Zusammenfassung
Dieser Artikel beschäftigt sich mit den Erkenntnissen, die neuropsychologische Forschungsstudien für das Verständnis der Psychopathologie bipolarer affektiver Erkrankungen erbracht haben. Im ersten Teil des Artikels wird das breite Spektrum bipolarer Störungen skizziert. Anschließend folgt eine selektive Übersicht über die wichtigsten neuropsychologischen Untersuchungsergebnisse bei bipolaren Störungen. Auch wenn bislang erst ein sehr grobes Bild über psychopathologische Mechanismen bipolarer Störungen gewonnen werden konnte, zeichnet sich ab, dass Patienten mit bipolaren Störungen spezifische Defizite im Bereich der Aufmerksamkeit, des Gedächtnisses und der exekutiven Funktionen aufweisen. Es zeigt sich weiter, dass neuropsychologische Störungen auch in euthymen Phasen vorhanden sind, die das psychosoziale Funktionsniveau der Patienten im Alltag beeinträchtigen können. Abschließend werden die neuropsychologischen Befunde im Hinblick auf Diagnostik, Behandlung und Prognose diskutiert.
Abstract
In this article the contribution of neuropsychological research for a better understanding of the psychopathology of mood disorders is reviewed. First, the broad spectrum of bipolar disorders is described. Second, a selective review of important results of neuropsychological studies with patients with mood disorders is presented. Although several methodological problems limit the interpretation of the findings, there is evidence that patients with a bipolar disorder show a consistent impairment in attention, memory/learning and executive functions. The cognitive deficits are still visible during clinical recovery (euthymia) and closely associated with psychosocial limitation in daily life. Finally, the impact of neuropsychological findings is considered in relation to assessment, treatment and prognosis.
Literatur
-
1
Angst J.
The emerging epidemiology of hypomania and bipolar II disorder.
Journal of Affective Disorders.
1998;
50
143-151
-
2
Judd L L, Akiskal H S.
The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases.
Journal of Affective Disorders.
2003b;
73
123-131
-
3
Leboyer M, Henry C, Paillere-Martinot M-L, Bellivier F.
Age at onset in bipolar affective disorders: a review.
Bipolar Disorders.
2005;
7
111-118
-
4 Goodwin F K, Jamison K R. Manic-depressive illness. New York, Oxford; Oxford University Press 1990
-
5
Keck Jr P E, McElroy S L, Strakowski S M, West S A, Sax K W, Hawkins J M, Bourne M L, Haggard P.
12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode.
Am J Psychiatry.
1998;
155
646-652
-
6
Keller M B, Lavori P W, Coryell W, Endicott J, Mueller T I.
Bipolar I: A five-year prospective follow-up.
Journal of Nervous and Mental Disease.
1993;
181
238-245
-
7
Goldberg J F, Garno J L, Portera L, Leon A C, Kocsis J H, Whiteside J E.
Correlates of suicidal ideation in dysphoric mania.
Journal of Affective Disorders.
1999;
56
75-81
-
8
Faedda G L, Baldessarini R J, Glovinsky I R, Austin N B.
Pediatric bipolar disorder: phenomenology and course of illness.
Bipolar Disorders.
2004;
6
305-313
-
9
Mitchell P B, Malhi G S.
Bipolar depression: phenomenological overview and clinical characteristics.
Bipolar Disorders.
2004;
6
530-539
-
10
Judd L L, Akiskal H S, Schettler P J, Coryell W, Maser J, Rice J A, Solomon D A, Keller M B.
The comparative clinical phenotype and long-term longitudinal episode course of bipolar I and II: a clinical spectrum or distinct disorders?.
Journal of Affective Disorders.
2003a;
73
19-32
-
11
Mackin P, Young A H.
Rapid cycling bipolar disorder: historical overview and focus on emerging treatments.
Bipolar Disorders.
2004;
6
523-529
-
12
Rihmer Z, Kiss K.
Bipolar disorders and suicide behaviour.
Bipolar Disorders.
2002;
4
21-25
-
13
McElroy S L, Altshuler L L, Suppes T, Keck Jr P E, Frye M A, Denicoff K D, Nolen W A, Kupka R W, Leverich G S, Rochussen J R, Rush A J, Post R M.
Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder.
Am J Psychiatry.
2001;
158
420-426
-
14
Chengappa K NR, Levine J, Gershon S, Kupfer D J.
Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry.
Bipolar Disorders.
2000;
2
191-195
-
15
Simon N M, Smoller J W, Fava M, Sachs G, Racette S R, Perlis R, Sonawalla S, Rosenbaum J F.
Comparing anxiety disorders and anxiety-related traits in bipolar disorder and unipolar depression.
Journal of Psychiatric Research.
2003;
37
187-192
-
16
Mc EIroy S L, Kotwal R, Keck P E, Akiskal H S.
Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations?.
Journal of Affective Disorders.
2005;
86
107-127
-
17
Nierenberg A A, Miyahara S, Spencer T, Wisniewski S R, Otto M W, Simon N, Pollack M H, Ostaccher M J, Yan L, Siegel R, Sachs G S.
Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: Data from the First 1000 STEP-BD participants.
Biol Psychiatry.
2005;
57
1467-1473
-
18
Schiavone P, Dorz S, Confort D, Scarso C, Borgherini G.
Comorbidity of DSM-IV personality disorders in unipolar and bipolar affective disorders: A comparative study.
Psychological Reports.
2004;
95
121-128
-
19
Brieger P, Ehrt U, Marneros A.
Frequency of comorbid personality disorders in bipolar and unipolar affective disorders.
Comprehensive Psychiatry.
2003;
44
28-34
-
20
Calabrese J R, Hirschfeld R M, Reed M, Davies M A, Frye M A, Keck P E, Lewis L, McElroy S L, McNulty J P, Wagner K D.
Impact of bipolar disorder on a U. S. community sample.
J Clin Psychiatry.
2003;
64
425-432
-
21
Fagiolini A, Kupfer D J, Masalehdan A, Scott J A, Houck P R, Frank E.
Functional impairment in the remission phase of bipolar disorder.
Bipolar Disorders.
2005;
7
281-285
-
22
Sierra P, Livianos L, Rojo L.
Quality of life for patients with bipolar disorder: relationship with clinical and demographic variables.
Bipolar Disorders.
2005;
7
159-165
-
23
Kusznir A, Scott E, Cooke R G, Young L T.
Functional consequences of bipolar affective disorder: An occupational therapy perspective.
Canadian Journal of Occupational Therapy.
1996;
63
313-322
-
24
Flor-Henry P.
Neuropsychology and psychopathology: a progress report.
Neuropsychol Rev.
1990;
1
103-123
-
25 Lautenbacher S, Gauggel S (Hrsg). Neuropsychologie psychischer Störungen 2003. Berlin; Springer 2003
-
26
Halligan P W, David A S.
Cognitive neuropsychiatry: towards a scientific psychopathology.
Nat Rev Neurosci.
2001;
2
209-215
-
27
Glahn D C, Bearden C E, Niendam T A, Escamilla M A.
The feasibility of neuropsychological endophenotypes in the search for genes associated with bipolar affective disorder.
Bipolar Disorders.
2004;
6
171-182
-
28
Ferrier I N, Chowdhury R, Thompson J M, Watson S, Young A H.
Neurocognitive function in unaffected first-degree relatives of patients with bipolar disorder: a preliminary report.
Bipolar Disorders.
2004;
6
319-322
-
29
Silverstein M L, Harrow M, Bryson G J.
Neuropsychological prognosis and clinical recovery.
Psychiatry Res.
1994;
52
265-272
-
30 Frith C D. The cognitive neuropsychology of schizophrenia. Hove; Erlbaum 1992
-
31
Keefe R S.
The contribution of neuropsychology to psychiatry.
Am J Psychiatry.
1995;
152
6-15
-
32
Ferrier I N, Thompson J M.
Cognitive impairment in bipolar affective disorder: implications for the bipolar diathesis.
Br J Psychiatry.
2002;
180
293-295
-
33
Krüger T, Schönhoff M, Dettling M.
Neurokognition, psychosozialer Outcome und berufliche Integration.
Psychiat Prax.
2004;
31, S2
224-229
-
34
Brand M, Markowitsch H J.
Neurokognition psychiatrischer Patienten.
Psychiat Prax.
2004;
31, S2
200-209
-
35
Martínez-Arán A, Vieta E, Colom F, Reinares M, Benabarre A, Gastó C, Salamero M.
Cognitive dysfunctions in bipolar disorder: evidence of neuropsychological disturbances.
Psychother Psychosom.
2000;
69
2-18
-
36
Martínez-Arán A, Vieta E, Reinares M, Colom F, Torrent C, Sánchez-Moreno J, Benabarre A, Goikolea J M, Comes M, Salamero M.
Cognitive function across manic or hypomanic, depressied, and euthymic states in bipolar disorders.
Am J Psychiatry.
2004;
161
262-270
-
37
Quraishi S, Frangou S.
Neuropsychology of bipolar disorder: a review.
Journal of Affective Disorders.
2002;
72
209-226
-
38
Malhi G S, Ivanovski B, Szekeres V.
Bipolar disorder: It's all in your mind? The neuropsychological profile of a biological disorder.
Canadian Journal of Psychiatry.
2004;
49
813-819
-
39
Clark L, Iversen S D, Goodwin G M.
A neuropsychological investigation of prefrontal cortex involvement in acute mania.
Am J Psychiatry.
2001;
158
1605-1611
-
40
Deckersbach T, Savage C R, Dougherty D D, Darin D, Bohne A, Loh R, Nierenberg A, Sachs G, Rauch S L.
Spontaneous and directed application of verbal learning strategies in bipolar disorder and obsessive-compulsive disorder.
Bipolar Disorders.
2005;
7
166-175
-
41
Bearden C E, Hoffman K M, Cannon T D.
The neuropsychology and neuroanatomy of bipolar affective disorder: A critical review.
Bipolar Disord.
2001;
3
106-150
-
42
Martínez-Arán A, Vieta E, Colom F, Reinares M, Benabarre A, Torrent C, Goikolea J M, Corbella B, Sánchez-Moreno J, Salamero M.
Neuropsychological performance in depressed and euthymic bipolar patients.
Neuropsychobiology.
2002;
46
16-21
-
43
Ferrier I N, Stanton B R, Kelly T P, Scott J.
Neuropsychological function in euthymic patients with bipolar disorder.
Br J Psychiatry.
1999;
175
246-251
-
44
Kessing L V.
Cognitive impairment in the euthymic phase of affective disorder.
Psychol Med.
1998;
28
1027-1038
-
45
McKay A P, Tarbuck A F, Shapleske J, McKenna P J.
Neuropsychological function in manic-depressive psychosis. Evidence for persistent deficits in patients with chronic, severe illness.
Br J Psychiatry.
1995;
167
51-57
-
46
Rossi A, Arduini L, Daneluzzo E, Bustini M, Prosperini P, Stratta P.
Cognitive function in euthymic bipolar patients, stabilized schizophrenic patients, and healthy controls.
J Psychiatr Res.
2000;
34
333-339
-
47
Rubinsztein J S, Michael A, Paykel E S, Sahakian B J.
Cognitive impairment in remission in bipolar affective disorder.
Psychol Med.
2000;
30
1025-1036
-
48
Tham A, Engelbrektson K, Mathe A A, Johnson L, Olsson E, Aberg-Wistedt A.
Impaired neuropsychological performance in euthymic patients with recurring mood disorders.
J Clin Psychiatry.
1997;
58
26-29
-
49
Zubieta J K, Huguelet P, O'Neil R L, Giordani B J.
Cognitive function in euthymic bipolar I disorder.
Psychiatry Res.
2001;
102
9-20
-
50
Martínez-Arán A, Vieta E, Colom F, Torrent C, Sánchez-Moreno J, Reinares M, Benabarre A, Goikolea J M, Brugué E, Daban C, Salamero M.
Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome.
Bipolar Disorders.
2004;
6
224-232
-
51
Clark L, Iversen S D, Goodwin G M.
Sustained attention deficit in bipolar disorder.
Br J Psychiatry.
2002;
180
313-319
-
52
Cavanagh J TO, Beck M van, Muir W, Blackwood D HR.
Case-control study of neurocognitive function in euthymic patients with bipolar disorder: an association with mania.
Br J Psychiatry.
2002;
180
320-326
-
53
Sapin L R, Berrettini W H, Nurnberger J I, Rothblat L A.
Mediational factors underlying cognitive changes and laterality in affective illness.
Biol Psychiatry.
1987;
22
979-986
-
54
Liu S K, Chiu C H, Chang C J, Hwang T J, Hwu H G, Chen W J.
Deficits in sustained attention in schizophrenia and affective disorders: stable versus state-dependent markers.
Am J Psychiatry.
2002;
159
975-982
-
55
Martínez-Arán A, Penadés R, Vieta E, Colom F, Reinares M, Benabarre A, Salamero M, Gastó C.
Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome.
Psychotherapy and Psychosomatics.
2002;
71
39-46
-
56
Balanzá-Martínez V, Tabarés-Seisdedos R, Selva-Vera G, Martínez-Arán A, Torrent C, Salazar-Fraile J, Leal-Cercós C, Vieta E, Gómez-Beneyto M.
Persistent cognitive dysfunctions in bipolar I disorder and schizophrenic patients: A 3-year follow-up study.
Psychotherapy and Psychosomatics.
2005;
74
113-119
-
57
Basso M R, Lowery N, Neel J, Purdie R, Bornstein R A.
Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder.
Neuropsychology.
2002;
16
84-91
-
58
Dixon T, Kravariti E, Frith C, Murray R M, McGuire P K.
Effect of symptoms on executive function in bipolar illness.
Psychological Medicine.
2004;
34
811-821
-
59 Gruber S, Rathgeber K, Bräunig P, Gauggel S. Stability and course of neuropsychological deficits in patients with affective disorders. In Vorb
-
60
Wolfe J, Granholm E, Butters N, Saunders E, Janowski D.
Verbal memory deficits associated with major affective disorders: A comparison of unipolar and bipolar patients.
J Affective Disord.
1987;
13
83-92
-
61
Borkowska A, Rybakowski J K.
Neuropsychological frontal lobe tests indicate that bipolar depressed patients are more impaired than unipolar.
Bipolar Disord.
2001;
3
88-94
-
62
Dickerson F, Boronow J J, Stallings C, Origoni A E, Cole S K, Yolken R H.
Cognitive functioning in schizophrenia and bipolar disorder: comparison of performance on the Repeatable Battery for the Assessment of Neuropsychological Status.
Psychiatry Research.
2004;
129
45-53
-
63
Sweeney J A, Kmiec J A, Kupfer D J.
Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery.
Biol Psychiatry.
2000;
48
674-684
-
64
Goldberg T E, Gold J M, Greenberg R, Griffin S, Schulz S C, Pickar D, Kleinman J E, Weinberger D R.
Contrasts between patients with affective disorders and patients with schizophrenia on a neuropsychological test battery.
Am J Psychiatry.
1993;
150
1355-1362
-
65
Albus M, Hubmann W, Wahlheim C, Sobizack N, Franz V, Mohr F.
Contrasts in neuropsychological test profile between patients with first-episode schizophrenia and first-episode affective disorders.
Acta Psychiatr Scand.
1996;
94
87-93
-
66
Cavanagh J TO, Beck M van, Muir W, Blackwood D HR.
Case-control study of neurocognitive function in euthymic patients with bipolar disorder: an association with mania.
Br J Psychiatry.
2002;
180
320-326
-
67
Denicoff K D, Ali S O, Mirsky A F, Smith-Jackson E E, Leverich G S, Duncan C C, Connell E G, Post R M.
Relationship between prior course of illness and neuropsychological functioning in patients with bipolar disorder.
J Affect Disord.
1999;
56
67-73
-
68
Burt T, Prudic J, Peyser S, Clark J, Sackeim H A.
Learning and memory in bipolar and unipolar major depression: effects of aging.
Neuropsychiatry Neuropsychol Behav Neurol.
2000;
13 (4)
246-253
-
69
Fossati P, Coyette F, Ergis A M, Allilaire J F.
Influence of age and executive functioning on verbal memory of inpatients with depression.
J Affect Disord.
2002;
68
261-271
-
70
Rieger M, Gauggel S, Burmeister K.
Inhibition of ongoing responses following frontal, nonfrontal, and basal ganglia lesions.
Neuropsychology.
2003;
17
272-282
-
71
Marvel C L, Paradiso S.
Cognitive and neurological impairment in mood disorders.
Psychiatr Clin North Am.
2004;
27
19-36
-
72
Coffman J A, Bornstein R A, Olson S C, Schwarzkopf S B, Nasrallah H A.
Cognitive impairment and cerebral structure by MRI in bipolar disorder.
Biol Psychiatry.
1990;
27
1188-1196
-
73
Videbech P.
MRI findings in patients with affective disorder: a meta-analysis.
Acta Psychiatr Scand.
1997;
96
157-168
-
74
Adler C M, Holland S K, Schmithorst V, Wilke M, Weiss K L, Pan H, Strakowski S M.
Abnormal frontal white matter tracts in bipolar disorder: a diffusion tensor imaging study.
Bipolar Disorders.
2004;
6
197-203
-
75
Silverstone T, McPherson H, Li Q, Doyle T.
Deep white matter hyperintensities in patients with bipolar depression, unipolar depression and age-matched control subjects.
Bipolar Disorders.
2004;
5
53-57
-
76
Ferrier I N, Chowdhury R, Thompson J M, Watson S, Young A H.
Neurocognitive function in unaffected first-degree relatives of patients with bipolar disorder: a preliminary report.
Bipolar Disorders.
2004;
6
319-322
-
77
Swann A C, Dougherty D M, Pazzaglia P J, Pham M, Moeller F G.
Impulsivity: a link between bipolar disorder and substance abuse.
Bipolar Disorders.
2004;
6
204-212
-
78
Katzow J J, Hsu D J, Ghaemi S n.
The bipolar spectrum: a clinical perspective.
Bipolar Disorders.
2003;
5
436-442
-
79
Kent L, Craddock N.
Is there a relationship between attention deficit hyperactivity disorder and bipolar disorder?.
Journal of Affective Disorders.
2003;
73
211-221
-
80
Hervey A S, Epstein J N, Curry J F.
Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review.
Neuropsychology.
2004;
18
485-503
-
81
Hajek T, Slaney C, Garnham J, Ruzickova M, Passmore M, Alda M.
Clinical correlates of current level of functioning in primary care-treated bipolar patients.
Bipolar Disorders.
2005;
7
286-291
-
82
Lakshmi N Y, Lecrubier Y, Fieve R R, Davis K H, Harris S D, Krishnan A A.
Quality of life in patients with bipolar I depresssion: data from 920 patients.
Bipolar Disorders.
2004;
6
379-385
-
83
Brieger P, Röttig S, Marneros A.
Lebensqualität bei unipolar depressiven und bipolar affektiven Patienten.
Psychiat Prax.
2004;
31
304-309
-
84
Scott J, Gutierrez M J.
The current status of psychological treatments in bipolar disorders: a systematic review of relapse prevention.
Bipolar Disorders.
2004;
6
498-503
-
85
Colom F, Vieta E.
A perspective on the use of psychoeducation, cognitive-behavioral therapy and interpersonal therapy for bipolar patients.
Bipolar Disorders.
2004;
6
480-489
-
86
Colom F, Vieta E, Martínez-Arán A. et al .
A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission.
Arch Gen Psychiatry.
2003;
60
402-407
-
87
Gauggel S.
Grundlagen und Empirie der Neuropsychologischen Therapie: Hirnjogging oder Neuropsychotherapie?.
Zeitschrift für Neuropsychologie.
2003;
14
217-246
-
88 Roder V, Brenner H D, Kienzle N. Integriertes Psychologisches Therapieprogramm bei schizophren Erkrankten, IPT. 5. Aufl. Weinheim; Beltz 2002
-
89
Dickerson F B, Sommerville J, Origoni A E, Ringel N B, Parente F.
Outpatients with schizophrenia and bipolar I disorder: Do they differ in their cognitive and social functioning?.
Psychiatry Research.
2001;
102
21-27
-
90
Silverstein M L, Harrow M, Mavrolefteros G, Close D.
Neuropsychological dysfunction and clinical outcome in psychiatric disorders: a two-year follow-up study.
J Nerv Ment Dis.
1997;
185
722-729
-
91
Brieger P, Blöink R, Röttig S, Marneros A.
Die vorzeitige Berentung von unipolar depressiv und bipolar affektiv Erkrankten.
Psychiat Prax.
2004;
31
203-206
-
92 Murray C JL, Lopez A D. WHO. Global Health Statistics: a compendium of incidence, prevalence and mortality estimates for over 200 conditions (global burden of disease and injury). Cambridge, Ma; Harvard University Press 1996
-
93
Runge C, Grunze H.
Jährliche Krankheitskosten bipolarer Störungen in Deutschland.
Nervenarzt.
2004;
75
896-903
-
94
Dupont R M, Jernigan T L, Butters N, Delis D, Hesselink J R, Heindel W, Gillin J C.
Subcortical abnormalities detected in bipolar affective disorder using magnetic resonance imaging. Clinical and neuropsychological significance.
Arch Gen Psychiatry.
1990;
47
55-59
-
95
Strakowski S M, Woods B T, Tohen M, Wilson D R, Douglass A W, Stoll A L.
MRI subcortical signal hyperintensities in mania at first hospitalization.
Biol Psychiatry.
1993;
33
204-206
-
96
Fossati P, Harvey P-O, Bastard G Le, Ergis A-M, Jouvent R, Allilaire J-F.
Verbal memory performance of patients with a first depressive episode and patients with unipolar and bipolar recurrent depression.
Journal of Psychiatric Research.
2004;
38
137-144
-
97
Purcell R, Maruff P, Kyrios M, Pantelis C.
Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls.
Arch Gen Psychiatry.
1998;
55
415-423
-
98
Frith C D, Done D J.
Towards a neuropsychology of schizophrenia.
Br J Psychiatry.
1988;
153
437-443
-
99
Murphy F C, Sahakian B J, Rubinsztein J S, Michael A, Rogers R D, Robbins T W, Paykel E S.
Emotional bias and inhibitory control processes in mania and depression.
Psychol Med.
1999;
29
1307-1321
-
100
Soares J C, Mann J J.
The anatomy of mood disorders - Review of structural neuroimaging studies.
Biol Psychiatry.
1997;
41
86-106
Dr. rer. nat. Katrin Rathgeber
Vivantes Humboldt-Klinikum Berlin · Akademisches Lehrkrankenhaus der Charité · Universitätsmedizin Berlin
Am Nordgraben 2
13509 Berlin
Email: katrin.rathgeber@vivantes.de
