首发抑郁症患者的心灵理论认知障碍

目的探讨首发抑郁症患者心灵理论两成分加工的特点。方法采用眼区心理状态阅读任务和失言觉察任务分别测查56例首发抑郁症患者和55名正常对照心灵理论社会知觉加工和社会认知加工的能力,患者又分为有和无精神病性症状组(PD组和NPD组)。采用贝克抑郁自评量表和简明精神病量表评估患者的临床症状。结果患者组心理状态阅读成绩(t=7.42,P<0.01)和失言觉察问题得分(t=13.57,P<0.01)显著差于对照组。而PD组(n=23)、NPD组(n=33)和对照组3组间心理状态阅读成绩(F=33.08,P<0.01)和失言觉察得分(2=78.50,P<0.01)差异也有统计学意义,两两比较显示,在两种任务情况下PD组和NPD组均差于对照组(P<0.05)。以贝克抑郁量表评分为协变量的协方差分析进一步显示,PD组在两种任务下的得分均差于NPD组(P<0.01)。患者组心理状态阅读成绩和失言觉察问题得分分别与BPRS总分(r=-0.36,P<0.01;r=-0.48,P<0.01)和敌对因子分(r=-0.73,P<0.01;r=-0.77,P<0.01)呈显著负相关。结论抑郁症患者在心灵理论加工的两个亚成分上均存在损害,且与精神病性症状及其严重程度相关。     

首发精神分裂症病人治疗前后认知功能改变及其与精神症状的相关研究

目的探讨利培酮治疗对未服药首发精神分裂症患者认知功能的影响,以及认知功能与症状变化的关联。方法采用威斯康星卡片分类测验、数字广度测试、词语流畅性测试、Stroop测试、连线测试评估42例首发未服药精神分裂症患者的执行功能、工作记忆、信息处理速度等变化;阳性和阴性症状量表评定患者精神症状;多元回归分析探讨认知功能与精神症状的关联。结果治疗前,患者组威斯康星测验持续错误数较对照组多(P0.001),完成分类数较对照组少(P=0.009);数字广度测试及词语流畅性分数(Ps0.001)均降低;Stroop及连线测试完成时间均较对照组延长(Ps0.001)。治疗后,患者组Stroop_B(P=0.022)、Stroop_C(P=0.033)完成时间较治疗前减少。治疗前连线测试A/B成绩越差,则阴性症状及总症状(Ps0.05)越严重;连线测试A成绩越差,阳性症状的改善越少(P=0.019)。结论精神分裂症患者发病早期存在认知功能损害;急性期治疗可改善精神病性症状及信息处理速度,但不改善执行功能及工作记忆;提示患者早期信息处理受损可能更接近状态性生物学标记,而执行功能、工作记忆受损更接近素质性生物学标记。     

首发女性精神分裂症患者P300与阴性、阳性症状关系的研究

目的研究首发女性精神分裂症患者事件相关电位P300与临床阴性、阳性症状的关系。方法对36例首发女性精神分裂症患者及20例正常女性进行测查，并运用阳性和阴性症状量表进行精神症状评定。结果（1）与正常对照组比较，病例组靶潜伏期N1、N2、P3及非靶P2延迟，靶波幅P3降低，及非靶P2波幅降低。（2）P3靶波幅下降与阴性量表分呈负相关。结论首发女性精神分裂症患者存在认知功能损害，尤其阴性症状为主者受损明显，其阴性、阳性症状可能有不同的生物学基础。     

首发精神分裂症与双相障碍及抑郁障碍认知功能比较

目的探讨首发精神分裂症、双相障碍及抑郁障碍患者认知功能差异。方法纳入首发精神分裂症患者61例,双相障碍患者57例,抑郁障碍患者48例,另设正常对照59名。所有研究对象采用重复性神经心理测查系统(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)评估认知功能,首发精神分裂症组采用阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评定精神病性症状,双相障碍组、抑郁障碍组采用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评估抑郁和焦虑症状,贝克—拉范森躁狂(Bech-Rafaelsen mania scale,BRMS)量表评估躁狂症状。结果 4组对象的RBANS总分(F=5.18,P0.01)、即刻记忆(F=4.09,P0.01)、言语功能(F=9.53,P0.01)、注意(F=3.87,P=0.01)、延时记忆(F=9.86,P0.01)因子得分差异具有统计学意义,其中首发精神分裂症、双相障碍组RBANS总分低于对照组(P0.01),首发精神分裂症、双相障碍、抑郁障碍组即刻记忆、言语功能、延时记忆得分低于对照组(P0.05),双相障碍组言语功能得分低于首发精神分裂症组(P0.01),首发精神分裂症组注意得分低于抑郁障碍及对照组(P0.01)。结论首发精神分裂症、双相障碍、抑郁障碍患者均存在认知功能损伤,首发精神分裂症认知功能缺陷重于抑郁障碍,轻于双相障碍。     

首发精神分裂症患者症状群因子分析研究

目的　探讨首发精神分裂症患者治疗前存在的独立症状群及其治疗后的变化。方法　对首发精神分裂症患者 ,在治疗前后分别评定简明精神病评定量表、阴性症状评定量表、汉密尔顿抑郁量表和测查 7种认知功能 ,然后进行因子分析。结果　首发精神分裂症患者的认知症状、阴性症状、情感症状在治疗前、后完全独立 ,无明显变化 ;而阳性症状的独立性在治疗前、后则不稳定 ,因子负荷分别在执行功能、情感症状因子上。结论　在首发精神分裂症患者中情感症状、认知症状是独立存在的 ,与治疗干预、阴性症状及阳性症状关系不肯定 ,应重视对两者的评估和治疗。     

康复期精神分裂症患者认知障碍分布情况调查

目的 了解不同症状和不同亚型精神分裂症患者认知障碍分布情况,为后期的针对性干预提供理论依据.方法 194例精神分裂症患者按主要临床症状不同分为阴性症状、阳性症状、阴阳性症状共存3组,按照ICD-10分为偏执型、青春型、紧张型、单纯型、未分化型5个亚型.用威斯康星卡片测验(WCST)和韦克斯勒智力测定(WAIS-R)对认知缺陷进行测评,用自编认知自评量表(WCSS)对认知歪曲进行评定.结果 精神分裂症患者的认知障碍分布在不同亚型之间、不同症状亚组之间存在显著性差异(P ＜0.05,P＜0.01).阴性症状亚组的认知缺陷评分显著高于阳性症状亚组和阴阳性症状共存亚组(P ＜0.05,P＜0.01);单纯型和青春型精神分裂症患者的认知缺陷评分显著高于偏执型、紧张型和未分化型(P＜0.01).认知歪曲评分在阳性症状、阴阳性症状共存亚组显著高于阴性症状亚组,在偏执型、紧张型、未分化型患者中显著高于青春型和单纯型(P＜0.01).结论 不同症状和不同亚型精神分裂症患者的认知障碍各异.     

精神分裂症首次发病未用药患者认知功能的改变

目的:探讨精神分裂症首次发病未用药患者认知功能改变的相关性。方法:124例首发未治疗精神分裂症患者为研究组,同期健康体检者60名作为对照组,采用MCCB、Stoop色词测验对两组的认知功能进行评价,采用阳性和阴性症状量表(PANSS)评估症状。结果:研究组患者认知功能各项评分均显著低于对照组,差异有统计学意义(P0.05);相关因素分析结果显示,首发未治疗精神病患者MCCB总分、Stroop色词测验与患者受教育年限呈正相关,与PANSS总分及各因子分呈负相关;数字广度测试与教育年限呈正相关;与阳性症状分、PANSS总分成负相关。回归分析表明精神分裂症患者认知功能与受教育年限及PANSS总分相关。结论:首发未治疗精神分裂症患者认知功能明显低于正常人,且患者的认知受损程度和其精神病症状有关。     

不同部位重复经颅磁刺激治疗对精神分裂症阴性症状及认知功能的影响

目的:探讨不同部位重复经颅磁刺激(r TMS)治疗对精神分裂症的阴性症状及认知功能的影响。方法:60例精神分裂症患者按照随机数字表法分为左、右前额叶背外侧皮质区组(L-DLPFC组、R-DLPFC组)及伪刺激组各20例;各组在服用原抗精神病药品种及剂量不变的基础上给予相应部位的真或伪r TMS治疗4周。分别于治疗前后应用阳性与阴性症状量表(PANSS)评价患者的精神症状,精神分裂症简明认知功能成套测评量表(BACS,包括言语流畅性、符号编码、数字序列、代币运动、语言记忆、伦敦塔及字词流畅性)评价患者的认知功能。结果:治疗前各组PANSS、BACS评分比较差异无统计学意义;治疗后,L-DLPFC组PANSS阳性因子及阴性因子评分较治疗前明显下降,显著低于R-DLPFC组及伪刺激组(P均0. 05),R-DLPFC组及伪刺激组治疗前后比较差异无统计学意义; L-DLPFC组BACS中各项成绩及R-DLPFC组的言语流畅性、字词流畅性评分明显好于伪刺激组(P均0. 05)。结论:L-DLPFC的r TMS治疗对精神分裂症患者的阴性症状及认知功能有明显的改善作用; R-DLPFC的r TMS治疗仅能部分改善认知功能。     

首发精神分裂症患者的认知功能与脑灰质体积的相关研究（英文）

背景:认知功能损害是精神分裂症的核心症状之一,其恢复程度关系到患者能否重新回归社会。目的:明确精神分裂症认知功能与脑灰质体积的关系。方法:采用画钟测试、连线测试、数字广度测试、听觉词语测试、威斯康星卡片分类测验、言语流畅性测试、语义相似性测验、斯特鲁色词测试对37例首发精神分裂症住院患者(病例组)和30名健康对照组(对照组)进行神经认知功能检测,采用面孔情绪认知任务测试对32例首发精神分裂症住院患者(病例组)和29名健康对照组(对照组)进行面孔情绪认知功能检测,采用阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)评定首发精神分裂症住院患者的精神症状,利用磁共振分别对病例组和对照组进行脑部影像学数据的采集。结果:病例组和对照组在画钟测试、连线测试、数字广度测验、听觉词语测验、威斯康星卡片分类测验、言语流畅性测验、语义相似性测验、斯特鲁色词测验反应时间中,两组间的差异有统计学意义;面孔情绪认知任务测试斜率(Slope)之间有统计学意义;病例组与对照组的脑灰质体积差异比较发现病例组的左侧额上回的灰质体积增加,左侧枕下回、舌回和小脑上部灰质体积减少;病例组神经认知数据与脑影像学数据分析,斯特鲁色词测验中的卡片C正确反应个数测验分数,显示与左侧额上回和右侧额上回、额中回灰质体积负相关;病例组面孔情绪认知任务与脑影像学数据分析,病例组转换斜率数据的相关灰质异常脑区为与右侧颞上回、颞中回,左侧颞中回、颞下回和梭状回灰质体积成正相关。结论:首发精神分裂症住院患者的神经认知功能和面孔情绪认知功能存在广泛性损害,上述结果提示灰质体积异常脑区可能为认知功能障碍的脑结构和功能基础。     

精神病未治疗期对首发未服药精神分裂症脑白质完整性的影响

目的 探讨精神病未治疗期(DUP)对首发未服药精神分裂症患者脑白质完整性的影响.方法 应用汉化的诺丁汉发病症状量表评定39例首发未服药精神分裂症患者的DUP,以其中位数为界将患者分为长DUP组和短DUP组,同时比较两组患者的性别构成、年龄、受教育年限、阳性和阴性症状量表总分.采用自旋回波序列得到弥散张量磁共振成像资料,以DTI-Studi0软件和统计参数图软件(SPM5)对所得图像进行预处理,得到的分子各向异性分数(FA)图像在SPM5软件中进行两样本t检验,获得两组FA差异统计参数图.结果 两组患者性别构成、年龄、受教育年限、阳性和阴性症状量表总分比较差异无统计学意义(P＞0.05).在P值小于0.001(未校正)水平下,长DUP组患者大脑右侧前扣带束(x=8,y=40,z=24)和左侧前额叶白质(x=32,y=34,z=4)FA值较短DUP组降低.结论 延长的DUP会降低首发未服药精神分裂症患者脑白质的完整性.     

Theory of mind disability in major depression with or without psychotic symptoms: a componential view

Previous reports have conceptualized theory of mind (ToM) as comprising two components and questioned whether ToM deficits are associated with psychotic symptoms. We investigated 33 nonpsychotic depressed inpatients, 23 psychotic depressed inpatients, and 53 normal controls with the following measures: Eyes Task, Faux pas Task, Verbal Fluency Test (VFT), Digit Span Test (DST) and WAIS-IQ. The depressed patients were also evaluated with the Beck Depression Inventory-II (BDI-II) and the Brief Psychiatric Rating Scale (BPRS). The nonpsychotic depressed patients and the psychotic depressed individuals were significantly impaired on tasks involving ToM social-perceptual and social-cognitive components, as well as the VFT. The psychotic depressed patients performed significantly worse than nonpsychotic depressed patients on ToM tasks. An association was found between ToM performances and both BPRS total and hostile-suspiciousness scores in the depressed group. Both of the ToM components were impaired in depressed patients. Similar mechanisms and neurobiological substrate may contribute to schizophrenia and major depression.     

Neuropsychological frontal impairments and negative symptoms in schizophrenia

Negative symptoms have been associated with frontal lobe dysfunction in schizophrenia. However, neuropsychological studies that evaluated the correlation between performance in tests sensitive to the dorsolateral prefrontal cortex (DLPFC) and negative symptoms have shown inconsistent results. Growing evidence has appeared that not only the DLPFC but other prefrontal regions could be involved in schizophrenia. We evaluated schizophrenic patients and healthy controls using three "frontal tests": the Wisconsin Card Sorting Test (WCST), the Iowa Gambling Task (GT) and a Theory of Mind test (Faux Pas), and studied the relationship between performance in these tests and negative symptomatology. Schizophrenic patients had worse performance than normal controls on the WCST, GT and Faux Pas test. The severity of the negative symptoms showed a moderate to high correlation with performance in the Faux Pas test. Our findings support the idea that different prefrontal regions could be affected in people with schizophrenia and that the damage to each of these regions could be, at least in part, independent of the damage to the others. Some negative symptoms could be associated with frontal medial cortex dysfunction.     

神经心理测验预测首发精神分裂症的近期预后

目的：筛选与首发精神分裂症近期预后有关的神经心理测查指标。方法：对１６４例首发精神分裂症患者随机给予氯丙嗪或氯氮平治疗,于治疗前分别作韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击测验、利手测验、动作功能测验、手功能协调测验、连线测验、连线测验Ｂ、威期康辛卡片分类测验（ＷＣＳＴ）及语言流畅性测验等１１项刘经心理测查各１次,并作ＢＰＲＳ、ＳＡＮＳ、功能总体评定量表（ＧＡＦ）各１次,治疗１２周     

Social cognition and Theory of Mind in patients with relapsing‐remitting multiple sclerosis

Background: Theory of Mind (ToM) is an ability to understand and interpret another person’s beliefs, emotions, and intentions. ToM requires both cognitive and emotional perspective taking and is deficient in several neuropsychiatric disorders all connected with impaired social functioning. Cognitive and mood dysfunctions have been recognized as common symptoms in multiple sclerosis (MS). Methods: We investigated social cognition in 40 ambulatory patients with MS compared to 35 healthy controls by using verbal and non‐verbal ToM tests (Faux Pas, Baron‐Cohen’s Adult Eyes and Faces test) and Baron‐Cohen’s Empathy questionnaire. The effect of disability and disease duration on social cognition was also analyzed by multiple logistic regression analysis after adjusting for confounding factors of age, gender, intelligence, depression, and anxiety. Results: Even when adjusted, patients with MS made significantly more mistakes in non‐verbal test (adult Eyes Test), and more disabled patients performed worse in both verbal and non‐verbal ToM tests (Eyes Test and Faux Pas) compared to controls. Patients with a shorter disease course described themselves as more empathetic. Discussion: In the absence of marked cognitive decline and disability, patients with ambulatory MS had a deficit interpreting social situations and performing in interpersonal contexts.     

从心理理论能力看精神病高危综合征人群转归

目的探讨精神病高危综合征人群临床转归与其心理理论(theory of mind,To M)特征的关系。方法利用前驱期综合症结构式访谈(structured interview for psychosis-risk syndromes,SIPS)和前驱期综合症量表(scale of psychosis-risk symptoms,SOPS)筛选出精神病高危综合征(clinical high risk,CHR)者90例,用失言觉察任务(faux pas test,FPT)、眼神阅读测试(reading the mind in the eyes text,RMET)评估CHR者心理理论特征。进行为期2年随访,利用SIPS确定临床转归,根据精神病转归情况将CHR者分为转化组(20例)和未转化组(50例),对两组基线水平临床症状特征、FPT、RMET结果进行分析,比较其心理理论的差异。结果两组CHR者在基线水平临床症状差异无统计学意义(P0.05);在FPT中,两组CHR失言故事识别得分、失言故事理解得分和失言任务总分存在统计学差异(P0.05),在对照故事识别得分上无统计学差异(P0.05);两组RMET各结果无统计学差异(P0.05)。结论精神病高危人群心理理论能力受损严重个体精神病转化的风险更高。     

Exploration of irony appreciation in schizophrenia

Irony is a form of speech used to convey feelings in an indirect way. Patients with schizophrenia demonstrated an impaired irony processing, associated with poor theory-of-mind. We investigated irony appreciation in a sample of 20 subjects with schizophrenic disorder by using cartoon images. The primary aim was to examine the association between Positive and Negative Symptoms Scale (PANSS) scores (i.e. positive, negative and cognitive) and irony visual joke appreciation. The group performed significantly worse in the Theory of Mind (ToM) condition than in the physical one. We report a significant relationship between ToM performances with PANSS positive and cognitive symptoms but not with negative symptom scores. Average humour score significantly correlated with positive symptoms, i.e. more severe symptoms, less funny the cartoon, while the difficulty in understanding the jokes was related to PANSS cognitive cluster score, i.e. more cognitive symptoms, less difficult the ToM jokes. Our results offer evidence for a compromised ToM capability in appreciating visual jokes linked to specific symptomatology.     

Exploring theory of mind after severe traumatic brain injury

Previous studies have reported a dissociation between social behavioral impairments after severe traumatic brain injury (TBI) and relatively preserved performances in traditional tasks that investigate cognitive abilities. Theory of mind (ToM) refers to the ability to make inferences about other's mental states and use them to understand and predict others' behavior. We tested a group of 15 patients with severe TBI and 15 matched controls on a series of four verbal and non-verbal ToM tasks: the faux pas test, the first-order and second-order false belief task, the character intention task and the Reading the Mind in the Eyes Test. Participants with severe TBI were also compared to controls on non-ToM inference tasks of indirect speech act from the Montreal Evaluation of Communication (M.E.C.) Protocol and empathy (Davis Interpersonal Reactivity Index - I.R.I.) and tests for executive functions. Subjects with TBI performed worse than control subjects on all ToM tasks, except the first-order false belief task. The findings converge with previous evidence for ToM deficit in TBI and dissociation between ToM and executive functions. We show that ToM deficit is probably distinct from other aspects of social cognition like empathy and pragmatic communication skills.     

Theory of mind and schizophrenia

In social cognition, the notion of Theory of Mind (ToM) is widely studied among people with schizophrenia to give an account for intersubjective disturbances. ToM is classically defined as the ability to make inferences about other persons'mental states, as beliefs, thoughts or intentions. However, ToM is not understood or explored as a homogeneous notion. First, this review briefly describes main theoretical models, as well as experimental tasks of ToM. Second, clinical results strongly suggest that patients with schizophrenia present impaired ToM performances. However, the presence of a robust relationship between ToM and schizophrenic symptomatology, or clinical course, is still controversial. Third, we highlight main findings from functional brain imaging studies based on ToM. Finally and in a more critical perspective, we suggest a few theoretical and experimental limitations regarding impaired ToM as a core feature of schizophrenic disturbances in social interactions.     

Executive Function Mechanisms of Theory of Mind

This study examined the relationship between Executive Function (EF) and Theory of Mind (ToM) using the Delis-Kaplan Executive Function System (D-KEFS) and three tests of ToM (Reading the Mind in the Eyes test (RMET), Strange Stories test, and Faux Pas test). Separate regression analyses were conducted, and EF predictors varied by ToM test. No EF domains accounted for significant variance in RMET scores; only estimated IQ scores were significant predictors of RMET performance. Verbal fluency and deductive reasoning were significant predictors of performance on the Strange Stories test, while verbal fluency, problem solving, and gender accounted for a significant variance in the Faux Pas test. Results suggest that the ToM tests each utilized differing cognitive mechanisms.     

Executive Functions in Patients with Familial versus Sporadic Schizophrenia and Their Parents

Background: The aim of this study was to investigate the executive functions in patients with sporadic schizophrenia (SS) and familial schizophrenia (FS), and the executive functions in their parents. Methods: The study included 30 patients with FS and their 37 parents with a positive family history of schizophrenia; 30 patients with SS and their 44 parents; 30 controls matched with the patients for gender, age and education, and 40 controls matched with the parents for gender, age and education (211 subjects in total). All the subjects were interviewed with the Structured Clinical Interview for DSM-IV-Axis I (SCID-I). The executive functions were assessed using the Verbal Fluency Test (VFT), the Trail Making Test (TMT), the Wisconsin Card Sorting Test (WCST) and the Stroop Test. Results: Patients with FS and their parents, and patients with SS performed significantly worse than their controls on the VFT, TMT, WCST and the Stroop test. There were no statistically significant differences between parents of patients with SS and their controls on any of the tests except for the Stroop color score. FS parents performed significantly worse than SS parents on all tests. FS patients performed significantly worse than SS patients on the VFT, TMT, Stroop test. Conclusion: Previous studies that investigated the cognitive functions of relatives of patients with schizophrenia brought out inconsistent results. The present study investigated relatives with and without a family history of schizophrenia separately and found that executive functions were impaired only in parents with a positive family history of schizophrenia. These findings suggest that impairment in executive functions may represent a genetic endophenotype for schizophrenia.