006)、信息处理速度(33.4±9.2比41.7±6.0,P＜0.001)及总体认知功能(40.5±7.1比45.9±5.2,P＜0.001)方面的得分较双相抑郁组组受损严重.双相抑郁组及复发单相抑郁组认知表现差异无统计学意义(P＞0.05),复发单相抑郁组在执行功能计划亚领域较双相抑郁组表现差(40.1±9.04比46.0±10.7,P=0.030).双相抑郁组患者学习与记忆等认知变量与抑郁严重程度、病程、精神疾病住院次数呈负相关(均P ＜0.05).结论 双相Ⅰ型抑郁与精神分裂症认知损害的模式及程度存在明显差异,而双相Ⅰ型抑郁与复发单相抑郁受损模式相似.神经认知损害对临床鉴别双相Ⅰ型抑郁组与精神分裂症有一定提示意义,但尚不足以作为区分单双相抑郁的客观指标.双相Ⅰ型抑郁患者学习与记忆等认知表现与疾病特征呈负相关,以词语学习与记忆与临床变量相关最密切.
目的 比較雙相Ⅰ型抑鬱(bipolar depression type Ⅰ)、複髮單相抑鬱(recurrent unipolardepression)及精神分裂癥(schizophrenia)患者神經認知功能特點,探討雙相Ⅰ型抑鬱認知功能與臨床特徵的關繫.方法 2010年9月至201 1年4月于北京大學第六醫院門診及病房連續入組雙相抑鬱組(29例)、複髮單相抑鬱組(25例)、精神分裂癥組(30例),及社區來源的健康對照組30名.經《美國精神障礙診斷與統計手冊(第4版)》(DSM-Ⅳ)軸Ⅰ精神障礙定式臨床檢查錶病人版(SCID-I/P)診斷,比較4組研究對象的總體認知功能以及在持續註意、學習、記憶、精細動作、社會認知、執行功能和信息處理速度7項認知領域的錶現,分析BD認知功能與臨床特徵的相關性.結果 精神分裂癥組幾乎所有認知變量均達重度損害(ES=-0.81 ～-1.76),雙相抑鬱組及複髮單相抑鬱組損害多為輕到中度(ES=0.5～0.8).精神分裂癥組在持續註意(40.4±7.9比49.8±7.4,P=0.001)、學習(37.8±10.7比47.1±10.1,P=0.007)與記憶(40.6±11.9比48.6 ±9.3,P=0.035)、執行功能(40.5±7.1比45.9±5.2,P=0.006)、信息處理速度(33.4±9.2比41.7±6.0,P＜0.001)及總體認知功能(40.5±7.1比45.9±5.2,P＜0.001)方麵的得分較雙相抑鬱組組受損嚴重.雙相抑鬱組及複髮單相抑鬱組認知錶現差異無統計學意義(P＞0.05),複髮單相抑鬱組在執行功能計劃亞領域較雙相抑鬱組錶現差(40.1±9.04比46.0±10.7,P=0.030).雙相抑鬱組患者學習與記憶等認知變量與抑鬱嚴重程度、病程、精神疾病住院次數呈負相關(均P ＜0.05).結論 雙相Ⅰ型抑鬱與精神分裂癥認知損害的模式及程度存在明顯差異,而雙相Ⅰ型抑鬱與複髮單相抑鬱受損模式相似.神經認知損害對臨床鑒彆雙相Ⅰ型抑鬱組與精神分裂癥有一定提示意義,但尚不足以作為區分單雙相抑鬱的客觀指標.雙相Ⅰ型抑鬱患者學習與記憶等認知錶現與疾病特徵呈負相關,以詞語學習與記憶與臨床變量相關最密切.
목적 비교쌍상Ⅰ형억욱(bipolar depression type Ⅰ)、복발단상억욱(recurrent unipolardepression)급정신분렬증(schizophrenia)환자신경인지공능특점,탐토쌍상Ⅰ형억욱인지공능여림상특정적관계.방법 2010년9월지201 1년4월우북경대학제륙의원문진급병방련속입조쌍상억욱조(29례)、복발단상억욱조(25례)、정신분렬증조(30례),급사구래원적건강대조조30명.경《미국정신장애진단여통계수책(제4판)》(DSM-Ⅳ)축Ⅰ정신장애정식림상검사표병인판(SCID-I/P)진단,비교4조연구대상적총체인지공능이급재지속주의、학습、기억、정세동작、사회인지、집행공능화신식처리속도7항인지영역적표현,분석BD인지공능여림상특정적상관성.결과 정신분렬증조궤호소유인지변량균체중도손해(ES=-0.81 ～-1.76),쌍상억욱조급복발단상억욱조손해다위경도중도(ES=0.5～0.8).정신분렬증조재지속주의(40.4±7.9비49.8±7.4,P=0.001)、학습(37.8±10.7비47.1±10.1,P=0.007)여기억(40.6±11.9비48.6 ±9.3,P=0.035)、집행공능(40.5±7.1비45.9±5.2,P=0.006)、신식처리속도(33.4±9.2비41.7±6.0,P＜0.001)급총체인지공능(40.5±7.1비45.9±5.2,P＜0.001)방면적득분교쌍상억욱조조수손엄중.쌍상억욱조급복발단상억욱조인지표현차이무통계학의의(P＞0.05),복발단상억욱조재집행공능계화아영역교쌍상억욱조표현차(40.1±9.04비46.0±10.7,P=0.030).쌍상억욱조환자학습여기억등인지변량여억욱엄중정도、병정、정신질병주원차수정부상관(균P ＜0.05).결론 쌍상Ⅰ형억욱여정신분렬증인지손해적모식급정도존재명현차이,이쌍상Ⅰ형억욱여복발단상억욱수손모식상사.신경인지손해대림상감별쌍상Ⅰ형억욱조여정신분렬증유일정제시의의,단상불족이작위구분단쌍상억욱적객관지표.쌍상Ⅰ형억욱환자학습여기억등인지표현여질병특정정부상관,이사어학습여기억여림상변량상관최밀절.
Objectives To compare neurocognitive function in patients with bipolar depression type Ⅰ (BD),recurrent unipolar depression (UD) and schizophrenia (SZ).And try to explore the relationship between neuropsychological function and clinical features in bipolar.Methods 29 patients with BD,25 with UD,30 with SZ were consecutively recruited from clinics and wards of Peking University Sixth Hospital between September 2010 and April 2011,also including 30 controls from community.Four groups of participants were diagnosed by SCID-I/P (structured clinical interview for DSM-Ⅳ-TR axis Ⅰ disorder-patient edition),then accepted a cross-sectional comparison targeting on performance of seven cognitive domains including sustained attention,learning,memory,motor skills,social cognition,executive functions and psychomotor speed,as well as global cognitive function.Associations between cognitive function and clinical features were examined by correlation analysis in BD.Results Compared with controls,SZ group showed severe deficit nearly in all cognitive variables (ES =-0.81--1.76),while BD and UD groups almost showed a mild to moderate deficit (ES =0.5-0.8).SZ group performed significantly worse than BD group in sustained attention (40.4±7.9 vs.49.8 ±7.4,P=0.001),learning (37.8 ± 10.7 vs.47.1 ± 10.1,P =0.007),memory (40.6 ± 11.9 vs.48.6 ± 9.3,P =0.035),executive function (40.5 ± 7.1 vs.45.9 ±5.2,P =0.006),processing speed(33.4 ±9.2 vs.41.7 ±6.0,P ＜0.001),and global cognitive function (40.5 ±7.1 vs.45.9 ±5.2,P ＜0.001).BD and UD groups showed no difference in either cognitive domain(P ＞ 0.05),except UD performed worse than BD in executive planning task (40.1 ± 9.04 vs.46.0 ± 10.7,P =0.030).Negative association exited between cognitive variables and depression severity,course of illness,number of hospitalizations due to mental illness,especially for verbal learning and memory(P ＜ 0.05).Conclusions Patterns and severity of neurocognitive deficits in BD and SZ are possibly different,while similar impaired pattern exists in BD and UD.Neurocognitive deficit play a role in differentiating BD from SZ,but not an sufficient indicators to distinguish between BD and UD.Negative association exits between cognitive performance and clinical features in BD,especially for verbal learning and memory.
