青少年双相障碍患者治疗前后执行功能的变化

Control study on executive function in adolescents with bipolar disorder before and after therapy

目的研究青少年双相障碍患者的执行功能特点及其影响因素。方法采用威斯康星卡片分类测验（WCST）、Stroop色词测验（SCW）、空间广度测验、数字序列测验和伦敦塔测验分别对30例青少年双相抑郁发作患者和30例青少年双相躁狂发作患者（研究组）以及30名健康青少年（对照组）进行执行功能评估。结果（1）治疗前后，研究组全部执行功能指标与对照组比较，差异均具有统计学意义（P〈0．01）。治疗前，抑郁发作组和躁狂发作组WCST中的非持续性错误数（NRPE）、完成第一个分类的应答数（RF）以及SCW中的卡片A、卡片B、卡片C的反应时间（RTA、RTB、RTC），以及干扰效应反应时（SIE）等，差异具有统计学意义[NRPE：（27．30±5．19）个，（31．77±6．13）个；RF：（30．60±7．41）个，（35．33±9．06）个；RTA：（53．40±8．97）s，（63．63±8．85）s；RTB：（81．93±8．44）s，（93．87±6．98）s；RTC：（127．27±12．52）s，（160．27±13．70）s；SIE：（45．33±13．90）s，（66．40±13．56S），P〈0．05或P〈0．01]。治疗8周后，抑郁发作组和躁狂发作组的RF、TOL、RTA、RTB、RTC以及SIE等指标，差异具有统计学意义（P〈0．05或P〈0．01）。除RTA和RTB外，治疗后抑郁组的其他执行功能测验成绩与治疗前的差异有统计学意义（P〈0．01）。治疗后躁狂组全部执行功能指标与治疗前比较差异具有统计学意义（P〈0．01）。（2）伦敦塔测验和分类数（cc）与病程呈负相关（均P〈0．05），持续错误数（RPE）、NRPE和RF以及SIE等指标与病程呈正相关（均P〈0．05）。结论青少年双相障碍患者在整个疾病过程中存在执行功能障碍。

Objective To study the executive function and the related factors before and after therapy. Methods Thirty adolescents with depressed bipolar patients and 30 adolescents with manic bipolar patients （study group）,thirty health adolescents controls （control group） were assessed for executive function using the Wisconsin Card Sorting Test （WCST）, the Stroop Color Word Test （SCW）, the Tower of London Test, the Digital Sequence Test and Spatial Span Test. Neuropsychological assessment was performed respeclively in the 1 st week of entering the group and the end of the 8th week. Results Before and after the treatment the study group performed poorer on all of the neuropsychological tests than control group （ P〈 0.01 ）. Furthermore, follow-up assessment re- vealed that although study group demonstrated an overall improvement, the deficits in executive functions remain. Manic bipolar patients showed the worse performance than depressed bipolar patients on subtests reflecting inhibitory control before treatment（ NRPE ：27.30 ± 5.19 vs 31.77 ± 6.13 ; RF ： 30.60 ± 7.41 vs 35.33 ± 9.06 ; RTA ： （53.40 ±8.97）s vs （63.63 ±8.85）s;RTB：（81.93 ±8.44）s vs （93.87 ±6.98 ）s;RTC： （127.27 _± 12.52）s vs （160.27 ±13.70 ）s;SIE：（45.33±13.90）s vs （66.40±13.56）s,P〈O. 01 or P〈0.05）. After 8 weeks treatment,there were remarkable differences between depressed bipolar group and mania bipolar group on RF, TOL, RTA, RTB, RTC, SIE （P 〈 0.01 or P 〈 0.05 ）. Self-comparison of the depressed bipolar on neuropsychological performance before and after treatment showed significant difference （ P〈 0.01 ）, except RTA and RTB of the SCW （P 〉 O. 05 ）. Self-comparison of the manic bipolar on neuropsychological performance before and after treatment showed significant difference （ P〈0.01 ）. The Tower of London test and the number of categories of WCST were negatively correlated to the course of disease （P 〈 0.05 ） ; Perseverative Errors score, Non-Perseverative Errors score and the Responses of Finishing the first Category of WCST and the Interference of Stroop were positive correlated to the course of disease （P 〈 0.05 ）. Conclusion The impairment of executive function in young patients with bipolar disorder is observed in the period of disease, which could improve after treatment.