检查双相/精神分裂症诊断谱系中的认知。
Examining cognition across the bipolar/schizophrenia diagnostic spectrum.
机构信息
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).
出版信息
J Psychiatry Neurosci. 2018 Jul;43(4):245-253. doi: 10.1503/jpn.170076.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
LIMITATIONS
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.
CONCLUSION
Cognitive impairments represent a symptom dimension that cuts across traditional diagnostic boundaries.
背景
认知障碍是精神分裂症的显著特征，但关于分裂情感障碍和双相情感障碍患者的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情感障碍型分裂情感障碍，再到抑郁型分裂情感障碍和精神分裂症，认知障碍呈逐渐加重的趋势。
方法
我们使用协方差分析和事后比较，比较了精神分裂症（n=558）、抑郁型分裂情感障碍（n=112）、分裂情感障碍（n=76）、双相情感障碍（n=78）和健康对照组（n=103）在精神分裂症认知测试量表（MATRICS）共识认知测试中的表现。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（最轻者）到精神分裂症（最重者）的假设谱。除了分类诊断，我们还研究了症状领域的影响，检查了认知与躁狂、抑郁和精神病之间的关联。
结果
认知障碍从双相情感障碍到双相情感障碍型分裂情感障碍、精神分裂症和抑郁型分裂情感障碍逐渐加重。精神分裂症和抑郁型分裂情感障碍患者的表现相当（=0.07，=0.90）。有序逻辑回归的结果与从双相情感障碍到双相情感障碍型分裂情感障碍、精神分裂症/抑郁型分裂情感障碍的缺陷谱一致（优势比=1.98，<0.001）。在症状维度与认知之间的关联分析中，精神病维度得分较高与认知表现较差相关（B=0.015，标准误差=0.002，<0.001）。
局限性
分裂情感障碍和双相情感障碍患者的数量少于精神分裂症患者。尽管如此，我们的分析对组间差异具有稳健性，并且我们能够检测到组间的差异。
结论
认知障碍是一种跨越传统诊断界限的症状维度。
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