Sercan YILMAZ, GÖKHAN SARISOY, Ahmet Rifat ŞAHİN, Ali Cezmi ARIK, HATİCE GÜZ, Ömer BÖKE, Ozan PAZVANTOĞLU, Ömer Faruk KAÇAR

Majör depresif bozukluk hastalarında nöbet sayısının remisyon sırasındaki nörobiliĢsel iĢlevlerle ilişkisi

Amaç: Bir veya birden fazla nöbet geçirmiş remisyondaki majör depresif bozukluk hastalarında nörobilişsel işlev- leri karşılaştırmak ve olası etkilenmenin nöbet sayısı ile ilişkisini incelemektir. Yöntem: Çalışmaya halen remis- yonda olan 60 depresif bozukluk hastası (yarısı bir nöbet, yarısı birden fazla nöbet geçirmiş) ile 30 sağlıklı gönüllü olmak üzere toplam 90 kişi alınmıştır. Hasta grupları ve kontrol grubu yönetici işlevler, dikkat, bellek ve görsel-uzaysal işlevleri ölçen testler aracılığıyla karşılaştırılmıştır. Sonuçlar: Test performansları bir nöbet geçi- ren grupta istatistiksel anlamlılığa ulaşmış veya ulaşmamış olsun, kontrol grubundan düşük, çok nöbet geçiren gruptan yüksek bulunmuştur. Artan nöbet sayısı ile test performanslarındaki düşüşün ilişkili olduğu saptanmıştır. Tartışma: Depresyonda her nöbetle birlikte kalıcı nörobilişsel defisitler gelişiyor olabilir. Nöbetler yineledikçe hem yeni defisitler oluşuyor, hem eskiler belirginleşiyor olabilir. Defisitlerin remisyonda da sürmesi, bu defisitlerin sadece nöbet dönemlerinde ortaya çıkan durum bağımlı fenomen olmadığını düşündürmektedir.

Correlation between number of episodes and neurocognitive functions during remission in major depressive disorder patients

Objective: To compare neurocognitive functions of patients diagnosed with major depressive disorder, in remis- sion and having undergone one or more episodes, and to examine the relationship between probable effect and number of episodes. Methods: Ninety individuals, 60 depressive disorder patients still in remission (half having experienced one episode and the other half more than one) and 30 healthy volunteers, were included. The patient and control groups were compared by means of tests measuring executive, attentional, memory and visual-spatial functions. Results: Test performances in the group that had undergone a single episode were lower than those of the control group and higher than those of the group with multiple episodes, whether the differences achieved statistical significance or not. A correlation was determined between increasing numbers of episodes and a decrease in test performances. Discussion: Permanent neurocognitive deficits may develop with every episode in depression. As episodes recur, new deficits may appear and previous ones may become more pronounced. The fact that deficits may also persist in remission suggests that these deficits are not solely a state-dependent phenomenon appearing during episodic periods.

PDF

___

1. Williams RA, Hagerty BM, Cimprich B, Therrien B, Bay E, OE H. Changes in directed attention and short-term memory in depression. J Psychiatr Res 2000;34:227-38.
2. Atre-Vaidya N, Taylor MA, Seidenberg M, Reed R, Perrine A, Glick-Oberwise F. Cognitive defi- cits, psychopathology, and psychosocial func- tioning in bipolar mood disorder. Neuropsychiatry Neuropsychol Behav Neurol 1998;11:120-6.
3. Miller LS, Foustman WO, Moses JA, Csernansky JG. Evaluating cognitive impairment in depres- sion with Luria-Nebraska Neuropsychological Test Battery: Severity, correlates and com- parisons with non-psychiatric controls. Psychiatry Res 1991;37:219-27.
4. Purcell R, Maruff P, Kyrios M. Neuropsycho- logical deficits in obsessive-compulsive disorder: A comparison with unipolar depression, panic disorder and normal controls. Arch Gen Psychiatry 1998;55:415-23.
5. Golinkoff M, Sweeney JA. Cognitive impairments in depression. J Affect Disord 1989;17:105-12.
6. Demir B, Göğüs A, Savaşır I. Depresyon hasta- larında bilişsel işlevler. Türk Psikiyatri Dergisi 2000;11:179-89.
7. Neu P, Kiesslinger U, Schlattmann P, Friedel MR. Time-related cognitive deficiency in four different types of depression. Psychiatry Res 2001;103:237-47.
8. Ravnkilde B, Videbech P, Clemmensen K, Egander A, Rasmussen NA, Rosanberg R. Cognitive deficits in major depression. Scand J Psychol 2002;43:239-51.
9. Porter RT, Gallagher P, Thompson JM. Neuro- cognitive impairment in drug-free patient whit smajor depressive disorder. Br J Psychiatry 2003;182:214-20.
10. Austin MP, Mitchell P, Goodwin GM. Cognitive deficits in depression: Possible implication for functional neuropathology. Br J Psychiatry 2001;178:200-6.
11. Reischies FM, Neu P. Comorbidity of mild cogni- tive disorder and depression: Neuropsychological analysis. Eur Arch Psychiatry Clin Neurosci 2000;250:186-93.
12. Sweeney JA, Kmiec JA, Kupfer DJ. Neuro- psychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biol Psychiatry 2000;48:674-85.
13. Smith DJ, Muir WJ, Blackwood DHR. Neuro- cognitive impairment in euthymic young adults with bipolar spectrum disorder and recurrent major depressive disorder. Bipolar Disord 2006;8:40-6.
14. Reppermund S, Ising M, Lucae S, Zihl j. Cognitive impairment in unipolar depression is persistent and non-spesific: Further evidence for the final common pathway disorder hypothesis. Psychol Med 2009;39:603-14.
15. DeglInnocenti A, Agren H, Badanan L. Executive deficits in major depression. Acta Psychiatr Scand 1998;97:182-8.
16. Lampe IK, Sitskoorn MM, Heeren TJ. Effects of recurrent major depressive disorder on behavior and cognitive function in female depressed patients. Psychiatry Res 2004;125:73-9.
17. Zakzanis KK, Leach L, Kaplan E. On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry Neuro- psychol Behav Neurol 1998;11:111-9.
18. DeglInnocenti A, Backman L. Source memory in major depression. J Affect Disord 1999;54:205-9. 19. Shah PJ, OCarrol RE, Rogers A, Moffoot AP, Ebmeier KP. Abnormal response to negative feedback in depression. Psychol Med 1999;29:63-7.
20. King DA, Cox C, Lyness JM, Conwell Y, Cain ED. Quantitative and qualitative differences in the verbal learning performance of elderly de- pressives and healthy controls. J Int Neuro- psychol Soc 1998;4:115-26.
21. Tham A, Engelbrektson K, Mathe AA, Johnson L, Olsson E, Aberg-Wistedt A. Impaired neuro- psychological performance in euthymic patients with recurring mood disorders. J Clin Psychiatry 1997;58:26-9.
22. Kessing LV. Cognitive impairment in the euthy- mic phase of affective disorder. Psychol Med 1998;28:1027-38.
23. Fossati P, Coyette F, Ergis AM, Allilaire JF. Influence of age and executive functioning on verbal memory of inpatients with depression. J Affect Disord 2002;68:261-71.
24. Branconnier RJ, Devirt DR, Cole JO, Spera KF. Amitriptyline selectively disrupts verbal recall from secondary memory of the normal aged. Neurobiol Aging 1982;3:55-9.
25. Lamping DL, Spring B, Gelenberg AJ. Effects of two antidepressants on memory performance in depressed outpatients: A double-blind study. Psychopharmacology 1984;84:254-61.
26. Schmitt JAJ, Kruizinga MJ, Riedel WJ. Non-sero- tonergic pharmacological profiles and associated cognitive effects of serotonin reuptake inhiibitors. J Psychopharmacol 2001;15:173-9.
27. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62. 28. Akdemir A, Örsel SD, Dağ İ, Türkçapar MH, İşcan N, Özbay H. Hamilton Depresyon Derece- lendirme Ölçeği (HDDÖ)nin geçerliği-güvenirliği ve klinikte kullanımı. 3P 1996;4:251-9.
29. First MB, Robert L, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV axis I disorders (SCID-I). Washington DC: American Psychiatric Press, 1997.
30. Çorapçıoğlu A, Aydemir Ö, Yıldız M, Köroğlu E. DSM-IV Eksen I bozuklukları (SCID-I) için yapılandırılmış klinik görüşme, Klinik versiyon. Ankara: Hekimler Yayın Birliği, 1999.
31. Rey A. L'Examen Clinique en Psychologie. Paris: Press Universitaires de France, 1964.
32. Genç-Açıkgöz D, Karakaş S. AVLT (İSÖT)'nin Türk diline uyarlanmasına ilişkin bir çalışma. IX. Ulusal Psikoloji Kongresi (İstanbul). Türk Psiko- loglar Derneği, Boğaziçi Üniversitesi, 1996.
33. Wechsler D. WMS-R: Wechsler Memory Scale Revised. New York: The Psychological Corpora- tion, Harcourt Brace Jovanovich, 1987.
34. Karakaş S, Kafadar IT. Şizofrenide bilişsel süreç- lerin değerlendirilmesinde nöropsikolojik testler: Bellek ve dikkatin ölçülmesi. Şizofreni Dizini 1999;4:132-52.
35. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-62.
36. Karakaş S, Irak M, Ersezgin ÖU. Wisconsin Kart Eşleme Testi (WCST) ve Stroop Testi TBAG formu puanlarının test içi ve testler-arası ilişkileri. X. Ulusal Psikoloji Kongresi, Özet Kitabı, 1998,s.44.
37. Heaton RK, Chelune GJ, Talley JL Kay GG, Curtis G. Wisconsin Card Sorting Test Manual: Revised and Expanded. Florida: Psycological Assessment Resources, 1993.
38. Benton AL, Hamsher K, Varney NR, Spreen O. Judgement of line orientation. Contributions to Neuropsychological Assessment: A Clinical Man- ual. New York: Oxford University Press, 1983, p.44-54.
39. Karakaş S. BİLNOT Bataryası El Kitabı: Nöro- psikolojik Testler İçin Araştırma ve Geliştirme Çalışmaları. Ankara: Dizayn Ofset, 2004.
40. Özdemir O. Medikal İstatistik. İstanbul: Medikal Yayıncılık, 2005, s.218.
41. Karabekiroğlu A, Topçuoğlu V, Gönentür AG, Karabekiroğlu K. İlk epizod major depresyon ve yineleyici major depresyon grupları arasında yönetici işlev farklılıkları. Türk Psikiyatri Dergisi 2010;21:280-8.
42. Grant M, Thase M, Sweeney J. Cognitive dis- turbance in outpatient depressed younger adults: Evidence of modest impairment. Biol Psychiatry 2001;50:35-43.
43. Alexopoulos GS, Raue PJ, Kanellopoulos D, Mackin S, Arean PS. Problem solving therapy for the depression-executive dysfunction syndrome of late life. Int J Geriatr Psychiatry 2008;23:782-8.
44. Paelecke-Habermann Y, Pohl J, Leplow B. Attention and executive functions in remitted major depression patients. J Affect Disord 2005;89:125-35.
45. Weiland-Fiedler P, Erickson K, Waldeck T, Luckenbaugh DA, Pike D, Bonne O, et al. Evidence for continuing neuropsychological impairments in depression. J Affect Disord 2004;82:253-8.
46. Preiss M, Kucerova FI, Lukavsky J, Stepankova H, Sos P, Kawaciukova R. Cognitive deficits in the euthymic phase of unipolar depression. Psychiatry Res 2009;169:235-9.
47. Trichard C, Martinot JL, Alagille M, Masure MC, Hardy P, Ginestet D, et al. Time course of prefrontal lobe dysfunction in severely depressed inpatients: A longitudinal neuropsychological study. Psychol Med 1995;25:79-85.
48. Biringer E, Lundervold A, Stordal K, Mykletun A, Egeland J, Bottlender R, et al. Executive function improvement upon remission of recurrent unipolar depression. Eur Arch Psychiatry Clin Neurosci 2005;255:373-80.
49. Bhalla RK, Butters MA, Mulsant BH, Begley AE, Zmuda MD, Schoderbek B, et al. Persistence of neuropsychological deficits in the remitted state of late-life depression. Am J Geriatr Psychiatry 2006;14:419-27.
50. Mandelli L, Serretti A, Kolombo C, Florida M, Santoro A, Rossini D, et al. Improvement of cognitive functioning in mood disorder patients with depressive recovery during treatment: An explanatory analysis. Psychiatry Clin Neurosci 2006;60:598-604.
51. Hviid LB, Ravnkilde B, Ahdidan J, Rosenberg R, Stodkilde-Jorgensen H, Videbech P. Hippo- campal visuospatial function and volume in remitted depressed patients: An 8-year follow-up study. J Affect Disord 2010;125:177-83.