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Yıl:2009; Cilt: 20; Sayı: 4>> Özet
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Türk Psikiyatri Dergisi; 2009;20(4):332-338
Bipolar Bozuklukta Öznel Bilişsel Değerlendirme Neyi Ölçüyor? Nesnel Bilişsel Değerlendirme İle Bağıntısı
Ö Aydemir, E Kaya
Celal Bayar Ü Hastanesi, Psikiyatri AD., Manisa
Amaç: Bipolar bozuklukta remisyonda iken bile bilişsel kusurlar sıklıkla saptanmaktadır. Bu kusurların karmaşık ve ayrıntılı testlerle değerlendirilmesi gündelik uygulamada ihmal edilebilmelerine yol açabilmektedir. Oysa daha kısa özbildirim sorularıyla bunları araştırmak yararlı olacaktır. Bu çalışmada bipolar bozuklukta nesnel ve öznel bilişsel değerlendirmenin bağıntısının araştırılması amaçlanmıştır.

Yöntem: Araştırma bipolar bozukluğu olan ve son 6 aydır remisyonda olan 38 hasta ve 19 kontrol deneği ile yürütülmüştür. Öznel bilişsel değerlendirme için Bipolar Bozuklukta İşlevsellik Ölçeğinin zihinsel işlevsellik alt ölçeği, nesnel bilişsel değerlendirme için ise Stroop Testi ve İşitsel Sözel Öğrenme Testi kullanılmıştır. Ayrıca Hamilton Depresyonu Derecelendirme Ölçeği ve Young Mani Derecelendirme Ölçeği uygulanmıştır.

Bulgular: Nesnel değerlendirmede, hastalarla kontrol denekleri tüm İşitsel Sözel Öğrenme Testi alanları açısından anlamlı farklılık gösterirken, Stroop Testi açısından fark göstermemişlerdir. Öznel değerlendirmede ise, yine hastalarla kontrol denekleri zihinsel işlevsellik toplam puanı ile birinci madde açısından anlamlı farklılık gösterirken, diğer maddeler yönünden fark göstermemişlerdir. Nesnel ve öznel bilişsel değerlendirmenin bağıntısına bakıldığında, zihinsel işlevsellik toplam puanı ile ?basit hesapları zihninden yapma? ve ?kendisinden istenilenleri yerine getirme? maddeleri İşitsel sözel öğrenme testinin anlık bellek, sözel öğrenme, tanıma, hatırlama ve Stroop testinin şekil renk okuma alt boyutlarıyla orta-zayıf düzeyde bağıntı göstermektedir. Diğer maddeler ile bağıntı saptanmamıştır.

Sonuç: Öznel bilişsel değerlendirmede bipolar hastalar kendilerini olduğundan iyi göstermektedirler. Ayrıca bipolar hastalar etkin performans göstermeleri gereken durumlarda nesnel bilişsel değerlendirme ile bağıntılı düzeyde kusur bildirirlerken, böylesi bir durum olmadığında bu düzeyde bilişsel kusur bildirmemektedirler.
What Does the Subjective Assessment of Cognitive Functioning Measure in Bipolar Disorder? Correlation with the Objective Assessment of Cognitive Functioning
Objective: Even in remission, cognitive deficits are frequently observed in bipolar disorder. Because these deficits are assessed with complex and comprehensive tests, they seem to be neglected in routine daily practice; however, assessing them with short self-rated questionnaires could be beneficial. This study aimed to investigate the correlation between objective and subjective cognitive assessment in bipolar disorder.

Method: The study included 38 patients with bipolar disorder that were in remission for at least 6 [month]s and 19 healthy controls. The Stroop Test and Auditory Verbal Learning Test were used for the objective assessment of cognitive functioning, and the cognitive functioning subscale of the Bipolar Disorder Functioning Questionnaire was used for the subjective assessment of cognitive functioning. Mood symptoms were assessed using the Hamilton Depression Rating Scale and Young Mania Rating Scale.

Results: Based on objective assessment there were significant differences in all domains of the Auditory Verbal Learning Test between the bipolar patients and healthy controls, whereas there weren't any significant difference in Stroop Test results. Based on subjective assessment there were significant differences between the bipolar patients and healthy controls in terms of cognitive functioning subscale total score and first item score, but not in terms of the other items. When the correlation between the objective and subjective cognitive assessments was investigated, total score of the cognitive functioning subscale and 2 items¾1. to run simple calculations in one's mind and 2. gathering and performing what one is asked to do¾were moderately to weakly correlated with immediate recall, verbal learning, recognition, retrieval, and reading shape color. No correlation was observed between the other items of the cognitive functioning subscale.

Conclusion: Based on subjective assessment of cognitive functioning, the bipolar patients tended to over-estimate themselves. Furthermore, bipolar patients tended to report more deficits correlated with objective cognitive assessment when they had to display active performance, whereas they did not report cognitive deficits at this level when such a condition was not present.

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