双相情感障碍早期抑郁发作对认知缺陷的影响：来自早期躁狂系统治疗优化项目（STOP-EM）的数据。
Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM).
机构信息
Kesavan Muralidharan, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, Britich Columbia, Canada, and Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India; Ivan J. Torres, PhD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Leonardo E. Silveira, MD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos, Porto Alegre, Brazil; Jan-Marie Kozicky, BSc, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Joana Bücker, PsyD, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, and Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil; Nadeesha Fernando, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Lakshmi N. Yatham, FRCPC, MRCPsych, Mood Disorders Centre, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
Br J Psychiatry. 2014 Jul;205(1):36-43. doi: 10.1192/bjp.bp.113.135525. Epub 2014 Apr 24.
BACKGROUND
Although manic episodes reportedly contribute to cognitive deficits in bipolar I disorder, the contribution of depressive episodes is poorly researched.
AIMS
We investigated the impact of depressive episodes on cognitive function early in the course of bipolar I disorder.
METHOD
A total of 68 patients and 38 controls from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM) first-episode mania programme were examined. We conducted (a) a cross-sectional analysis of the impact of prior depressive episodes on baseline cognitive function and (b) a prospective analysis assessing the contribution of depression recurrence within 1 year following a first episode of mania on cognitive functioning.
RESULTS
The cross-sectional analysis showed no significant differences between patients with past depressive episodes compared with those without, on overall or individual domains of cognitive function (all P>0.09). The prospective analysis failed to reveal a significant group×time interaction for cognitive decline from baseline to 1 year (P = 0.99) in patients with a recurrence of depressive episodes compared with those with no recurrence. However, impaired verbal memory at baseline was associated with a depression recurrence within 1 year.
CONCLUSIONS
Although deficits in all domains of cognitive function are seen in patients early in the course of bipolar disorder, depressive episodes do not confer additional burden on cognitive function. However, poorer verbal memory may serve as a marker for increased susceptibility to depression recurrence early in the course of illness.
背景
据报道，躁狂发作会导致双相 I 型障碍患者认知功能受损，但抑郁发作对认知功能的影响研究较少。
目的
我们研究了双相 I 型障碍早期抑郁发作对认知功能的影响。
方法
共有来自系统性治疗优化方案治疗早期躁狂（STOP-EM）首发躁狂症项目的 68 名患者和 38 名对照者参与了该研究。我们进行了（a）横断面分析，以评估既往抑郁发作对基线认知功能的影响，以及（b）前瞻性分析，以评估首发躁狂后 1 年内抑郁复发对认知功能的影响。
结果
横断面分析显示，与无抑郁发作史的患者相比，有抑郁发作史的患者在总体或各认知功能领域的认知功能（均 P>0.09）上无显著差异。前瞻性分析显示，与无复发组相比，抑郁复发组的认知功能从基线到 1 年的下降无显著的组间×时间交互作用（P = 0.99）。然而，基线时的言语记忆受损与 1 年内的抑郁复发有关。
结论
尽管在双相障碍早期，所有认知功能领域都存在缺陷，但抑郁发作不会对认知功能造成额外的负担。然而，较差的言语记忆可能是疾病早期易发生抑郁复发的一个标志物。
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