情感性疾患之病程前期臨床特質對後期認知注意力下降的影響因子

The Influences of Early Clinical Features on Later Attention Deficit in Patients with Affective Disorders

胡倢君(Chieh-Chun Hu)

指導教授 ： 郭柏秀

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201703948

摘要

情感性疾患是精神疾病當中最常見的，患者通常會有不正常的情緒起伏，並且可能會有神經認知功能下降，造成工作場合與社交人際關係的嚴重干擾。在神經認知功能方面，注意力下降為常見的情感性疾患症狀之一，其下降幅度受到疾病嚴重程度、精神藥物使用以及臨床特質影響。然而過去的研究在臨床特質對注意力的影響程度上有不一致的結果，除此之外，情感性疾患患者的症狀異質性高，對於疾病前期的症狀對後期注意力的影響仍然不清楚。因此本篇研究將分別探討不同情感性疾患的臨床特質（發病年紀、精神病症狀、發作的次數與病程的長度）和注意力的關係，還有第一次憂鬱或躁發作的症狀和後期注意力下降的關係。本研究收入390位診斷為躁鬱症或重度憂鬱症的個案，利用半結構式問卷訪談或自填式問卷搜集臨床特質與疾病嚴重程度之相關資料，並且使用電腦注意力測試得到注意力指標。
結果，情緒疾患的患者中，注意力的表現和日常生活功能為正相關。依據診斷分層，在躁鬱症患者中，過去有精神病症狀、發病年齡較晚對注意力有負面影響。但在重度憂鬱症的個案中，發作次數較高和和注意力表現呈負相關。在第一次憂鬱發作的症狀中，「情緒反應較少」與注意力為負相關，然而「睡眠過度」與注意力呈正相關。另外在第一次躁症發作的症狀中，「暴躁情緒」與後期注意力表現成正相關。在憂鬱症狀和臨床特質的逐步回歸分析當中，除了前述三種症狀以外，「缺乏興趣」也被選入模型，另外在躁症症狀和臨床特質的逐步回歸分析當中，「暴躁情緒」與「判斷力下降」也被選入模型，以解釋注意力下降的情況。本篇研究發現情感性疾患的早期臨床特質和症狀功能與注意力下降存在顯著相關，但是此相關背後的原因需要進一步、更完整的研究才能下結論。

關鍵字

情感性疾患 ； 躁鬱症 ； 重度憂鬱症 ； 注意力 ； 發病年齡 ； 精神病症狀 ； 情緒發作 ； 憂鬱症狀 ； 躁症症狀

並列摘要

Affective disorders were severe mental illnesses with functional deficits. Patients with affective disorders are often reported to have impairments in many neurocognitive domains, which play important roles in psychosocial functioning and quality of life. Attention impairment was among the most common characteristic of neurocognitive domains in patients with affective disorders. The magnitude of attention deficits in patients with affective disorders varies by symptom severity, medication use, and clinical features. However, previous studies have shown inconsistent results of the effects of clinical features on attention deficits in patients with affective disorders. In addition, patients of affective disorders usually possessed heterogeneous symptomatology. Whether specific symptoms of depression and mania in early stage have effects on later attention deficit is less known. Therefore, the aims of the current study are to investigate the relationships between early clinical features, such as onset age, numbers of episodes, duration of illness, psychosis, and attention deficit at later disease course in patients with bipolar disorders (BP) and major depressive disorder (MDD). We also evaluated the associations between early symptom presentations and attention function at later years.
We recruited 390 BP-I, BP-II, or MDD patients based on DSM-V diagnosis from psychiatry clinics in five hospitals in Taipei. Each subject was interviewed with the schedule for affective disorders and schizophrenia to collect information on clinical features. Symptoms severity was measured using Beck depression inventory-II for depression and Yang Mania Rating Scale for mania. The global assessment of function was used to evaluate social, occupational, and psychological functioning. Attentional function was assessed by the continuous performance test (CPT) to derive four indices, including hit rate, false alarm rate, sensitivity, and response criterion, and their values were normalized by age, gender, and education using previously established norm data. Multiple linear regressions were applied to analyze the relationships between CPT indices and clinical features. Stepwise multiple regression analysis was used to select relevant variables for better explanations of attention deficit in patients with affective disorders.
We found that attention performance was positively correlated to life functioning. In stratified analyses by diagnosis, we reported that previous psychosis and later onset age have significantly negative influences on attention in BP, while adjusted for depressive and mania severity. In addition, larger numbers of episodes lead to poor performance of attention in MDD. For depressive symptoms at the first episode in affective disorders, ‘depressed appearance’ was significantly associated with poorer attention, but ‘sleep more’ was related to better attention. On the other hand, ‘irritability’ at the first mania episode was related to better attention in BP. In stepwise analysis including depressive symptoms, not only the three aforementioned symptoms, but also ‘loss of interest or pleasure” was included in the model, while for stepwise analysis including manic symptoms, ‘irritability’ and ‘poor judgment’ were chosen into models to explain attention deficit in patients with affective disorders.
In conclusion, the current study found significant associations between early clinical features and symptoms and attention deficits in affective disorders. Further investigation is needed to replicate current results and further establish the causal relationship between clinical features and attention deficit.

並列關鍵字

Affective disorder ； bipolar disorder ； major depressive disorder ； attention ； onset age ； psychosis ； episodes ； depressive symptom ； manic symptom

參考文獻

REFERENCE

1. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, de Graaf R, Demyttenaere K, Hu C, Iwata N, Karam AN, Kaur J, Kostyuchenko S, Lépine J-P, Levinson D, Matschinger H, Mora MEM, Browne MO, Posada-Villa J, Viana MC, Williams DR, Kessler RC. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9:90.

2. Fagiolini A, Forgione R, Maccari M, Cuomo A, Morana B, Dell’Osso MC, Pellegrini F, Rossi A. Prevalence, chronicity, burden and borders of bipolar disorder. J Affect Disord. 2013 Jun 1;148(2):161–169.

3. Liao S-C, Chen WJ, Lee M-B, Lung F-W, Lai T-J, Liu C-Y, Lin C-Y, Yang M-J, Chen C-C. Low prevalence of major depressive disorder in Taiwanese adults: possible explanations and implications. Psychol Med. 2012 Jun;42(6):1227–1237. PMID: 22051196

4. Hwu HG, Yeh EK, Chang LY. Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatr Scand. 1989 Feb;79(2):136–147. PMID: 2923007