Универзитет у Крагујевцу, Факултет медицинских наука
Abstract
Procena socijalne kognicije i neurokognicije u neurorazvojnim bolestima i endogenim psihozama je od fundamentalnog značaja u rasvetljavanju kognitivnih i bioloških osnova bolesti.
Istraživanje ima za cilj poređenje neurokognitivnih i sociokognitivnih performansi bolesnika sa shizofrenojom i bipolarnim afektivnim poremećajem, markiranje interkorelacije psihopatologije i stepena kognitivnog oštećenja, kao i ispitivanje uticaja kognitivnih deficita na funkcionalni ishod.
Istraživanje je dizajnirano kao neinterventna komparativna klinička studija preseka, koja je uključila bolesnike sa shizofrenijom (30) i bipolarnim afektivnim poremećajem (31) i zdrave kontrole (31) odgovarajućeg uzrasta i pola. Shizofreni bolesnici procenjivani su primenom Skale pozitivnih i negativnih simptoma. U grupi bolesnika sa bipolarnim poremećajem primenjena je Jangova skala manije i Hamiltonova skala depresije. Kod sve tri grupe ispitanika procenjivan je neurokognitivni status upotrebom Mini Mental State Examination, Go/No-Go testa i Trail Making testa B. Sociokognitivni status procenjivan je primenom Foux Pas Test i Reading the Mind in the Eyes Test. Testovi socijalne kognicije su prevedeni i adaptirani za srpsku populaciju u okviru validacione strudije koja je obuhvatila ukupno 336 ispitanika, kako iz opšte tako i iz kliničke populacije. Poddomeni funkcionalnog ishoda procenjivani su primenom upitnika Svetske zdravstvene organizacije o kvalitetu života i skale globalnog funkcionisanja.
Rezultati istraživanja pokazuju da bolesnici za shizofrenijom i bipolarnim afektivnim poremećajem imaju kognitivne deficite i tokom perioda remisije osnovne bolesti. Stepen neurokognitivnog deficita je veći u grupi shizofrenih bolesnika. Subklinička patologija pokazalo se ima značajan uticaj na kognitivne performanse. Funkcionalni ishod i kvalitet života u obe ispitivane grupe korelišu sa kognitivnim postignućima. Adaptacije testova socijalne kognicije na srpskom jeziku imaju dobru pouzdanost.
Homogenost neuropsihološkog profila deficita koja koreliše sa klinički heterogenim prezentacijama ukazuje za zajedničku neuropsihološku osnovu ovih deficita, što implicira sličnost neurobioloških korelata ova dva entiteta. Uticaj kognitivnih deficita na funkcionalni ishod i kvalitet života impilicira potrebu uvođenja neuropsihološke rehabilitacije radi poboljšanja ishoda lečenja.The assessment of social cognitive and neurocognitive disorders in neurodevelopmental diseases and endogenous psychoses tends to be fundamental to elucidating both the cognitive and the biological basis of the specific disease.
The aim of this study is to compare the neurocognitive and the social cognitive performance exhibited by schizophrenia patients and bipolar affective disorder patients, analyze the inter-correlation structure between psychopathology and the degree of cognitive impairment, and examine the impact of cognitive deficits on the functional outcome.
The study was designed as a non-interventional comparative cross-sectional clinical study comprising schizophrenia patients (30), bipolar affective disorder patients (31) and 31 age/gender-matched healthy controls. Schizophrenic patients were assessed using the Positive and Negative Syndrome Scale (PANSS). In the group involving bipolar affective disorder patients, the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were applied. In each of the three groups of subjects, the neurocognitive status was evaluated using the MMSE: Mini-Mental State Examination, the Go / No-Go Test and the TMT-B Trail Making Test. The social cognitive status was evaluated using the Faux Pas Test and the Reading the Mind in the Eyes Test. The respective social cognitive tests were translated and adapted for the Serbian population within the scope of the validation study which included a total of 336 subjects, from both general and clinical population. Sub-domains of functional outcomes were assessed using the World Health Organization's Questionnaire on the Quality of Life (WHOQOL) and the Global Assessment of Functioning (GAF) Scale applied accordingly.
The results of the present study demonstrate that patients suffering from both schizophrenia and bipolar affective disorder tend to exhibit cognitive deficits during the underlying disease remission period. The degree of neurocognitive deficit appears to be higher in the group comprising schizophrenic patients. Subclinical pathology has been shown to have a significant impact on cognitive performance. Functional outcome and quality of life in both groups examined appear to be correlating with cognitive achievements. Serbian-adapted versions of social cognitive tests seem to have high degree of reliability.
The homogeneity of the neuropsychological deficit profile correlating with clinically heterogeneous presentations, indicates that these deficits share a common neuropsychological
basis, which further implies an underlying similarity consistent across the neurobiological correlates of these two entities. The impact of cognitive deficits on functional outcome and quality of life suggests the necessity of a neuropsychological rehabilitation introduced for the sake of improving the overall outcome of treatment
