摘要
研究背景
雙極症除了造成個案情緒障礙，亦會造成社會心理及職業功能下降，並對個人、家屬和社會帶來沉重負擔，研究指出雙極症心理社會職業功能的下降不只與情緒症狀有關，亦與病程導致的廣泛神經心理功能損傷，尤其是執行功能與語言記憶有關。此外，研究亦指出雙極症是第一軸診斷中與物質濫用或依賴呈現最高比例共病的精神疾病，其中又以酒精為最常見的物質使用，原因可能為患者希望藉由酒精改善或減輕情緒症狀。因此，除雙極症病程本身造成患者認知功能缺損之外，長期酒精濫用或依賴則導致神經心理功能更加惡化。另外，因為DSM-IV-TR診斷準則缺乏敏感性的原故，過往第二型雙極症常被誤診為輕型雙極症或是憂鬱症，以致於過去國、內外對於雙極症第二型的研究明顯少於第一型，探討神經心理功能損傷的研究也以第一型雙極症為主，第二型雙極症神經功能損傷則呈現不一致的研究結果。除此之外，因西方白種人無酒精代謝酶基因ALDH-2生物性保護的緣故，國外雙極症共病酒精依賴患者高達雙極症人口近一半，因此關於雙極症患者認知神經心理功能表現的國外相關文獻，幾乎都無法排除酒精濫用或依賴條款，進而無法清楚說明雙極症病程與酒精使用分別如何損害患者的認知神經心理功能及其嚴重程度，因此本研究認為有必要將此兩者(即第二型雙極症與第二型雙極症共病酒精依賴)神經心理功能分開比較。
研究目的與假設
為了能了解第二型雙極症在情緒症狀解除後，與其在日常生活中可能習慣性的『借酒消愁』，分別如何影響執行功能與語言記憶及其嚴重程度的不同，進而可能導致社會功能或預後的狀況差異，故本研究假設為『在情緒症狀卸除後，第二型雙極症與第二型雙極症共病酒精依賴在神經心理功能損傷上的差異。』
研究方法
研究對像為成大精神科門診與病房收取18至65歲的第二型雙極症與第二型雙極症共病酒精依賴euthymic state的受試者各20-30人，除了酒精依賴外，排除目前或曾經達到其他物質濫用、依賴診斷者、正在服用會影響認知功能之藥物者、有腦傷病史、或神經退化性疾病患者、符合DSM-IV-TR第一軸其他診斷患者。取得個案同意後經精神科醫師的初步晤談，再經由訓練良好的臨床人員以SADS-L確定診斷。病人達症狀穩定之標準施予各項神經心理學測驗。另收集相同人數健康受試者，做為控制組。在控制患病時間後，以ANOVA比較三組在神經心理功能的差異。
研究結果
在人口統計學方面，除教育年數、發病年齡與住院次數外，其他方面三組皆無差異。神經心理功能方面，除工作記憶外，第二型雙極症共病酒精依賴表現皆比第二型雙極症與控制組差，第二型雙極症與控制組則無顯著差異。在工作記憶方面，第二型雙極症共病酒精依賴表現最差，其次是第二型雙極症，再來為控制組。
討論
與過往研究發現相同，第二型雙極症共病酒精依賴患者通常有較早的發病年齡，進而導致患者較短的教育年數、較差的病程與更多的住院次數。共病酒精依賴組在大部分的神經心理測驗表現都較差，單純第二型雙極症組在工作記憶部分則有下降的表現。因此推論在情緒症狀緩解期，酒精依賴都將持續影響患者神經心理功能的表現，如果研究方法不排除酒精使用條款，每日大量的酒精使用量將導致神經心理測驗結果不足採信且毫無意義，因此在第二型雙極症部分，過往研究不一致的結果可能與未排除酒精使用條款有關。

ABSTRACT
OBJECTIVE: Studies exploring neuropsychological functions of bipolar disorder (BP) specifically include patients with alcohol abuse or dependence. Contradictory assessments of neuropsychological impairment may be caused by not excluding the confounding effects of comorbid alcohol dependence disorder (AD). Most of the literature discusses BP without subtyping, which overlooks that BP-II may be a valid diagnosis different from BP-I. Because neuropsychological functions are involved in overall BP-II outcomes, we addressed the variations in neuropsychological function in BP-II patients.
METHOD: Using DSM-IV criteria, the study included 69 patients with interepisode bipolar disorder (BP-II without AD (BP-AD): n = 28; BP-II with AD (BP+AD): n = 19) and 22 healthy controls compared using a battery of neuropsychological tests that assessed memory, psychomotor speed, and certain aspects of frontal executive function.
RESULTS: BP+AD patients had lower scores than did BP-AD patients and controls in verbal memory, visual memory, attention, psychomotor speed, and executive function. Working memory was poorer for BP+AD than BP-AD patients and for both BP groups than for controls.
CONCLUSIONS: BP+AD patients manifested wide neuropsychological dysfunctions and BP-AD patients showed a reduction in working memory, which suggested that working memory might be related to a history of BP-II. Neuropsychological dysfunctions seemed more strongly associated with AD than with BP-II in the inter-episode stage.

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