喹硫平及其联合丙戊酸钠治疗双相情感障碍躁狂发作认知功能损害的对照研究  

A comparative study of valproate combined with quetiapine to quetiapine alone in the treatment of cognitive impairment in manic state of bipolar patients

作　　者：王永钦[1] 王学义[1] 安翠霞[1] 姚绍敏[1] 

机构地区：[1]河北医科大学第一医院河北医科大学精神卫生研究所河北省脑老化与认知科学重点实验室,050031

出　　处：《神经疾病与精神卫生》2011年第4期365-368,共4页Journal of Neuroscience and Mental Health

基　　金：河北省科学技术研究与发展计划项目（项目编号09276103D-10）

摘　　要：目的应用神经心理学方法评估双相障碍躁狂发作认知损害特点，并探讨丙戊酸钠对双相躁狂认知损害的治疗作用。方法64例双相躁狂患者随机分为两组：丙戊酸钠联合喹硫平治疗组33例（联合治疗组），单用喹硫平治疗组31例（单药治疗组），两组于治疗前与治疗6周末均给予威斯康星卡片分类测验（WCST）、言语记忆测验（HVLT—R）、持续操作测验（CPT）、杨氏躁狂评定量表（YMRS）、临床总体疗效量表（CGI—S）评定。对照组为30名健康人。结果（1）两个患者组治疗前WCST操作的完成分类数、错误应答数、持续应答数、持续错误数以及HVLT—R、CPT的操作分均低于对照组，差异有统计学意义（P〈0．01），两个患者组间的差异无统计学意义（P〉0．05）。6周治疗后两个治疗组WCST和HVLT—R的操作分仍低于对照组，差异有统计学意义（P〈0．01）。CPT的操作得分三组间差异无统计学意义（P〉0．05）；（2）治疗后与治疗前比较，联合治疗组WCST的完成分类数增加，错误应答数、持续错误数减少，差异有统计学意义（P〈0．01）。单一治疗组的完成分类数增加、错误应答数减少，差异有统计学意义（P〈0．01）。两个治疗组的HVI，T—R操作分与治疗前的差异无统计学意义（P〉0．05）。CPT操作分与治疗前比较明显提高，差异有统计学意义（P〈0．01）。结论双相障碍躁狂发作时存在执行功能、学习和记忆能力、注意力等神经认知领域损害；病情稳定后，执行功能和言语记忆功能损害仍持续存在；6周的丙戊酸钠联合喹硫平或单一喹硫平治疗均能有效地改善双相躁狂患者的部分认知功能。Objective To investigate characteristic of cognitive impairment in the patients with bipolar disorder, and explore effectiveness of valproate and quetiapine on cognitive impairment in manic state of bipolar patients. Methods Wisconsin Card Sorting Test （WCST） ,Verbal Memory Test （HVLT -R）, Continuous Performance Test （CPT）, Young Mania Rating Scale （YMRS）, Clinical Global Impression of Severity of Illness（CGI--SI） were used to assess 64 patients with bipolar mania at pre-and post treatment（6 weeks）. Valproate combined with quetiapine group （combined group） had 33 patients and quetihpine monotherapy group （monotherapy group） had 31 patients, normal control group had 30 healthy volunteers. Results （1） The performance of categories completed, responses error, preservative responses, preservative errors of WCST and performance of HVLT- R and CPT in the two patient groups were poorer than that in normal control at pre- treatment,the difference was statistically significant （P〈 0.01）. The difference was not significant between the two patient groups （P 〉 0.05）. Performance of HVLT-R and WCST in the two patient groups remained poorer than that of the control group at post-- treatment,the difference was statistically significant （P 〈 0.01）. The performance of CPT showed no significant difference among the three groups （P 〈 0.05）. （2）Compared with pre--treatment, numbers of categories completed of WCST in combined group was increased,number of responses error and number of preservative errors of WCST in combined group were reduced at post-- treatment, the difference was statistically significant （P 〈 0.01）. The number of completed categories in monotherapy group was increased,number of responses error was reduced, the differences were statistically significant （P 〈0. 0l）. Compared with pre--treatment, scores of HVLT--R in two patient groups showed no significant difference at post-- treatment （P 〈 0.05）, but scores of CPT in both patient gr

关 键 词：双相情感障碍 神经心理学测验 躁狂 认知功能损害 丙戊酸钠 喹硫平 

分 类 号：R749.4[医药卫生—神经病学与精神病学]