A meta-analysis on the Link Between medical Impulsive Behavior, Cognitive Impairment, and Social Function Deficits in People with Bipolar Disorder
Zai Jhang1,a,Tie Xu2,b* 1School of Psychology,Jiangxi Normal University, Nanchang, 330022, Jiangxi, China 2School of Psychology,Jiangxi Normal University, Nanchang, 330022, Jiangxi, China aEmail: zaijhang@126.com bEmail: tiexu@jxnu.edu.cn Abstract：Bipolar disorder (BD) is a prevalent and chronic psychiatric disorder characterized by recurrent fluctuations of manic and depressive episodes, accompanied by persistent behavioral abnormalities, neurocognitive dysfunctions and social adaption disorders. Impulsive behaviors, cognitive function impairments and social function deficits are three core clinical manifestations that run through the whole course of BD, severely affecting patients’ disease prognosis, quality of life and social integration ability. This study aimed to explore the correlation mechanism among impulsive behaviors, cognitive function damage and social function deficits in BD patients, so as to provide theoretical support for clinical intervention, symptom improvement and functional rehabilitation of BD. A total of 220 patients diagnosed with BD in a tertiary psychiatric hospital from January 2023 to December 2024 were enrolled as the observation group, and 220 healthy volunteers with matched age, gender and educational level were recruited as the control group. All subjects were evaluated by Barratt Impulsiveness Scale (BIS-11), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Social Disability Screening Schedule (SDSS). Statistical analysis was conducted to compare the differences of impulsivity level, cognitive function and social function between the two groups, and analyze the correlation and predictive effect among the three indicators in BD patients. The results showed that the total score and each dimension score of BIS-11 and SDSS in the observation group were significantly higher than those in the control group, while the total score and each sub-item score of RBANS were significantly lower than those in the control group (P<0.05). Correlation analysis indicated that the impulsivity level of BD patients was negatively correlated with cognitive function level, and positively correlated with social function deficit degree; cognitive function impairment was negatively correlated with social function ability (P<0.01). Regression analysis verified that impulsive behaviors and cognitive function impairment were independent predictive factors of social function deficits in BD patients. This study confirms that impulsive behaviors, cognitive impairments and social function deficits have significant interactive correlation in BD patients. Severe impulsive tendencies and progressive cognitive damage can jointly aggravate social functional disorders, which provides a new perspective for targeted clinical treatment and functional rehabilitation intervention of BD. Key words: Bipolar Disorder; Impulsive Behavior; Cognitive Impairment; Social Function Deficit; Correlation Analysis 1. Introduction 1.1 Research Background: Disease Burden and Functional Impairment of Bipolar Disorder Bipolar disorder is a severe mental disorder with high morbidity, high recurrence rate and high disability rate, ranking among the top causes of global mental disease-related disability. Epidemiological data show that the lifetime prevalence of BD in the general population is about 2.4% to 3.8%, and nearly 60% of patients will have recurrent episodes within 5 years after the first diagnosis. Different from single mood disorder, BD not only presents extreme emotional swings of mania and depression, but also accompanies multiple dimensional functional damage covering behavior, cognition and social interaction throughout the stable stage of the disease, which is the core cause of long-term social disability of patients. In recent years, with the continuous progress of psychiatric research, the clinical focus of BD has gradually shifted from single emotional symptom control to comprehensive functional rehabilitation, and the persistent subclinical functional impairment during the inter-episode stable period has become a research hotspot in the field of BD prognosis[1-3]. Impulsive behavior is one of the most prominent behavioral characteristics of BD patients. It refers to the unplanned, hasty and unregulated behavioral response without full rational thinking and risk assessment, which is extremely common in both manic episodes and stable periods of BD. Typical impulsive behaviors of BD patients include impulsive consumption, aggressive behavior, reckless driving, substance abuse and suicidal and self-injurious behaviors. Clinical studies have confirmed that the incidence of impulsive behaviors in BD patients is 3 to 5 times higher than that in healthy people, and severe impulsive behaviors are closely related to disease recurrence, adverse clinical events and poor long-term prognosis. Impulsive behavior is no longer regarded as a transient symptomatic performance of manic episodes, but a stable trait characteristic of BD patients, which runs through the whole disease course. Cognitive function impairment is another core residual symptom of BD, which exists stably in the remission stage of mood symptoms and cannot be completely improved by conventional mood-stabilizing treatment. The cognitive damage of BD mainly involves multiple core fields such as attention, memory, executive function, language comprehension and visual-spatial ability. A large number of neuropsychological studies have shown that even in the euthymic stage with normal emotional performance, BD patients still have persistent deficits in working memory, inhibitory control and decision-making ability. Cognitive dysfunction not only affects patients’ daily learning and work efficiency, but also restricts their ability of emotional regulation and behavioral control, becoming the internal neuropsychological basis of abnormal behavioral manifestations of BD[4-6]. Social function deficit is the ultimate disability manifestation of BD, which is characterized by the decline or loss of patients’ abilities in social communication, interpersonal interaction, family function, occupational performance and social role adaptation. Long-term follow-up studies have found that more than 70% of BD patients have different degrees of social adaption disorders after repeated disease episodes, and nearly 40% of patients cannot return to normal work and social life for a long time. Social functional disability is the key factor leading to the decline of patients’ quality of life and the increase of social medical burden, and improving social function has become the ultimate goal of clinical treatment and rehabilitation of BD. 1.2 Research Status: Independent Study Limitations of Three Core Symptoms At present, domestic and foreign scholars have carried out extensive research on impulsive behavior, cognitive impairment and social function deficit of BD respectively. In terms of impulsive behavior research, most studies focus on the correlation between impulsivity and disease episode type, suicidal behavior and substance abuse, confirming that high impulsivity is an important risk factor for adverse events of BD. In the field of cognitive function research,
The Study of Teachers’ Digital-Cultural Literacy on the Teaching Effectiveness of Chinese Classical Poetry: A Path Analysis Based on the Culture-DPACK Framework
Dr. Sophia Bertha Chinese Department, Suqian College, Suqian223800, Jiangsu,China e-mail: nianbiandong @163.com Abstract：Chinese classical poetry, as the core carrier of traditional Chinese culture, bears the dual functions of language inheritance and cultural education in basic Chinese education. In the era of digital education transformation, teachers’ comprehensive literacy integrating digital technology and cultural cognition has become a key variable affecting the quality of classical poetry teaching. Based on the improved Culture-DPACK theoretical framework, this study constructs a multi-dimensional influence mechanism model of teachers’ digital-cultural literacy on Chinese classical poetry teaching effect. Through questionnaire survey and path analysis of 426 Chinese teachers in primary and secondary schools, this study systematically explores the direct path, indirect path and regulatory boundary of digital-cultural literacy acting on poetry teaching effect. The research results show that teachers’ five-dimensional literacy of Culture-DPACK (intrinsic knowledge literacy, traditional pedagogical literacy, digital literacy, digital humanities pedagogical literacy, general cultural literacy) all have significant positive predictive effects on classical poetry teaching effect. Among them, digital humanities pedagogical literacy has the strongest direct influence, and general cultural literacy plays a core mediating role in transforming technical ability into teaching quality. Classroom cultural immersion and digital teaching adaptation present significant dual regulatory effects. This study clarifies the internal logical relationship between teachers’ literacy structure and poetry teaching practice, expands the application boundary of the Culture-DPACK framework in traditional cultural teaching, and provides empirical support and optimization paths for the digital and high-quality development of Chinese classical poetry teaching. Keywords: Digital-Cultural Literacy; Chinese Classical Poetry; Teaching Effect; Culture-DPACK Framework; Path Analysis 1. Introduction 1.1 Background of Teaching Reform: Digital Empowerment for Traditional Poetry Inheritance Chinese classical poetry is a treasure of traditional Chinese culture, condensing the aesthetic connotation, humanistic spirit and historical heritage of the Chinese nation. It occupies an irreplaceable core position in Chinese curriculum teaching and cultural inheritance education. In the context of the new curriculum reform, basic education has clearly put forward the educational goal of “cultivating students’ cultural confidence and humanistic literacy”, and higher requirements have been placed on the depth and effectiveness of classical poetry teaching. Traditional classical poetry teaching mostly adopts the teaching mode of text interpretation, sentence translation and mechanical memorization, which is limited by single teaching method and shallow cultural excavation[1-3]. It is difficult to activate students’ perceptual experience of poetic aesthetics and cultural connotation, resulting in the disconnection between poetry teaching and cultural inheritance, and the dilemma of “memorization without comprehension, learning without appreciation” in teaching practice. With the comprehensive penetration of digital education technologies such as big data, virtual simulation and intelligent classroom, digital transformation has become an inevitable trend of basic Chinese education. Digital technologies break the time and space limitations of traditional classroom teaching, and provide diversified presentation forms and interactive paths for the display of poetic artistic conception, interpretation of cultural connotation and inheritance of classical aesthetics. However, the empowerment effect of digital technology on poetry teaching is not automatic. The teaching effect depends entirely on teachers’ comprehensive ability to integrate digital technology, cultural cognition and pedagogical skills. Teachers’ digital-cultural literacy, as a compound literacy integrating technical operation, cultural understanding and teaching design, has become the core key to determine whether digital technology can effectively empower classical poetry teaching and realize the deep integration of technical tools and cultural education[4]. 1.2 Research Gaps: Deficiencies in Literacy Mechanism and Framework Application Existing studies on classical poetry teaching mainly focus on three dimensions: teaching method innovation, classroom teaching design and student learning effect optimization. Most studies explore the application effect of single digital technology in poetry teaching, or discuss the teaching strategies of cultural infiltration in poetry classroom. In terms of teacher literacy research, domestic and foreign scholars mostly focus on the independent research of digital teaching literacy or traditional cultural literacy, and there is a lack of systematic research on the compound digital-cultural literacy adapted to traditional cultural teaching. In particular, the internal influence mechanism of teachers’ multi-dimensional literacy on poetry teaching effect is still unclear, and there is a lack of empirical path verification based on mature theoretical frameworks. The Culture-DPACK framework, as an improved theoretical system based on the traditional TPACK model for Chinese language teaching scenarios, constructs a multi-dimensional literacy structure integrating knowledge, pedagogy, digital technology and cultural cognition, which is highly compatible with the research theme of this study. However, the current application of the Culture-DPACK framework is mostly limited to the scale development and literacy evaluation of Chinese teachers, and there is no in-depth discussion on its internal mechanism acting on specific curriculum teaching effects. In view of this, this study takes the Culture-DPACK framework as the core theoretical support, constructs an influence mechanism model of digital-cultural literacy on classical poetry teaching effect, and verifies the action path and influence intensity of each dimension through empirical analysis, so as to make up for the research gaps in the field of poetry teaching literacy research. 1.3 Research Significance: Theoretical Innovation and Practical Value In terms of theoretical significance, this study expands the application scope of the Culture-DPACK framework from teacher literacy evaluation to curriculum teaching mechanism research, clarifies the multi-dimensional structure of teachers’ digital-cultural literacy in classical poetry teaching scenarios, and reveals the direct, indirect and regulatory paths of each literacy dimension affecting teaching effect. It constructs a systematic theoretical system of “literacy structure-behavior practice-teaching effect” for traditional cultural curriculum teaching, which enriches the theoretical research achievements of digital education and traditional cultural teaching. In terms of practical value, this study verifies the key literacy dimensions and core action paths that affect the quality of classical poetry teaching, provides targeted optimization strategies for teachers’ digital-cultural literacy improvement and poetry digital teaching reform, and helps to solve the practical dilemmas of superficial digital application and insufficient cultural infiltration in current poetry teaching[5]. It provides empirical basis and practical reference for educational administrative departments to formulate teacher training plans and promote the high-quality development of traditional cultural education. 1.4 Research Framework and Technical Route This study follows the research