Dines Micaela, Kes Mariana, Ailán Delfina, Cetkovich-Bakmas Marcelo, Born Christoph, Grunze Heinz
Department of Psychiatry, Instituto de Neurología Cognitiva (INECO), Buenos Aires, Argentina.
Department of Psychiatry, Instituto de Neurociencia Cognitiva y Traslacional (Consejo Nacional de Investigaciones Científicas y Técnicas - Fundación INECO - Universidad Favaloro), Buenos Aires, Argentina.
Front Psychiatry. 2024 Apr 30;15:1352250. doi: 10.3389/fpsyt.2024.1352250. eCollection 2024.
With similarities in heritability, neurobiology and symptomatology, the question has been raised whether schizophrenia and bipolar disorder are truly distinctive disorders or belong to a continuum. This narrative review summarizes common and distinctive findings from genetics, neuroimaging, cognition and clinical course that may help to solve this ethiopathogenetic puzzle.
The authors conducted a literature search for papers listed in PubMed and Google Scholar, using the search terms "schizophrenia" and "bipolar disorder" combined with different terms such as "genes", "neuroimaging studies", "phenomenology differences", "cognition", "epidemiology". Articles were considered for inclusion if they were written in English or Spanish, published as full articles, if they compared subjects with schizophrenia and bipolar disorder, or subjects with either disorder with healthy controls, addressing differences between groups.
Several findings support the hypothesis that schizophrenia and bipolar disorder are discrete disorders, yet some overlapping of findings exists. The evidence for heritability of both SZ and BD is obvious, as well as the environmental impact on individual manifestations of both disorders. Neuroimaging studies support subtle differences between disorders, it appears to be rather a pattern of irregularities than an unequivocally unique finding distinguishing schizophrenia from bipolar disorder. The cognitive profile displays differences between disorders in certain domains, such as premorbid intellectual functioning and executive functions. Finally, the timing and trajectory of cognitive impairment in both disorders also differs.
The question whether SZ and BD belong to a continuum or are separate disorders remains a challenge for further research. Currently, our research tools may be not precise enough to carve out distinctive, unique and undisputable differences between SZ and BD, but current evidence favors separate disorders. Given that differences are subtle, a way to overcome diagnostic uncertainties in the future could be the application of artificial intelligence based on BigData.
Despite the detailed search, this article is not a full and complete review of all available studies on the topic. The search and selection of papers was also limited to articles in English and Spanish. Selection of papers and conclusions may be biased by the personal view and clinical experience of the authors.
鉴于精神分裂症和双相情感障碍在遗传力、神经生物学和症状学方面存在相似性，人们提出了这样一个问题，即这两种疾病是真正不同的疾病，还是属于一个连续体。这篇叙述性综述总结了来自遗传学、神经影像学、认知和临床病程方面的共同及不同的研究结果，这些结果可能有助于解决这一病因发病机制难题。
作者在PubMed和谷歌学术上检索列出的论文，使用检索词“精神分裂症”和“双相情感障碍”，并与不同的术语如“基因”、“神经影像学研究”、“现象学差异”、“认知”、“流行病学”相结合。如果文章是用英语或西班牙语撰写、作为全文发表、比较了精神分裂症和双相情感障碍患者或任一疾病患者与健康对照，并阐述了组间差异，则考虑纳入。
多项研究结果支持精神分裂症和双相情感障碍是不同疾病的假说，但也存在一些结果重叠。精神分裂症和双相情感障碍的遗传证据以及环境对这两种疾病个体表现的影响都很明显。神经影像学研究支持这两种疾病之间存在细微差异，这似乎是一种不规则模式，而不是将精神分裂症与双相情感障碍明确区分开来的独特发现。认知概况在某些领域显示出这两种疾病之间的差异，如病前智力功能和执行功能。最后，这两种疾病认知障碍的时间和轨迹也有所不同。
精神分裂症和双相情感障碍是属于一个连续体还是不同的疾病，这个问题仍然是进一步研究的挑战。目前，我们的研究工具可能不够精确，无法明确区分精神分裂症和双相情感障碍之间独特且无可争议的差异，但目前的证据支持它们是不同的疾病。鉴于差异很细微，未来克服诊断不确定性的一种方法可能是应用基于大数据的人工智能。
尽管进行了详细检索，但本文并非对该主题所有现有研究的全面完整综述。论文的检索和选择也仅限于英语和西班牙语文章。论文的选择和结论可能受到作者个人观点和临床经验的影响。
