Bipolar bozuklukta tanısız geçen hastalık süresinin klinik özelikler ve bilişsel bozulmayla ilişkisi

Abstract

Amaç: Bipolar bozuklukta tanıda gecikmenin klinik seyir ve sonlanım üzerine olumsuz etkileri olabileceği düşünülmektedir. Çalışmamızda tanıda gecikme ile klinik değişkenler ve nöro/sosyal bilişsel bozukluklar arasındaki ilişkinin araştırılması amaçlanmıştır. Gereç ve yöntem: Bipolar bozukluk tanılı remisyonda 84 hasta çalışmaya alındı. Katılımcılar sözel bellek/öğrenme, görsel bellek/öğrenme, sözel akıcılık, dikkat, işlem hızı, yürütücü işlevler, çalışma belleği ve sosyal biliş alanlarında değerlendirme imkanı veren nöropsikolojik bir batarya ile değerlendirildi. Bulgular: Tanısız geçen sürenin bipolar- II bozukluk tanılı hastalarda, yaşam boyu psikotik özellik göstermemiş hastalarda, yaşam boyu en az bir defa intihar girişiminde bulunmuş hastalarda, ilk epizodu depresif epizod olan hastalarda ve halihazırda tedavilerinde antidepresan bulunan hastalarda daha uzun olduğu bulundu. Tanısız geçen hastalık süresi ile Kontrollü Kelime Akıcılık Testi, toplam epizod sayısı, hipomanik epizod sayısı, depresif epizod sayısı, toplam epizod süresi, hipomanik epizod süresi ve depresif epizod süresi arasında anlamlı düzeyde pozitif yönde ilişki; manik epizod sayısı ve manik epizod süresi arasında ise anlamlı düzeyde negatif yönde ilişki saptanmıştır. Sonuç: Tanıda ve tedavide gecikmenin bipolar bozuklukta daha sık nüksle, daha sık depresif epizodla ve yaşamı boyunca en az bir defa intihar girişiminde bulunmuş olmakla ilişkili olduğunu bulduk. Tanısız geçen sürenin uzunluğu ile klinik seyir ve işlevsellik açısından kötü sonlanım arasındaki ilişkiye bilişsel bozulma eşlik etmemektedir.

Keywords

• Bipolar bozukluk
• gecikmeli tanı
• nörobilişsel bozukluklar
• sosyal zeka

Relationship between duration of undiagnosed illness, clinical features and cognitive impairment in bipolar disorder

Abstract

Purpose: It is believed that a delay in the diagnosis of bipolar disorder may adversely affect the clinical course and outcome. This study aimed to investigate the relationship between diagnostic delay and clinical variables, as well as neurocognitive and social cognitive disorders. Materials and methods: Eighty-four patients with bipolar disorder in remission were included in the study. Participants were evaluated using a neuropsychological battery that assessed verbal memory and learning, visual memory and learning, verbal fluency, attention, processing speed, executive functions, working memory, and social cognition. Results: The duration of undiagnosed illness was longer in patients with bipolar II disorder, those without psychotic features, those with at least one suicide attempt, those whose first episode was depressive, and those currently on antidepressants. A significant positive correlation was found between the duration of undiagnosed illness and scores on the Controlled Oral Word Association Test, total number of episodes, hypomanic episodes, depressive episodes, and their respective durations. Conversely, a significant negative correlation was found between the duration of undiagnosed illness and both the number and duration of manic episodes. Conclusion: We found that a delay in diagnosis and treatment was associated with more recurrences in bipolar disorder, an increased number of depressive episodes, and at least one lifetime suicide attempt. However, the association between extended periods of untreated illness and poor clinical and functional outcomes did not align with cognitive impairment.

Keywords

• Bipolar disorder
• delayed diagnosis
• neurocognitive disorders
• social intelligence

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