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Yıl:2010; Cilt: 47; Sayı: 2>> Özet
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Nöropsikiyatri Arşivi; 2010;47(2):150-157
Bilişsel Bozukluk Açısından Şizofreni ve Bipolar Bozukluk; Benzerlikler ve Farklar, Sistematik Gözden Geçirme
S Çakır, A Üçok
İstanbul Üniversitesi İstanbul Tıp Fakültesi
on yıllarda şizofreni (ŞZ)'de olduğu kadar, bipolar bozukluk(BB)'ta da bilişsel bozukluklarla ilgili bilgi düzeyi artmaktadır. Her iki tanı grubunda aralarında bilişsel bozukluğun da olduğu olası ortak endofenotipler belirlenmesi, kategorik sınıflamanın yetersizliği tartışmalarını arttırmıştır. Bu gözden geçirme yazısında son 10 yılda erişkin ŞZ ve BB hastalarında bilişsel bozukluk düzeylerini karşılaştıran çalışmalar sistematik biçimde incelenmiştir. Toplam 49 çalışmanın ölçütlere uyduğu saptanmış, bunların 42'si orijinal karşılaştırmalı çalışma, 2'si meta-analiz, 3'ü gözden geçirme, 2'si ise eleştiri/öneri yazısı olarak sınıflanmıştır. Araştırma sonuçları ŞZ ve BB hastalarındaki bilişsel bozulmanın nitelik olarak benzediğini, şiddet ve yaygınlık açısından ŞZ hastalarında daha belirgin ve farkın en çok IQ ve sözel öğrenme alanında olduğunu göstermektedir. Fakat bu farklılık her iki grubun ayırıcı tanısını yapacak özgüllük düzeyine erişmemektedir. Yöntem ve örneklem seçimlerinin farklı olması, sonuçların yorumlanmasını güçleştirmekle birlikte, ŞZ ve BB hasta grupları içinde bilişsel bozukluktan farklı etkilenen alt grupların varlığı dikkat çekmektedir. ŞZ için negatif belirtili ya da defisit sendromlu, BB için psikotik belirtili hastalarda bilişsel bozulma daha belirgindir. Bilişsel bozulma gösteren hastalanmamış aile bireylerinin ŞZ'de net, BB'ta ise olası varlığı, bilişsel bozulmanın bir yönü ile genetik geçişi ile ilişkilidir.
Schizophrenia and Bipolar Disorder In Terms of Cognitive Impairments; Similarities and Differences - A Systematic Review
There is growing evidence about cognitive impairments in bipolar disorder (BB) as well as schizophrenia (SZ) in the last [year]s. The identification of probable shared endophenotypes, as cognitive impairment, in these two diagnoses increased the discussions that emphasize the inadequacy of categorical classification. The studies published in the last ten [year]s that investigated the level of cognitive impairments in adult patients with SZ and BB was reviewed systematically. Forty-nine studies met the inclusion criteria and were classified as follows: original comparative research (42), meta-analysis (2), review (3), and comment/discussion (2). The results of studies that implied the cognitive impairment in SZ and BB were qualitatively similar, but more severe and common in patients with SZ, and differed most significantly in IQ and verbal learning. These differences are not specific enough to make differential diagnosis. Despite the difficulties caused by the variety of methods and selection of patient population in interpreting the results, the existence of different subgroups of patients with different level of cognitive impairment in both diagnoses draws the attention.The cognitive impairment is more significant with negative symptoms or deficit syndrome in SZ patients and psychotic symptoms in BB patients. The clear existence of unaffected first degree relatives with cognitive impairment in SZ and probable in BB shows the genetic liability of cognitive impairment.

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