The Neuropsychological Study Of Executive Function In Adolescent With Bipolar Disorder Before And After Treatment

Objective: Neuropsychological studies of adults with bipolar disorder (BPD) have revealed deficits in attention, memory and executive function. Furthermore, these impairments may be independent of affective state, as they are present in euthymic or symptom free individuals. These data are consistent with neuroimaging studies of adults with BPD suggesting impairments in frontlimbic circuits. However, we know a little about the neuropsychological status of adolescents with BPD. The clinical symptoms of adolescents with BPD are different from the adult of BPD. The adolescents of BPD are characterized by extreme affective and behavioral dysregulation, aggression, severe irritability and a chronic course. Because executive functions are association with the appropriate self-regulation of behavior, executive function deficits may be hypothesized to occur in bipolar adolescents.Methods: 30 adolescents with depressed bipolar patients and 30 adolescents with manic bipolar patients (study group), 30 health adolescents controls and 30 adolescents with schizophrenia (control group) were assessed for executive function using the Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCW), The Tower Of London Test (TOL), Digital Sequence Test and Spatial Span Test. Neuropsychological assessment was performed respectively. 30 schizophrenia patients performed the assessment of executive function only at the moment of entering the group, the others at the moment of entering the group and the end of the 8th week. 30 depressed of adolescents bipolar patients and 30 manic bipolar patients of adolescents were separately assessed for evaluating severity using Hamilton Depression Scale-17 (HAMD17) and Young Mania Rating Scale (YMRS) at the moment of entering the group and the end of the 8th week, respectively.Result: 1 Comparison of the neuropsychological performance between the study group and the control group before treatment: Before the treatment the study group performed poorer on all of the neuropsychological test than health control group (P<0.01), which had statistical significance, likewise, the study group performed better on all of the neuropsychological tests than schizophrenia group, which had statistical significance (P<0.01). Likewise, the study group performed better on all of the neuropsychological tests than schizophrenia group, which had statistical significance (P<0.01).2 Comparison of the neuropsychological performance between the study group and health control group after treatment: At the end of the 8th week, the study group performed poorer on all neuropsychological test than health control group, which had statistical significance (P<0.01).3 Self-comparison of the study group before and after the treatment on the neuropsychological performance: Self-comparison of the depressed bipolar on neuropsychological performance before and after treatment showed significant difference (P<0.01), except RTA and RTB of the SCW (P>0.05). The neuropsychological performance of the post-treatment outperformed the prior treatment. Self-comparison of the manic bipolar on neuropsychological performance before and after treatment showed significant difference (P<0.01). The neuropsychological performance of the post-treatment outperformed the prior treatment.4 Comparison of the neuropsychological performance of the before and after treatment between depressed bipolar and manic bipolar: In group comparison, there were statistics significance(P<0.05 or P<0.01) on the Non-Perseverative Errors score, the Responses of Finishing the first Category and Stoop Color Word Test before treatment. Depressed bipolar were better than manic bipolar on these neuropsychological performance; in group comparison, there were statistics significance (P<0.05 or P<0.01) on Finish the first Category of the Responses, The Tower of London and Stoop Color Word Test after treatment. Depressed bipolar were better than manic bipolar on these neuropsychological performance.5 The Pearson correlation analysis between neuropsychological variances and the course of disease and between neuropsychological variances and the decreased score of the HAMD17 and the YMRS 8 weeks after treatment respectively: There are certain relationships between neuropsychological variances and the course of disease. The Tower Of London test and the number of categories of WCST were negatively correlated to the course of disease(P<0.05); Perseverative Errors score, Non-Perseverative Errors score and the Responses of Finishing the first Category of WCST and the Interference of Stroop were positive correlated to the course of disease(P<0.05). However, decreased score of the twelve neuropsychological variances had no correlation with the decreased score of the HAMD17 and the YMRS 8 weeks after treatment (P>0.05).Conclusions: 1 Adolescents with bipolar disorder had deficits in executive function (including inhibitory control, cognitive flexibility, working memory and planning), no matter in acute phase or in remission, manic bipolar showed more serious deficits in inhibitory control than depressed bipolar. In acute phase,BPD showed slighter impairment in executive function than schizophrenia.2 Executive dysfunction had no correlation with the clinical symptoms and may be an independent symptom of adolescents of bipolar disorder, the longer the course of disease, the more serious of the impairment was.3 Compared with the acute phase, significant improvement was observed in executive function in remission, considering the improvement related to the mood stabilizer and the atypical antipsychotic agents.4 Adolescents with bipolar disorder show executive function deficits similar to impairments found in adults with the disorder.