Cardoso Taiane de A, Bauer Isabelle E, Jansen Karen, Suchting Robert, Zunta-Soares Giovana, Quevedo João, Glahn David C, Soares Jair C
Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas (UCPEL), Pelotas, RS, Brazil.
Psychiatry Res. 2016 Sep 30;243:225-231. doi: 10.1016/j.psychres.2016.06.044. Epub 2016 Jun 29.
Cognitive impairment is a well-established feature of bipolar disorder (BD). Comorbid BD and substance use leads to poor psychosocial and clinical outcomes. However, knowledge on the neurocognitive functioning of individuals with dual diagnosis is limited. The aim of this study is to assess the cognitive performance of subjects with BD, BD with comorbid alcohol use disorder (AUD), and BD with comorbid illicit substance use disorders (SUD) as compared to healthy individuals.
We included 270 inpatients and outpatients with BD and 211 healthy controls. The diagnostic of BD and substance use disorder was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Axis I. Demographic and clinical information were also collected. The cognitive assessment included the Wechsler Test of Adult Reading (WTAR), and a revised version of the California Verbal Learning Test (CVLT) as part of the South Texas Assessment of Neurocognition (STAN).
The STAN was administered to 134 BD patients (100 female, M±SD: 37.37±12.74 years), 72 BD patients with AUD (40 female, M±SD: 38.42±11.82), 64 BD patients with SUD (39 female, M±SD: 34.50±10.57), and 211 healthy controls with no lifetime history of mental illness and substance use (127 female, M±SD: 34.80±12.57 years). In terms of clinical characteristics, BD+SUD showed a marginally earlier onset of illness compared to BD. Compared to HC, BD performed poorly in the immediate recall and short-delay free tests of the CVLT, while BD patients with AUD and SUD showed significant memory deficits in both the immediate recall and recognition components of the CVLT. There were no differences in memory performance between BD and BD with either AUD or SUD.
A history of substance use disorders is associated with an earlier onset of BD. BD has marked effects on processes underlying the encoding of new information, while comorbid substance use in BD impairs more specifically the recognition of previously presented information. Future longitudinal studies should evaluate the effects of AUD and SUD on illness progression and therapeutic outcomes.
认知障碍是双相情感障碍（BD）的一个公认特征。双相情感障碍与物质使用障碍共病会导致不良的心理社会和临床结局。然而，关于双重诊断个体神经认知功能的知识有限。本研究的目的是评估双相情感障碍患者、合并酒精使用障碍（AUD）的双相情感障碍患者以及合并非法物质使用障碍（SUD）的双相情感障碍患者与健康个体相比的认知表现。
我们纳入了270例双相情感障碍住院患者和门诊患者以及211名健康对照者。使用《精神障碍诊断与统计手册》第一轴的结构化临床访谈来评估双相情感障碍和物质使用障碍的诊断。还收集了人口统计学和临床信息。认知评估包括韦氏成人阅读测验（WTAR），以及作为南德克萨斯神经认知评估（STAN）一部分的加利福尼亚言语学习测验（CVLT）的修订版。
对134例双相情感障碍患者（100名女性，平均年龄±标准差：37.37±12.74岁）、72例合并酒精使用障碍的双相情感障碍患者（40名女性，平均年龄±标准差：38.42±11.82岁）、64例合并物质使用障碍的双相情感障碍患者（39名女性，平均年龄±标准差：34.50±10.57岁）以及211名无精神疾病和物质使用终生史的健康对照者（127名女性，平均年龄±标准差：34.80±12.57岁）进行了STAN评估。在临床特征方面，与双相情感障碍相比，双相情感障碍合并物质使用障碍的发病时间略早。与健康对照者相比，双相情感障碍患者在CVLT的即时回忆和短延迟自由回忆测试中表现较差，而合并酒精使用障碍和物质使用障碍的双相情感障碍患者在CVLT的即时回忆和识别部分均表现出显著的记忆缺陷。双相情感障碍患者与合并酒精使用障碍或物质使用障碍的双相情感障碍患者在记忆表现上没有差异。
物质使用障碍史与双相情感障碍的发病较早有关。双相情感障碍对新信息编码的潜在过程有显著影响，而双相情感障碍合并物质使用则更具体地损害了对先前呈现信息的识别。未来的纵向研究应评估酒精使用障碍和物质使用障碍对疾病进展和治疗结果的影响。
