Lynham Amy J, Hubbard Leon, Tansey Katherine E, Hamshere Marian L, Legge Sophie E, Owen Michael J, Jones Ian R, Walters James T R
From the MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK (Lynham, Hubbard, Hamshere, Legge, Owen, Jones, Walters); and the College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK (Tansey).
J Psychiatry Neurosci. 2018 Apr 5;43(3):170076. doi: 10.1503/jpn.170076.
Cognitive impairments are well-established features of schizophrenia, but there is ongoing debate about the nature and degree of cognitive impairment in patients with schizoaffective disorder and bipolar disorder. We hypothesized that there is a spectrum of increasing impairment from bipolar disorder to schizoaffective disorder bipolar type, to schizoaffective disorder depressive type and schizophrenia.
We compared performance on the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery between participants with schizophrenia ( = 558), schizoaffective disorder depressive type ( = 112), schizoaffective disorder type ( = 76), bipolar disorder ( = 78) and healthy participants ( = 103) using analysis of covariance with post hoc comparisons. We conducted an ordinal logistic regression to examine whether cognitive impairments followed the hypothesized spectrum from bipolar disorder (least severe) to schizophrenia (most severe). In addition to categorical diagnoses, we addressed the influence of symptom domains, examining the association between cognition and mania, depression and psychosis.
Cognitive impairments increased in severity from bipolar disorder to schizoaffective disorder bipolar type, to schizophrenia and schizoaffective disorder depressive type. Participants with schizophrenia and schizoaffective disorder depressive type showed equivalent performance ( = 0.07, = 0.90). The results of the ordinal logistic regression were consistent with a spectrum of deficits from bipolar disorder to schizoaffective disorder bipolar type, to schizophrenia/schizoaffective disorder depressive type (odds ratio = 1.98, < 0.001). In analyses of the associations between symptom dimensions and cognition, higher scores on the psychosis dimension were associated with poorer performance (B = 0.015, standard error = 0.002, < 0.001).
There were fewer participants with schizoaffective disorder and bipolar disorder than schizophrenia. Despite this, our analyses were robust to differences in group sizes, and we were able to detect differences between groups.
Cognitive impairments represent a symptom dimension that cuts across traditional diagnostic boundaries.
认知障碍是精神分裂症公认的特征，但对于分裂情感性障碍和双相情感障碍患者认知障碍的性质和程度仍存在争议。我们假设从双相情感障碍到双相型分裂情感性障碍、再到抑郁型分裂情感性障碍和精神分裂症，存在一个认知障碍逐渐加重的谱系。
我们使用协方差分析及事后比较，比较了精神分裂症患者（n = 558）、抑郁型分裂情感性障碍患者（n = 112）、双相型分裂情感性障碍患者（n = 76）、双相情感障碍患者（n = 78）和健康参与者（n = 103）在精神分裂症认知改善测量与治疗研究（MATRICS）共识认知成套测验中的表现。我们进行了有序逻辑回归分析，以检验认知障碍是否遵循从双相情感障碍（最不严重）到精神分裂症（最严重）的假设谱系。除了分类诊断外，我们还探讨了症状领域的影响，研究了认知与躁狂、抑郁和精神病之间的关联。
从双相情感障碍到双相型分裂情感性障碍、再到精神分裂症和抑郁型分裂情感性障碍，认知障碍的严重程度逐渐增加。精神分裂症患者和抑郁型分裂情感性障碍患者表现相当（p = 0.07，d = 0.90）。有序逻辑回归分析结果与从双相情感障碍到双相型分裂情感性障碍、再到精神分裂症/抑郁型分裂情感性障碍的缺陷谱系一致（优势比 = 1.98，p < 0.001）。在症状维度与认知关联的分析中，精神病维度得分越高与表现越差相关（B = 0.015，标准误 = 0.002，p < 0.001）。
分裂情感性障碍和双相情感障碍患者比精神分裂症患者少。尽管如此，我们的分析对组间样本量差异具有稳健性，并且能够检测到组间差异。
认知障碍代表了一个跨越传统诊断界限的症状维度。
