Evaluation and Treatment of Cognitive Dysfunctions in Schizophrenia and Bipolar Disorder

Abstract

Cognitive dysfunction is the most important determinant for the recovery in schizophrenia and bipolar disorder. Cognitive dysfunction serves as an endophenotype although it may be a consequence of drug treatments. In schizophrenia starting from the first episode, pronounced cognitive defects such as cognitive flexibility, inhibition, verbal fluency, verbal memory and visual-motor processing are observable. These cognitive defects remain stable in the chronic phase of schizophrenia. On the other hand, cognitive dysfunctions in bipolar disorder patients have a heterogeneous pattern. One group of patients show no evidence of cognitive dysfunction while one group has limited dysfunction (of processing speed, attention, verbal learning and social cognition) and another one has wide spread dysfunctions as seen in schizophrenia. Despite its importance, no satisfactory results have been achieved in the treatment of cognitive dysfunctions in schizophrenia and bipolar disorder. In this article, the evaluation and treatment of the most frequent cognitive dysfunctions of schizophrenia and bipolar disorder are reviewed.

Keywords

• bipolar disorder
• cognitive dysfunction
• cognitive remediation
• schizophrenia
• cognitive evaluation

Şizofreni ve Bipolar Bozuklukta Bilişsel İşlev Bozukluklarının Değerlendirilmesi ve Tedavisi

Öz

Bilişsel bozukluklar hem şizofreni hem de bipolar bozukluk seyrinde iyileşme ile en yakından etkili hastalık bileşenidir. Bilişsel işlevlerdeki bozulma hem bir endofenotip özelliği göstermekte hem de tedavi sürecine bağlı olarak da ortaya çıkabilmektedir. Şizofrenide ilk ataktan başlayarak bilişsel esneklik, baskılama, sözel akıcılık, sözel bellek ve görsel-motor işleme alanlarında bozulmalar gözlenmekte ve kronik hastalık evresinde bu bulgular değişmemektedir. Öte yandan bipolar bozukluk hastaları ise bilişsel işlevler yönünden birbirinden çok farklı özellikler göstermektedir. Bir grup hastada hiçbir bilişsel bozukluk saptanmazken; diğer bir grupta sınırlı alanlarda (işlem hızı, dikkat, sözel öğrenme ve sosyal biliş) bozukluk gözlenmekte; üçüncü bir grupta ise şizofrenidekine benzer yaygın ve ağır bilişsel bozukluklar izlenmektedir. Bu hastalıklarda oynadığı önemli role karşın bilişsel işlevlerin tedavisinde ne yazık ki istenilen sonuçlara ulaşılamamıştır. Bu gözden geçirme yazısında şizofreni ve bipolar bozuklukta görülen bilişsel işlev bozuklukları ve bunların tanınmasına yönelik testler, bilişsel rehabilitasyon için yapılabilecekler ve henüz gelişme aşamasındaki bilişsel işlev farmakoterapisine yer verilecektir.

Anahtar Kelimeler

• şizofreni
• bipolar bozukluk
• bilişsel onarım
• bilişsel değerlendirme
• bilişsel işlev bozukluğu

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