Jabben Nienke, Arts Baer, Krabbendam Lydia, van Os Jim
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands.
Bipolar Disord. 2009 Mar;11(2):166-77. doi: 10.1111/j.1399-5618.2009.00663.x.
In schizophrenia, a distinction is made between psychosis with developmental and cognitive impairment on the one hand and psychosis without developmental impairment and positive symptoms on the other. In this study, we investigated whether this model can be extended to bipolar disorder by testing the hypothesis that neurocognitive functioning is inversely related to positive psychotic symptoms in bipolar disorder.
Neurocognitive functioning and psychopathology were assessed in (i) 76 patients with bipolar disorder, (ii) 39 of their healthy first-degree relatives, and (iii) 61 healthy controls. Cognitive performance of bipolar patients and their first-degree relatives was investigated, taking into account the possible moderating effect of the level of expression of psychosis in patients and relatives.
Bipolar patients showed impaired cognitive performance on multiple cognitive domains, whereas performance of their relatives was comparable to that of controls. A history of psychotic symptoms in patients was suggestive of less likelihood of cognitive alterations in relatives, and the presence of subclinical psychotic symptoms within the group of relatives predicted better cognitive performance.
The finding of similar psychosis-cognition associations in bipolar disorder as implied by the two pathways leading to nonaffective psychotic disorders suggests that this model might be extended to the continuum spanning affective and nonaffective psychosis. This is in line with the idea of a partially overlapping vulnerability to bipolar disorder and schizophrenia and provides an explanation for the apparent differences in cognitive alterations in those at risk for the two disorders.
在精神分裂症中，一方面区分伴有发育和认知障碍的精神病与另一方面不伴有发育障碍及阳性症状的精神病。在本研究中，我们通过检验双相情感障碍中神经认知功能与阳性精神病性症状呈负相关这一假设，来探究该模型是否可扩展至双相情感障碍。
对以下三组人群进行神经认知功能和精神病理学评估：（i）76例双相情感障碍患者；（ii）他们的39名健康一级亲属；（iii）61名健康对照者。研究双相情感障碍患者及其一级亲属的认知表现，并考虑患者及亲属中精神病性症状表达水平可能产生的调节作用。
双相情感障碍患者在多个认知领域的认知表现受损，而其亲属的表现与对照组相当。患者有精神病性症状病史提示其亲属认知改变的可能性较小，且亲属组中亚临床精神病性症状的存在预示着更好的认知表现。
双相情感障碍中精神病与认知关联的发现与导致非情感性精神病性障碍的两条途径所暗示的相似，这表明该模型可能扩展至涵盖情感性和非情感性精神病的连续谱。这与双相情感障碍和精神分裂症存在部分重叠易感性的观点一致，并为这两种疾病高危人群认知改变的明显差异提供了解释。
