Neurocognitive Function in the Euthymic Bipolar I Disorders / 신경정신의학

OBJECTIVES: The previous assumption that patients with bipolar I disorder make a full recovery of cognitive function in the euthymic phase has been challenged by studies that suggest neuronal changes, and recently persisting neuropsychological dysfunctions beyond episodes of the illness. The aim of the present study was to investigate the impairment of the neurocognitive performance of euthymic bipolar patients, the characteristics of cognitive impairment, and the relationship between cognitive dysfunction and clinical variables of illness in bipolar population. METHODS: 19 bipolar out-patients who had been euthymic for more than 3 months by Hamilton Depression Scale score below 7 and Young Mania Rating Scale score below 6 were compared with age- and education- matched 19 healthy subjects on neurocognitive tests. Patients showing observable extrapyramidal symptoms were excluded with the objective rating. The following tests were administered in according to cognitive domain: Korean-Wechsler Adult Intelligence Scale, subtests among Wechsler Memory Scale-Revised, Wisconsin Card Sorting Test, and Signal Detection/Decision-Reaction Timer/Psychomotor Performances among Vienna Test System. RESULTS: The bipolar group performed significantly lower than the control group on verbal and performance IQ, total IQ, and psychomotor function or coordination. There was no relationship between the cognitive impairment and clinical course of illness, except duration of neuroleptic exposure. CONCLUSIONS: Although our findings did not replicate the recently reported results, especially in the domain of executive function and verbal memory, they suggested the presence of neurocognitive difficulties, in the general ability and visuomotor function in stable bipolar patients. Also, we tailed to identify the influence of clinical course variables on cognitive area with statistically signficant differences.

Impairment of Neurocognitive Functions in Young Alcohol Dependent Patients: Problem Solving and Executive Functions / 신경정신의학

OBJECTIVES: The decline in general neurocognitive functions of alcoholics has been previously reported, especially in the area of memory, problem-solving and executive function which are important for occupational performance or adaptation to enviroment. On the other hand, young alcoholics under the age of 40 with relatively short duration of problem drinking were reported of no significant decline in neurocognitive functions consisting of memory, problem-solving and executive function. The objective of this study is to investigate whether there is a decline in neurocognitive functions around memory, problem-solving and executive function in abstinent young alcoholics. METHODS: 24 male and female alcohol dependent patients from the age of 19 to 39 years, who were detoxified in the hospotal were recruited as subjects. Normal control group of 20 males and females who matched for age, sex, educational level were selected. Clinical characteristics of the subjects were examined by demographic variables, alcohol history, Beck's Depression Inventory, Michigan Alcohol Screening Test and Standard Progressive Matrices. Also, subtests of Wechsler Memory Scale-Revised, Block design from the Korean-Wechsler Adult Intelligence, Wisconsin Card Sorting Test were performed in order to evaluate the subjects' neurocognitive functions. RESULTS: Compared to normal controls, significant decline in neurocognitive functions such as memory, problem-solving and executive function were observed in young alcohol dependent patients with an average age of 32. Parts of the neuropsychological tests showed significant correlation with duration of lifetime drinking and lifetime alcohol consumption. CONCLUSION: This study shows that, unlike previous reports, decline in memory, problem-solving and executive function occur in young alcoholics as in chronic alcoholics. This implies that young alcoholics can experience difficulty in occupational performance and adaptation to environment, and may be less responsive to treatment due to neurocognitive damage. The results of this study inclicate the importance of early identification, intervention, and planning therapeutic strategies in young alcoholics.