دانلود مقاله نظریه مرتبه بالاتر ذهن در بیماران مبتلا به اختلال دوقطبی و اسکیزوفرنی
خلاصه
مقدمه
مواد و روش ها
نتایج
بحث
محدودیت ها
نتیجه
اعلامیه ها
منابع
Abstract
Introduction
Methods
Results
Discussion
Limitations
Conclusion
Declarations
References
چکیده
برخی شواهد نشان می دهد که بیماران مبتلا به اختلال دوقطبی (BD) نسبت به بیماران مبتلا به اسکیزوفرنی/اختلال اسکیزوافکتیو (SCH) مهارت های نظریه ذهن (ToM) بهتری دارند. با این حال، این تفاوت به طور مداوم در بین مطالعات گزارش نشده است، بنابراین به جای جهانی بودن، ممکن است به جنبه های خاصی از ToM محدود شود. هدف اصلی ما مقایسه عملکرد درجه بالاتر ToM بین بیماران BD و SCH با استفاده از Hinting Task (HT) بود. نود و چهار بیمار بهبود یافته (BD = 47، SCH = 47) انتخاب شدند. ضریب هوش (IQ)، توجه، حافظه، عملکردهای اجرایی و سرعت پردازش نیز مورد ارزیابی قرار گرفت. بیماران مبتلا به BD در HT بهتر از بیماران مبتلا به SCH عمل کردند، حتی زمانی که آنالیز برای ضریب هوشی و شناخت عصبی تنظیم شده بود (001/0p<، 144/0 η2p = ). تجزیه و تحلیل رگرسیون در کل نمونه نشان داد که تشخیص SCH و ضریب هوشی پایین تر با نمرات HT پایین تر (R2 = 0.316، p <0.001) همراه بود. در گروه BD، حافظه کلامی و سرعت پردازش پیش‌بینی‌کننده‌های اصلی عملکرد HT بودند (R2 = 0.344، p < 0.001). در گروه SCH، هیچ متغیری در توضیح عملکرد HT معنادار نبود. در زمینه مطالعات قبلی که هیچ تفاوت قابل توجهی در اساسی ترین جنبه های ToM (به عنوان مثال، درک افکار/باورهای دیگران) پیدا نکردند، نتایج ما نشان می دهد که تفاوت بین این دو اختلال ممکن است به جنبه های چالش برانگیزتر محدود شود (مثلاً درک معنای مورد نظر درخواست های غیر مستقیم). در این مطالعه مقطعی نمی توان استنباط علی انجام داد. با این حال، تجزیه و تحلیل رگرسیون نشان می دهد که در حالی که در بیماران BD، عملکرد ToM تا حدی توسط عملکرد عصبی-شناختی تعدیل می شود، در بیماران SCH، می تواند تا حد زیادی مستقل از اختلال عصبی شناخته شده باشد.
توجه! این متن ترجمه ماشینی بوده و توسط مترجمین ای ترجمه، ترجمه نشده است.
Abstract
Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) skills than patients with schizophrenia/schizoaffective disorder (SCH). However, this difference is not consistently reported across studies, so rather than being global, it may be restricted to specific aspects of ToM. Our primary objective was to compare higher order ToM performance between BD and SCH patients using the Hinting Task (HT). Ninety-four remitted patients were recruited (BD = 47, SCH = 47). Intelligence quotient (IQ), attention, memory, executive functions, and processing speed were also assessed. Patients with BD performed better on the HT than patients with SCH, even when the analysis was adjusted for IQ and neurocognition (p < 0.001, η2p = 0.144). Regression analysis in the total sample showed that a diagnosis of SCH and lower IQ were associated with lower HT scores (R2 = 0.316, p < 0.001). In the BD group, verbal memory and processing speed were the main predictors of HT performance (R2 = 0.344, p < 0.001). In the SCH group, no variable was significant in explaining HT performance. In the context of previous studies that found no significant differences in the most basic aspects of ToM (e.g., understand other people's thoughts/beliefs), our results suggest that differences between the two disorders might be limited to the more challenging aspects (e.g., understand the intended meaning of indirect requests). No causal inferences can be made in this cross-sectional study. However, regression analyses show that whereas in BD patients, ToM functioning would be partially modulated by neurocognitive performance, in SCH patients, it could be largely independent of the well-known neurocognitive impairment.
Introduction
“Theory of Mind” (ToM) encompasses the ability to understand the cognitive and afective mental states of oneself and others and the ability to use this knowledge to predict and anticipate people’s behavior [1]. Patients with bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH) show mild-to-severe defcits in ToM throughout the course of the disease, including the prodromal, acute, and remitted phases [2, 3]. Although less severe, similar difculties have been observed in their unafected frst-degree relatives, suggesting some degree of heritability and that ToM difculties are a vulnerability marker for BD and SCH [4, 5].
ToM is more closely related to social functioning than most clinical and neurocognitive variables. Therefore, an intact ToM is essential for adequate performance at work and in the community [6, 7]. However, it is not a monolithic function. Instead, it consists of several sub-processes among which the frst-order ToM (i.e., the ability to know what another person thinks or believes), the second-order ToM (i.e., the ability to know what a person thinks that another person thinks or believes) and other forms of higher order ToM (e.g., understand sarcasm, metaphors or indirect requests) stand out [8].
Conclusion
Our results show that patients with BD perform signifcantly better on higher order ToM than patients with SCH, independent of group diferences in other neurocognitive domains, but that general intelligence infuences this difference. Contextualized in the current literature, the present fndings suggest that the diferences between the two disorders may be subtler than previously thought, mainly afecting the more complex and sophisticated aspects of ToM. As clinical implications, both groups of patients could beneft from rehabilitation interventions designed to improve cognitive functioning. However, whereas BD patients would beneft from rehabilitation of verbal memory and processing speed [61], in SCH patients, additional efort should be made to rehabilitate the more challenging aspects of ToM [62]. Our fndings also have practical implications for how we should communicate with patients with BD and, especially, SCH. Ambiguity, irony, and the use of double meanings are frequent sources of misunderstanding and should be avoided.