Tiihonen Jari, Haukka Jari, Henriksson Markus, Cannon Mary, Kieseppä Tuula, Laaksonen Ilmo, Sinivuo Juhani, Lönnqvist Jouko
Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, FIN-70240 Kuopio, Finland.
Am J Psychiatry. 2005 Oct;162(10):1904-10. doi: 10.1176/appi.ajp.162.10.1904.
Premorbid intellectual impairment has been described in schizophrenia, but little is known about premorbid intellectual functioning in bipolar disorder or other psychoses. In this study, premorbid intellectual ability was investigated in individuals with bipolar disorder, schizophrenia, or other psychoses.
Results on verbal, arithmetic, and visuospatial reasoning tests were obtained for 195,019 apparently healthy male subjects conscripted into the Finnish Defense Forces during 1982-1987 (mean age, 19.9 years). Linkage with the Finnish Hospital Discharge Register (mean follow-up time, 7.1 years) identified conscripts later diagnosed with bipolar disorder (N=100), schizophrenia (N=621), or other psychoses (N=527).
Poor performance on the visuospatial reasoning test at age 20 was associated with higher risks for all three disorders. The odds ratios indicating the difference in risk of illness between the lowest and highest of nine performance categories were 34.65 (95% confidence interval [CI], 4.05-296.44) for bipolar disorder, 13.76 (95% CI=5.49-34.47) for schizophrenia, and 4.28 (95% CI=2.09-8.77) for other psychoses. In contrast, the higher the score for arithmetic reasoning, the greater the risk of bipolar disorder; a high score was associated with a more than 12-fold greater risk. Verbal test performance was not associated with higher risk for psychiatric disorder.
These results indicate that premorbid visuospatial reasoning is impaired in bipolar disorder and schizophrenia and, to a smaller extent, in other psychoses. This suggests that a subtle neurodevelopmental aberration is involved in the etiology of bipolar disorder and schizophrenia. High arithmetic test performance may be associated with greater risk for bipolar disorder.
已有研究描述了精神分裂症患者病前存在智力损害，但对于双相情感障碍或其他精神病的病前智力功能了解甚少。在本研究中，对双相情感障碍、精神分裂症或其他精神病患者的病前智力能力进行了调查。
获取了1982年至1987年期间应征加入芬兰国防军的195,019名表面健康男性受试者（平均年龄19.9岁）的语言、算术和视觉空间推理测试结果。与芬兰医院出院登记册（平均随访时间7.1年）进行关联，确定后来被诊断为双相情感障碍（N = 100）、精神分裂症（N = 621）或其他精神病（N = 527）的应征者。
20岁时视觉空间推理测试表现不佳与这三种疾病的较高风险相关。九个表现类别中最低和最高类别之间疾病风险差异的比值比，双相情感障碍为34.65（95%置信区间[CI]，4.05 - 296.44），精神分裂症为13.76（95% CI = 5.49 - 34.47），其他精神病为4.28（95% CI = 2.09 - 8.77）。相比之下，算术推理得分越高，双相情感障碍的风险越大；高分与超过12倍的更高风险相关。语言测试表现与精神疾病的较高风险无关。
这些结果表明，双相情感障碍和精神分裂症患者病前的视觉空间推理受损，在其他精神病中受损程度较小。这表明双相情感障碍和精神分裂症的病因涉及一种微妙的神经发育异常。算术测试高分可能与双相情感障碍的更大风险相关。
