Sabater Ana, García-Blanco Ana C, Verdet Hélade M, Sierra Pilar, Ribes Josep, Villar Irene, Lara Mª José, Arnal Pilar, Rojo Luis, Livianos Lorenzo
Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.
Health Research Institute La Fe, Valencia, Spain; University of Valencia, Spain.
J Affect Disord. 2016 Jan 15;190:34-40. doi: 10.1016/j.jad.2015.10.008. Epub 2015 Oct 14.
The aim of choosing a mood-stabilizing drug (lithium or anticonvulsants) or a combination of them with minimal neurocognitive effects is to stimulate the development of criteria for a therapeutic adequacy, particularly in Bipolar Disorder (BD) patients who are clinically stabilized.
Three groups of BD patients were established according to their treatment: (i) lithium monotherapy (n=29); (ii) lithium together with one or more anticonvulsants (n=28); and (iii) one or more anticonvulsants (n=16). A group of healthy controls served as the control (n=25). The following tests were applied: Wechsler Adult Intelligence Scale, Trail Making Test, Wechsler Memory Scale, Rey Complex Figure Test, Stroop color-word test, Wisconsin Card Sorting Test, Tower of Hanoi, Frontal Assessment Battery, and Reading the Mind in the Eyes Test.
Relative to healthy controls, BD patients showed the following: (i) those on lithium monotherapy, but not other BD groups, had preserved short-term auditory memory, long-term memory, and attention; (ii) those who took only anticonvulsants showed worse findings in short-term visual memory, working memory, and several executive functions; and (iii) all BD patients showed worse performance in processing speed, resistance to interference, and emotion recognition.
Medication alone cannot explain why all BD patients showed common cognitive deficits despite different pharmacological treatment.
The impairment on some executive functions and emotion recognition is an inherent trait in BD patients, regardless of their pharmacological treatment. However, while memory, attention, and most of the executive functions are preserved in long-term stable BD patients, these cognitive functions are impaired in those who take anticonvulsants.
选择具有最小神经认知效应的心境稳定剂（锂盐或抗惊厥药）或它们的组合的目的是促进制定治疗充分性标准，特别是在临床病情稳定的双相情感障碍（BD）患者中。
根据治疗情况将三组BD患者分组：（i）锂盐单药治疗组（n = 29）；（ii）锂盐与一种或多种抗惊厥药联合治疗组（n = 28）；以及（iii）一种或多种抗惊厥药治疗组（n = 16）。一组健康对照者作为对照组（n = 25）。应用了以下测试：韦氏成人智力量表、连线测验、韦氏记忆量表、雷-复杂图形测验、斯特鲁普色词测验、威斯康星卡片分类测验、河内塔测验、额叶评估量表以及读心术测验。
与健康对照者相比，BD患者表现出以下情况：（i）锂盐单药治疗组患者（而非其他BD组）保留了短期听觉记忆、长期记忆和注意力；（ii）仅服用抗惊厥药的患者在短期视觉记忆、工作记忆和几种执行功能方面表现较差；以及（iii）所有BD患者在处理速度、抗干扰能力和情绪识别方面表现较差。
仅药物治疗无法解释为什么所有BD患者尽管接受了不同药物治疗但仍表现出共同的认知缺陷。
某些执行功能和情绪识别方面的损害是BD患者的固有特征，无论其药物治疗如何。然而，虽然长期病情稳定BD患者的记忆、注意力和大多数执行功能得以保留，但服用抗惊厥药的患者这些认知功能受损。
