Wegbreit Ezra, Cushman Grace K, Weissman Alexandra B, Bojanek Erin, Kim Kerri L, Leibenluft Ellen, Dickstein Daniel P
Brown University Alpert Medical School, Department of Psychiatry and Human Behavior, Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States.
Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Riverside, RI 02915, USA.
J Affect Disord. 2016 Oct;203:46-54. doi: 10.1016/j.jad.2016.05.046. Epub 2016 May 26.
Bipolar disorder (BD) is a severe mental illness that can have high costs for youths (<18 years old) and adults. Relative to healthy controls (HC), individuals with BD often show impaired attention, working memory, executive function, and cognitive flexibility (the ability to adapt to changing reward/punishment contingencies). In our study of youths and young adults with BD, we investigated 1) how cognitive flexibility varies developmentally in BD, and 2) whether it is independent of other executive function deficits associated with BD.
We measured errors on a reversal-learning task, as well as spatial working memory and other executive function, among participants with BD (N=75) and HC (N=130), 7-27 years old. Regression analyses focused on the effects of diagnosis on reversal-learning errors, controlling for age, gender, IQ, spatial span, and executive function. Similar analyses examined non-reversal errors to rule out general task impairment.
Participants with BD, regardless of age, gender, or cognitive ability, showed more errors than HC on the response reversal stages of the cognitive flexibility task. However, participants with BD did not show more errors on non-reversal stages, even when controlling for other variables.
Study limitations include the cross-sectional, rather than longitudinal, design; inability to measure non-linear age effects; and inclusion of medicated participants and those with psychiatric comorbidity.
Individuals with BD show a specific impairment in reversing a previously rewarded response, which persists across the transition from childhood to young adulthood. Tailored interventions targeting this deficit may be effective throughout this developmentally turbulent time.
双相情感障碍（BD）是一种严重的精神疾病，对青少年（<18岁）和成年人来说代价高昂。相对于健康对照者（HC），双相情感障碍患者往往表现出注意力、工作记忆、执行功能和认知灵活性（适应不断变化的奖励/惩罚条件的能力）受损。在我们对患有双相情感障碍的青少年和青年成年人的研究中，我们调查了：1）双相情感障碍患者的认知灵活性在发育过程中如何变化；2）它是否独立于与双相情感障碍相关的其他执行功能缺陷。
我们测量了7至27岁的双相情感障碍患者（N = 75）和健康对照者（N = 130）在反转学习任务中的错误，以及空间工作记忆和其他执行功能。回归分析重点关注诊断对反转学习错误的影响，同时控制年龄、性别、智商、空间跨度和执行功能。类似的分析检查了非反转错误，以排除一般任务损伤。
无论年龄、性别或认知能力如何，双相情感障碍患者在认知灵活性任务的反应反转阶段比健康对照者表现出更多错误。然而，即使在控制其他变量时，双相情感障碍患者在非反转阶段也没有表现出更多错误。
研究局限性包括横断面而非纵向设计；无法测量非线性年龄效应；纳入了正在服药的参与者和患有精神疾病共病的参与者。
双相情感障碍患者在反转先前获得奖励的反应方面存在特定损伤，这种损伤在从童年到青年成年的过渡过程中持续存在。针对这一缺陷的量身定制的干预措施在这个发育动荡时期可能是有效的。
