研究背景
　　雙極症為一種嚴重且失能的精神疾病，除了情緒極端失常，亦損害其社會心理及職業功能，造成個人痛苦、家屬和社會福利制度的沈重負擔，並有廣泛神經心理功能損傷。近年臨床與流行病學研究顯示，雙極症共病焦慮症之終生盛行率高達 51% 至 93%，對病程造成極為嚴重的負面影響，增加自殺風險與物質濫用，並降低患者生活品質，除了雙極症病程本身造成的神經心理功能損傷外，共病焦慮症可能使其更加惡化。此外，雙極症的錯誤診斷與不當治療極為常見，尤其第二型雙極症常被誤診為憂鬱症或較輕微的雙極症亞型，加上以往國內外關於雙極症神經心理功能的相關研究，皆以第一型雙極症為主要研究對象，第二型雙極症之神經心理功能損傷尚未明瞭。除此之外，由於國人漢族有酒精代謝酶基因的生物保護因素，因此較國外更能排除酒精濫用或依賴的情況，以及國人雙極症患者有較低之共病焦慮症比率，進而能更清楚比較雙極症病程與共病之焦慮症對神經心理功能的損害與嚴重程度，因此本研究將進一步比較第二型雙極症與第二型雙極症共病焦慮症之神經心理功能差異。

研究目的與假設
　　本研究目的欲了解第二型雙極症、第二型雙極症共病焦慮症與健康受試者的神經心理功能差異，以做為臨床實務治療與介入之參考，並藉由這些臨床的重要特徵強調雙極症共病焦慮症的重要性及增進對第二型雙極症神經心理功能的探索。本研究假設在情緒症狀穩定 (inter-episode) 後，第二型雙極症共病焦慮症患者的神經心理功能相較於第二型雙極症與健康控制組有較差的表現。

研究方法
　　共收集 40 名情緒症狀穩定之第二型雙極症患者 (第二型雙極症 20 人，第二型雙極症共病焦慮症 20 人)，健康受試者 19 名。分別進行記憶力、心理運動速度、注意力與執行功能等一系列神經心理學測驗。

研究結果
第二型雙極症共病焦慮症相較於第二型雙極症與健康控制組有較差的語文記憶、非語文記憶、工作記憶與心理運動速度表現。第二型雙極症於所有認知功能表現則皆與健康控制組相近。

研究結論
第二型雙極症共病焦慮症有較差的語文記憶、非語文記憶、工作記憶與心理運動速度功能；第二型雙極症則顯示無任何認知功能損傷。顯示兩組雙極症有不同的認知功能表現，且第二型雙極症共病焦慮症有廣泛且嚴重的認知功能損傷，然而第二型雙極症情緒症狀穩定後，認知功能表現可恢復至與正常人相當。因此治療時，除了使情緒症狀穩定外，也需加強對共病焦慮症之治療，且復健計畫應針對這些功能損傷類型設計適當的治療與認知復健計畫。

Objectives: Bipolar disorder (BP) is often comorbid with anxiety disorder (ANX), especially in bipolar II disorder (BP-II). BP patients with comorbid ANX often manifest intensified symptoms and harmful dysfunctions. However, most studies have focused on bipolar I disorder (BP-I); few have investigated the effect of comorbid ANX on the neuropsychological function of BP-II patients. We examined neuropsychological functions in BP-II patients with and without comorbid ANX.
Methods: Fifty-nine participants were recruited: 20 patients with interepisode (symptom-free) BP-II without comorbid ANX, 20 with interepisode BP-II with comorbid ANX, and 19 healthy controls. All participants were screened using the Chinese version of the Modified Schedule of Affective Disorder and Schizophrenia-Lifetime (SADS-L). Individuals comorbid with major or minor mental illness other than BP-II were excluded. Comparisons were made between the three groups using neuropsychological tests to assess memory, attention, psychomotor speed, and frontal executive function.
Results: BP-II patients with comorbid ANX showed poorer neuropsychological functions than those in the BP-II-only and control groups. Additionally, BP-II-only patients and controls showed equal cognitive performance.
Conclusions: Because BP-II patients with comorbid ANX had the lowest scores in the majority of neuropsychological functional tests, we conclude that they have greater cognitive impairments than do BP-II patients without comorbid ANX. Neuropsychological dysfunctions seemed more strongly associated with ANX than with BP-II in interepisode periods. Identifying and managing ANX comorbidity is critical when treating BP-II patients.

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