研究背景
焦慮疾患居雙極症共病率之最高位，共病焦慮疾患對雙極症的病程、社會心理功能、自殺危險性、治療療效與預後等方面帶來許多負面的影響，加重雙極症惡化。研究發現雙極症患者之社會心理失功能已被認為與認知缺損有關連，即使在情緒症狀緩解時仍存在廣泛的神經心理功能損傷，因此，探討雙極症共病焦慮症患者之神經心理功能極具重要性，目前雙極症共病焦慮之神經心理功能研究仍非常缺乏，過去文獻多未清楚區分第一型、第二型雙極症，僅有數篇研究比較了第一型、第二型雙極症之神經心理功能，然而，以上研究或未在情緒穩定期施測，或未清楚排除物質使用，且研究呈現不一致之結果。有鑑於此，本研究欲施測神經心理測驗，進一步驗證與釐清：
(1)第一型、第二型雙極症患者(BPI-total、BPII-total)之神經心理功能差異。
(2)有、無合併焦慮疾患之第一型雙極症患者(BPI+AD、BPI-AD)之神經心理功能差異。
(3)有、無合併焦慮疾患之第二型雙極症患者(BPII+AD、BPII-AD)之神經心理功能差異。
若能釐清與瞭解雙極症共病焦慮患者神經心理功能損傷之情形與程度，將有助於復健計畫之擬訂，協助患者針對損傷之功能進行合宜的復健與治療，減少並彌補因神經心理功能損傷導致生活品質、社會心理等諸多功能持續下降與惡化。
 
研究方法
於成大附設醫院精神科門診與精神科病房收取18至65歲的第一型及第二型雙極症、第一型及第二型雙極症共病焦慮疾患的受試者共79人。除雙極症及焦慮疾患外，排除其他符合DSM-IV-TR第一軸其他重大精神疾病診斷患者、酒精與藥物濫用或依賴者、有腦傷病史、或神經退化性疾病患者。取得受試者同意後，先經精神科專科醫師初步晤談，再由受訓良好之臨床人員或臨床心理師以SADS-L確定診斷，若受試者符合緩解期(inter episode)標準，邀請其進行神經心理功能評估。另收集健康控制組30人，在取得同意後亦施測相同之神經心理測驗，以統計方法比較五組在人口學變項、神經心理功能比現之差異情形。

研究結果
人口學與臨床變項：BP-I與BP-II患者在住院次數、精神症狀、楊氏躁症量表達到顯著差異。神經心理功能表現方面：
(1)BPI-total呈現聽覺語文記憶、注意力、執行功能方面損傷；
BPII-total未顯示認知功能損傷。
(2)BPI+AD在工作記憶方面表現差於BPI-AD。
(3)BPII+AD在視覺記憶、工作記憶、心理運動速度方面表現差於BPII-AD。
 
結論
過去研究指出雙極症患者之社會心理層面之失功能，可能導因於神經心理功能之缺損。本研究進一步發現：(1)第一型雙極症患者之神經心理功能表現差於第二型雙極症患者；(2)兩型雙極症患者具有不同之神經心理功能損傷型態。(3)合併焦慮疾患對兩型雙極症所帶來之神經心理功能損傷程度不同--合併焦慮之第一型雙極症患者僅加重了工作記憶方面的缺損，但合併焦慮卻加重了第二型雙極症患者在視覺記憶、工作記憶、心理運動速度方面的功能下降。
因此未來在雙極症患者之治療與復健介入方面，應考慮針對不同亞型之雙極症、及其是否有合併焦慮疾患所可能存在之神經心理功能缺損，來訂立適合的復健計畫、補償策略與處遇，也進一步防止焦慮干擾雙極症之治療與復健效果，提升日常社會、家庭、職業、生活品質等各方面之適應程度。未來對於雙極症合併焦慮疾患之族群進行心理治療與復健時，期望本研究能提供專業醫療人員及家屬更明確的參考方向。

Abstract
Objective: Bipolar disorder (BP) patients comorbid with anxiety disorders (AD) showed more severe clinical characteristics, psychosocial function impairment, worse response to treatment and more substance use—than those without AD. However, few studies focused on differences between BPI and BPII and those with or without AD in neuropsychological function.

Methods: Seventy-nine BP patients in the inter-episode state were classified into four groups—BPI without AD (BPI-AD) (n = 22), BPI with AD (BPI+AD) (n = 20), BPII without AD (BPII-AD ) (n = 18), BPII with AD (BPII+AD) (n = 19), and normal controls (n = 30)—and given neuropsychological tests.

Results: BPI-total patients performed worse than BPII-total in auditory immediate memory, auditory delayed memory, attention, and executive function. The BPI+AD performed worse than BPI-AD only in working memory. The BPII+AD performed worse than BPII-AD in visual immediate memory, visual delayed memory, working memory, and psychomotor speed.

Conclusions: BPI with AD has limited effects on neuropsychological performance. However, significant effects were found in the BPII with AD compared to those without AD, because AD led to more neuropsychological impairment in BPII patients. BPI and BPII patients have different patterns of cognitive deficits in asymptomatic stages.

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