Özlem Devrim BALABAN, Murat İlhan ATAGÜN, Halise DEVRİMCİ-ÖZGÜVEN

Information Processing Abnormalities in Schizophrenia and Bipolar Disorder

Objective: Patients with bipolar disorder and schizophrenia exhibit abnormalities in attention, memory, working memory, verbal/visual learning and executive functions. However, many of the tests fail to detect slight changes in cognitive performance due to ceiling effect. It was aimed to determine sensitivity and specificity of the tests that measure information processing in schizophrenia and bipolar disorder in this study. Method: Thirty four patients with schizophrenia, 35 patients with bipolar disorder according to DSM-IV and 33 healthy control subjects matched for age, education level and gender were enrolled to the study. For clinical assessments Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Hamilton Depression Rating Scale, Young Mania Rating Scale, Clinical Global Impression Scale and Abnormal Involuntary Movements Scale were used. All participants performed a battery consisting of tests measuring information processing including Adult Memory and Information Processing Battery (AMIPB), Trail Making Test (TMT) Form A and B, Digit Symbol Coding Task (DST) and Auditory and Visual Reaction Time Tests (RTT). Results: The schizophrenia group had significantly lower performance than the healthy control group in all tests and lower performance than the bipolar disorder group in AMIPB- A and B tests, TMT A and B tests. The bipolar disorder group had lower performance than the healthy control group only in DST test. The AMIPB A and B tests were the most sensitive and specific tests in the ROC analysis. Conclusion: Changes in cognitive function might be better monitored by the tests whose sensitivity and specificity are higher. Since psychiatric disorders are highly heterogeneous, measurement tools are important for precise measurements.

Şizofrenide ve bipolar bozuklukta bilgi işleme bozuklukları

Amaç: Şizofreni ve bipolar bozuklukta bellek, dikkat, çalışma belleği, sözel/görsel öğrenme ve yürütücü işlevler gibi birçok alanda bilişsel işlev bozuklukları görülebilmektedir. Ancak bu işlevlerin değerlendirildiği testlerde tavan etkisi nedeniyle hafif farklar ayırt edilememekte, bulgu tespit edilememektedir. Bu çalışmada şizofrenide ve bipolar bozuklukta bilgi işlemeyle ilgili değerlendirme yapan testlerin özgüllük ve duyarlılıklarının incelenmesi amaçlanmıştır. Yöntem: Çalışmaya, yaş, eğitim durumu ve cinsiyet açısından benzer, DSM-IV ölçütlerine göre şizofreni tanısı olan 34 ve bipolar bozukluk tanısı olan 35 hasta ile 33 sağlıklı kontrol dahil edilmiştir. Klinik değerlendirme açısından Pozitif Semptomları Değerlendirme Ölçeği, Negatif Semptomları Değerlendirme Ölçeği, Hamilton Depresyon Derecelendirme Ölçeği, Young Mani Derecelendirme Ölçeği, Klinik Global İzlem Ölçeği, Anormal İstemsiz Hareketler Ölçeği kullanılmıştır. Tüm katılımcılara Yetişkin Bellek ve Bilgi İşleme Bataryası (Adult Memory and Information Processing Battery -AMIPB) Form A ve B, İz Sürme Testi (Trail Making Test- TMT) A ve B, Sayı Sembol Kodlama Testi (Digit Symbol Coding Task- DST) ve Reaksiyon Zamanı Testi (Reaction Time Test-RTT) İşitsel ve Görsel Alt-testlerinden oluşan bir batarya uygulanmıştır. Bulgular: Şizofreni grubu tüm testlerde kontrol grubundan, yine AMIPB A ve B, TMT A ve B testlerinde bipolar bozukluk grubundan anlamlı derecede daha kötü performans sergilemiştir. Bipolar bozukluk grubuysa sadece DST’de kontrol grubuna göre anlamlı olarak daha kötü performans sergilemiştir. ROC analizinde duyarlılığı en yüksek olan testler AMIPB-A ve AMIPB-B çıkmıştır. Sonuç: Duyarlılığı ve özgüllüğü yüksek testler bilişsel işlevlerdeki değişikliklerin daha hassas biçimde ölçülebilmesi açısından avantajlıdırlar. Psikiyatrik hastalıklar oldukça heterojen olduklarından ölçüm araçlarının daha hassas olmaları yararlı olabilir.

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