雙極症除了造成個體情緒障礙外，即使在疾病穩定階段，亦殘存嚴重的認知神經功能缺損，不但對其社會心理及職業功能帶來負面影響，並對個人、家屬和社會帶來沉重負擔。此外，許多研究亦指出雙極症是第一軸診斷中最易合併物質濫用或依賴之精神疾病，其中又以酒精為最常見的物質使用。國人因酒精代謝酶基因ALDH-2的活動缺陷產生生物性保護的緣故，因此國人漢族酒精依賴盛行率較歐美研究低許多，更可確實排除雙極症患者之終生酒精依賴之診斷(lifetime alcohol dependence)，而獲得未合併酒精依賴之單純雙極症患者。本研究目的希望進一步釐清，在精神症狀緩解階段，合併酒精依賴與未合併酒精依賴之不同亞型雙極症患者及健康控制組在神經心理功能上之差異，來了解雙極症與酒精依賴確實的神經損傷情況，以進一步擬定合宜的復健預後計畫。
本研究蒐集到29位健康受試者以及94位雙極症患者，並將疾病組分為以下四組：（1）未合併酒精依賴診斷之單純第一型雙極症患者共22位（BP-I ; n=22）；（2）未合併酒精依賴診斷之單純第二型雙極症患者共38位（BP-II ; n=38）；（3）合併酒精依賴診斷之第一型雙極症患者共16位（BP-I+OH; n=16）；（4）合併酒精依賴診斷之第二型雙極症患者18位（BP-II+OH; n=18）。
結果顯示若未排除酒精依賴之患者，比較BP-I及BP-II 之神經心理功能未發現差異；然而，在排除酒精依賴之患者後，發現BP-I 之神經心理功能顯著較BP-II 差。BP-I 在大部分之語言記憶功能、注意力/專注功能均較BP-II 及健康控制組差；然而BP-II 之神經心理功能表現在緩解階段則可恢復近似於健康控制組。
本研究結果指出透過神經心理功能區分雙極症亞型前，排除酒精依賴患者的重要性；此外，本研究結果亦發現酒精依賴對第二型雙極症患者帶來較為顯著之影響，除可能嚴重惡化其神經心理功能外，更可能使其臨床病程陷入持續惡化之負向迴圈中。

Objective: Bipolar disorder (BP) is a mental disorder most likely to co-occur with substance dependence and abuse, especially with alcoholism. Because of the genetic characteristics of the Han Chinese population, it was easier to recruit BP patients without alcoholism among Han Chinese in Taiwan. The aim of this study was to examine the influence of lifetime alcohol dependence (ALD) on neuropsychological function in BP.
Methods: We recruited 29 normal control (NC) participants and 94 BP whom were categorized into four groups: (1) BP-I without any lifetime substance abuse or dependence (BP-I; n=22); (2) BP-II without any lifetime substance abuse and dependence (BP-II; n=38), (3) BP-I with ALD (BP-I+OH; n=16), and (4) BP-II with ALD (BP-II+OH;n=18). Only males were recruited in this study.
Results: If we didn’t excluded the ALD patient, no differences on neuropsychological tests were found between BP-I and BP-II. However, while excluding those patients with ALD, significant differences were found between the two BP groups. BP-I performed more poorly on most of the verbal memory and attention/concentration functions than NC and BP-II, while BP-II performed similarly to NC.
Conclusion: This result indicates the importance of excluding ALD patients when we evaluate neuropsychological functions among the different types of BP. We found that ALD has a severe effect on BP-II than on BP-I. BP-II+OH not only deteriorates neuropsychological function, but alcohol use will also eventually worsen the clinical course and lead to a more pernicious status and negative cycle.

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