Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.
Department of Medicine, University of Valencia, Valencia, Spain.
Aust N Z J Psychiatry. 2021 Oct;55(10):1005-1016. doi: 10.1177/0004867420969819. Epub 2020 Nov 6.
Neurocognitive dysfunction is a common feature of bipolar disorder even in euthymia, and psychopharmacological treatment could have an effect on cognition. Long-term prescription of benzodiazepines in bipolar disorder is a common practice, and their effect on neurocognition has not been well studied in this population. The aim of this study was to evaluate the impact of concomitant benzodiazepine long-term use on neurocognitive function in stable euthymic bipolar disorder patients.
Seventy-three euthymic bipolar disorder outpatients and 40 healthy individuals were assessed using a neurocognitive battery. Patients were classified in two groups according to the presence of benzodiazepines in their treatment: the benzodiazepine group ( = 34) and the non- benzodiazepine group ( = 39). Neurocognitive performance was compared between the groups using a multivariate analysis of covariance, considering age, number of depressive episodes, adjuvant antipsychotic drugs, Young Mania Rating Scale score and Hamilton Depression Rating Scale score as covariates.
Both bipolar disorder groups (benzodiazepine and non-benzodiazepine) showed an impairment in memory domains (Immediate Visual Memory [ = 0.013], Working Memory [ < 0.001], and Letter-Number Sequence [ < 0.001] from the Wechsler Memory Scale-Revised-III) and slower processing speed functions (Stroop Colour [ < 0.001]) relative to the control group. Nevertheless, the benzodiazepine group showed a greater impairment in executive functions (Conceptual Level Responses [ = 0.024] from the Wisconsin Card Sorting Test and Frontal Assessment Battery [ = 0.042]).
Although memory and processing speed impairments were found in bipolar disorder, regardless of their benzodiazepine treatment, benzodiazepine users presented additional neurocognitive impairments in terms of executive functioning. These findings support restricted prescription of benzodiazepines in individuals with bipolar disorder.
神经认知功能障碍是双相情感障碍的一个常见特征，即使在病情稳定时也是如此，而精神药理学治疗可能会对认知产生影响。长期开苯二氮䓬类药物治疗双相情感障碍是一种常见的做法，但在该人群中，其对神经认知的影响尚未得到很好的研究。本研究旨在评估长期使用苯二氮䓬类药物对稳定期双相情感障碍患者神经认知功能的影响。
对 73 名病情稳定的双相情感障碍门诊患者和 40 名健康个体进行神经认知测试。根据患者治疗中是否使用苯二氮䓬类药物将患者分为两组：苯二氮䓬组（n=34）和非苯二氮䓬组（n=39）。使用协方差的多变量分析比较两组之间的神经认知表现，考虑年龄、抑郁发作次数、辅助抗精神病药物、杨氏躁狂量表评分和汉密尔顿抑郁量表评分作为协变量。
双相情感障碍组（苯二氮䓬组和非苯二氮䓬组）在记忆领域（韦氏记忆量表修订版的即时视觉记忆[=0.013]、工作记忆[<0.001]和字母数字序列[<0.001]）和较慢的加工速度功能（斯特鲁普颜色[<0.001]）方面均表现出损害。然而，苯二氮䓬组在执行功能方面表现出更大的损害（威斯康星卡片分类测验的概念水平反应[=0.024]和额叶评估量表[=0.042]）。
尽管在双相情感障碍患者中发现了记忆和加工速度损害，无论其是否使用苯二氮䓬类药物治疗，但苯二氮䓬类药物使用者在执行功能方面表现出额外的神经认知损害。这些发现支持在双相情感障碍患者中限制使用苯二氮䓬类药物。
