多元化治疗对首发精神分裂症患者疗效及认知功能改善的对照研究

目的探讨多元化治疗对首发精神分裂症患者疗效及认知功能改善的效果。方法将80例首发精神分裂症患者随机分为研究组40例（接受多元化治疗）和对照组40例（仅接受药物治疗）,共干预12周。在基线及治疗后第12周末分别进行阳性和阴性综合征量表（PANSS）、韦氏成人智力量表（WAIS．RC）、韦氏记忆量表（WMS）、威斯康星卡片分类测验（WCST）及治疗中需处理的不良反应症状量表（TESS）测定以评定疗效及不良反应。结果治疗后第12周末研究组PANSS总分、WCST的总测验数、持续错误数、随机错误数评分显著低于对照组（P〈0．05,P〈0．01）,WAIS—RC的语言智商量表、操作智商量表、总智商量表、WMS总分评分显著高于对照组（P〈0．05,P〈0．01）。两组TESS评分差异无统计学意义（P〉0．05）。结论多元化治疗可明显改善首发精神分裂症患者的精神症状及认知功能,安全性较高。     

音乐治疗对慢性精神分裂症患者康复效果及认知功能的影响

目的 探讨音乐治疗对慢性精神分裂症患者康复效果及认知功能的影响。方法 选取80例慢性精神分裂症患者随机分为研究组（抗精神病药物治疗辅助音乐治疗）和对照组（单纯抗精神病药物治疗）,各40例。采用阴性症状评定量表（SANS）、阳性症状评定量表（SAPS）、简明精神病评定量表（BPRS）及护士用住院病人观察量表（NOSIE）评价患者康复效果及认知功能变化。结果 治疗后研究组BPRS、SAPS、SANS量表总分均较治疗前降低（P〈0.05）;治疗后对照组BPRS和SAPS总分较治疗前降低（P〈0.05）。治疗后研究组BPRS、SAPS、SANS量表总分均低于对照组（P〈0.05）。研究组治疗后NOSIE总分及各因子分均较治疗前升高（P〈0.05）;对照组治疗后NOSIE总分较治疗前升高（P〈0.05）。治疗后,研究组NOSIE总分及各因子分均高于对照组（P〈0.05）。结论 慢性精神分裂症患者在抗精神病药物治疗的基础上辅以音乐治疗,可明显减少患者的精神症状,提高患者社会适应能力、社会兴趣和改善认知功能,值得临床推广应用。     

奥氮平对精神分裂症认知障碍的疗效及糖、脂代谢的影响

目的 观察奥氮平对精神分裂症患者认知功能障碍的疗效及其对患者糖、脂代谢影响。方法 将60例接受单一奥氮平治疗的精神分裂症患者，采用修订韦氏记忆量表（WMS-RC）评定记忆功能；威斯康星卡片分类测验（WCST）评定执行功功能；PANSS量表评定精神症状；并检测血糖、胆固醇和甘油三脂，分别在治疗前、治疗8周末各进行1次。结果 经过8用的奥氮平治疗后，记忆商数显著提高（P〈0．001）；威斯康星卡片分类测验的总测验次数、持续错误数及随机错误数均显著下降（P〈0，05或P〈0．01）；并且奥氮平对记忆功能、执行功能的改善与阳性症状、阴性症状的下降呈显著正相关。治疗8周末血糖、胆固醇和甘油三脂水平均显著高于治疗前（P〈0．05或P〈0．01）。结论 奥氮平能有效的改善精神分裂症患者的认知功能障碍，但应重视其对患者糖脂代谢的副作用．     

氨磺必利联合奥氮平对首发精神分裂症患者的疗效

目的探讨氨磺必利联合奥氮平用于首发精神分裂症患者中疗效,并观察其对患者认知功能的影响。方法收集2014年1月~2016年3月本院78例诊断为首发精神分裂症患者,随机分为对照组(奥氮平)与治疗组(奥氮平联合氨磺必利),每组各39例。分别于治疗前、治疗8周后采用阳性症状与阴性症状量表(PANSS)、威斯康星卡片分类测验(WCST)及韦氏记忆量表(WMS)评价患者其临床症状及认知功能改善情况;统计两组临床疗效及不良反应。结果治疗前两组患者的PANSS评分、WCST评分和WMS评分,组间差异无统计学意义(P0.05);治疗8周后,两组患者PANSS评分、WCST评分和WMS评分均较治疗前明显改善,且治疗组上述各项评分改善程度均优于对照组(P0.05)。治疗组治疗总有效率92.31%,明显高于对照组69.23%(P0.05);治疗期间两组患者均无严重性不良反应发生。结论氨磺必利联合奥氮平治疗首发精神分裂症可有效改善患者临床症状及认知功能,同时具有较好的安全性。     

氯氮平治疗对首发精神分裂症患者认知功能的影响

目的观察氯氮平治疗对首发精神分裂症认知功能的影响。方法将31例首发精神分裂症患者经氯氮平治疗前及治疗12周后,用韦氏成人智力量表、韦氏记忆量表、阳性症状量表、阴性症状量表、简明精神症状评定量表、维斯康星卡片分类测验进行评估,观察氯氮平对认知功能的影响及与精神症状变化的关系。结果治疗后,阳性症状量表、阴性症状量表、简明精神症状评定量表、维斯康星卡片分类测验中错误应答数的评估分值显著降低(P＜0．01)。维斯康星卡片分类测验中的非持续性错误、韦氏记忆量表中的再生、理解评估分值明显降低(P＜0．05)。结论氯氮平治疗精神分裂症可改善部分患者的认知功能。     

50岁以上精神分裂症患者的认知特征

目的：探讨50岁以上精神分裂症患者的认知损害特征及其影响因素。方法：对60例50岁以上精神分裂症患者和40例正常人进行了威斯康星卡片分类测验（WCST）、韦氏成人智力量表（WAIS－R）、韦氏记忆量表（WMS）、语言流利性测验（LF）、手指敲击测验（FTT）、简明精神病评定量表（BPRS）及阴性症状评定量表（SANS）等测查。结果：患者组的所有认知测查结果均较正常人显著减退,且年龄、病程、阴性症状及亚型对患者认知功能有显著影响。结论：年龄较大、病程较长、阴性症状较重及非偏执型的精神分裂症患者认知缺损严重。     

精神分裂症患者认知功能损害与阴阳性症状的关系

目的：探讨精神分裂症认知功能损害与阴性、阳性症状的关系。方法:至73例入组的患者随机给予利培酮、氯氮平治疗12周,并于治疗前、后盲法评定Wisconsin卡片分类测验（WCST）,Wechsler记忆测验（WMS）,阴状症状评定量表（SANS）与阳性症状评定量表（SAPS）。结果：治疗前精神分裂症患者的阴性症状、阳性症状均与认知功能有显著相关。主要与执行功能相关;注意障碍与记忆相关。治疗后,仅SAPS中怪异行为得分与WCST的持续反应数、持续错误数显著相关。结论：精神分裂症的认知功能损害是原发性的,并不是在阳性、阴性症状基础上产生的。     

阿尼西坦改善慢性精神分裂症患者认知功能的临床研究

目的探讨阿尼西坦改善慢性精神分裂症患者认知功能的疗效。方法将64例慢性精神分裂症患者随机分为研究组32例和治疗组32例,分别予以奎的平(350±50)mg/d治疗8周,研究组同时合并阿尼西坦100mg/d,并于治疗前及治疗后分别进行阳性和阴性症状量表(PANSS)、简明精神状态量表(MMSE)、中国修订韦氏成人智力量表(WAIS-RC)、韦氏记忆量表(WMS)及威斯康星卡片分类测定(WCST)等评定,并与正常人组成的对照组进行比较。结果治疗前研究组和治疗组的MMSE、WMS及WAIS-RC均低于对照组,差异有显著性(P〈0.05),提示患者的认知功能有广泛性损害。治疗后研究组MMSE、WCST、WMS、WAIS-RC分数与治疗前比较差异有显著性(P〈0.05),而治疗后治疗组的WCST、WMS、WAIS-RC分数与治疗前比较无显著性差异(P〈0.05)。结论阿尼西坦改善慢性精神分裂症患者的认知功能疗效确切。     

坦度螺酮辅助治疗精神分裂症临床研究

目的探讨坦度螺酮辅助治疗精神分裂症患者的临床疗效及认知功能改善效果。方法 64例精神分裂症患者随机分为对照组32例和研究组32例,治疗12周。治疗前及治疗后第12周末分别进行阳性和阴性症状量表(PANSS)、韦氏成人智力量表(WAIS-RC)、韦氏记忆量表(WMS)、威斯康星卡片分类测验(WCST)及不良反应症状量表(TESS)测定以评定疗效及不良反应。结果治疗第12周末研究组WCST的总测验数、持续错误数、随机错误数评分显著低于对照组(P0.05),临床有效率、WAIS-RC的语言量表、操作量表、总智商量表、WMS总分评分显著高于对照组(P0.05)。2组TESS评分差异无统计学意义(P0.05)。结论坦度螺酮可明显改善精神分裂患者的精神症状及认知功能,且安全性较高。     

老年精神分裂症患者认知功能与社会功能研究

目的探讨老年精神分裂症患者的认知功能及社会功能损害情况。方法采用一系列标准化神经心理测验工具：韦氏记忆测验（WMS）、威斯康星卡片分类测验（WCST）、简易智力状态检查（MMSE）和日常生活能力量表（ADL），测定45例老年精神分裂症患者（研究组）的认知功能和社会功能，并与42例正常老年人（对照组）作对照。结果研究组在WMS中的经历、定向、1→100、100→1、累加、再认、记图、再生、联想、触摸、理解、背数等项成绩均差于对照组（P均〈0．05或0．01）。WCST研究组总正确数和分类次数均小于对照组，而总错误数、持续错误数和持续反应数均高于对照组（P均〈0．01）。MMSE成绩研究组显著低于对照组（P〈0．05），ADL研究组显著高于对照组（P〈0．05）。结论老年精神分裂症患者存在突出的认知功能和社会功能损害。     

女性精神分裂症首次发病患者血清心肌酶的临床研究

目的:探讨女性精神分裂症首次发病患者血清心肌酶水平与病情的关系。方法:对63例首次发病的女性精神分裂症患者采用简明精神病评定量表(BPRS)、阳性症状量表(SAPS)及阴性症状量表(SANS)评估病情;同时测定血清乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平。根据心肌酶是否高于正常值分为:观察组(心肌酶增高组)30例和对照组33例(心肌酶正常组)。观察组于治疗4周后复查心肌酶和量表再次评估。结果:治疗前观察组血清LDH、α-HBDH、CK及CK-MB水平均显著高于对照组(P均0.01),其中以CK、CK-MB值增高显著(P均0.001);治疗后明显下降(P均0.01)。治疗前观察组SAPS评分较对照组显著增高,SANS评分较对照组明显降低(P均0.01),BPRS评分两组间差异无统计学意义;治疗后BPRS、SAPS评分显著下降(P均0.01)。观察组SAPS评分与血清CK、CK-MB水平呈正相关(r=0.42,P=0.02;r=0.37;P=0.04)。结论:女性精神分裂症首次发病患者血清心肌酶水平升高,并与病情严重程度及阳性症状密切相关。     

Duration of untreated psychosis may predict acute treatment response in first-episode schizophrenia

There is growing evidence for a relationship between the duration of untreated psychosis (DUP) and the prognosis in schizophrenia. The objective of this study is to evaluate whether DUP and premorbid level of social functioning are related to treatment response in acute treatment of first-episode schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed with BPRS, SAPS, and SANS on admission and discharge during their first hospitalisation. Percentage of the difference between admission and discharge in total scores of all scales were taken as measures of absolute symptom reduction. The median DUP was 6 months (mean=8.6). DUP was correlated with reduction in BPRS and SAPS scores but not SANS scores. Patients with a short DUP (n=41) also showed a higher reduction in BPRS, and SAPS scores than those with a long DUP. Premorbid Adjustment Scale (PAS) scores were inversely correlated with age at onset and positively correlated with BPRS scores at admission. We did not find any relationship between PAS scores and response to treatment. Our findings suggest that DUP may be an important predictor of response in acute treatment of first-episode schizophrenia and thus, attempts for early diagnosis may also have a positive effect on acute treatment response.     

家庭干预对首发精神分裂症患者辅助治疗的随访研究

目的:探讨家庭干预对首发精神分裂症患者预后的影响。方法:将90例首发精神分裂症患者随机分为抗精神病药物合并家庭干预组(干预组,45例)及单用抗精神病药物组(对照组,45例),进行为期1年的随访研究。采用家庭亲密度和适应性量表(FACESⅡ-CV)、家庭功能量表(FAD)、简明精神病评定量表(BPRS)、阳性症状评定量表(SAPS)及阴性症状评定量表(SANS)评估患者家庭状况和精神症状。结果:随访结束后,干预组家庭亲密度和适应性及家庭功能改善明显(P<0.01);干预组FACESⅡ-CV中的实际亲密度、理想亲密度因子评分显著高于对照组[(66.7±12.2)分、(57.7±10.4)分、(68.4±10.6)分、(55.8±9.7)分,P均<0.01],干预组FAD中的沟通、角色、情感反应、情感介入、行为控制及总的功能因子评分显著低于对照组(P均<0.05);两组BPRS、SAPS及SANS评分均较入组时有明显下降(P均<0.01),随访期干预组BPRS和SANS评分显著低于对照组[(19.6±10.7)分、(21.8±12.5)分、(16.7±6.4)分、(18.8±7.2)分,P均<0.01];多元逐步回归分析显示患者精神症状预后与基线期精神症状严重程度呈正相关,与基线期家庭功能及发病年龄呈负相关(t=2.65,-2.49,-2.79,P均<0.05)。结论:对精神分裂症患者进行家庭干预,可增加患者家庭亲密度和适应性,提高家庭功能,改善疾病预后。     

医院内职业康复对精神症状的影响

目的：评估医院内职业康复对慢性精神分裂症患者精神症状的影响。方法：83例慢性精神病住院患者随机分为康复组和对照组,对康复组病例施行医院内职业康复,在治疗前、后以简明精神病评定量表（BPRS）、阳性症状评定量表（SAPS）、阴性症状评定量表（SANS）、住院病人护士观察量表（NOSIE－30）评估。疗程6个月。结果：康复组BRPS总分及缺乏活力和思维障碍两个因子的减分值显著大于对照组;SAPS总分减分值两组间差异无显著性;康复组SANS总分及其各因子分的减分值均显著大于对照组;康复组NOSIE－30总分及社会兴趣因子的减分值显著大于对照组。结论：医院内职业康复对于慢性精神分裂症患者的精神症状有一定的影响,尤其有助于改善阴性症状。     

Insight in persons with schizophrenia: effects of switching from conventional neuroleptics to atypical antipsychotics

The primary aim of our study is to evaluate the level of insight during the switch from a classical antipsychotic drug to a atypical neuroleptic. Twenty-two schizophrenic patients were admitted to the study, 9 were male and 13 were female. Standardized questionnaire were: Scale for Assessment of Negative Symptoms (SANS), Scale for Assessment of Positive Symptoms (SAPS), Brief Psychiatric Rating Scale (BPRS) and Schedule for Assessing the three components of Insight (SAI). All patients were receiving haloperidol at time of recruitment. Eight patients were switched to clozapine, 3 to risperidone and 11 to olanzapine. The global function, measured with BPRS, increased after administration of atypical antipsychotics. The positive and negative symptoms were reduced. The level of insight was increased after the administration of the atypical antipsychotics. The cognitive effect of the atypical antipsychotics changed the level of insight and augmented the compliance.     

Obsessive-compulsive disorder in patients with first-episode schizophrenia

OBJECTIVE: The aim of the present study was to determine the rate of obsessive-compulsive disorder (OCD) in patients with first-episode schizophrenia. METHOD: Fifty patients consecutively hospitalized with first-episode psychosis who met DSM-IV criteria for schizophrenia spectrum disorders were assessed for OCD. The instruments used were the Structured Clinical Interview for DSM-IV, Schedule for the Assessment of Positive Symptoms (SAPS), Schedule for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Seven (14%) of the 50 schizophrenic patients met DSM-IV criteria for OCD and scored significantly lower than schizophrenic patients without OCD on the formal thought disorder subscale of the SAPS and the flattened affect subscale of the SANS. CONCLUSIONS: OCD is relatively frequent in patients with first-episode schizophrenia and may have a "protective" effect on some schizophrenic symptoms, at least in the early stages of the disease.     

Electroconvulsive therapy in first-episode schizophrenia

Knowledge about the efficacy of electroconvulsive therapy (ECT) on schizophrenia comes from chronic patients and little known on young, first-episode patients. The aim of this study is to evaluate short-term and long-term efficacy of ECT in patients with first-episode schizophrenia.In the first phase of the study, 90 hospitalized, first-episode patients with schizophrenia were enrolled; psychopathology was evaluated with Brief Psychiatric Research Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS) on admission and discharge. Antipsychotics were first-line treatment for most of the patients, but medication for nonrespondent catatonic patients and patients who had violent behaviors were treated with ECT. The patients who met the remission criteria were intended to a 1-year follow-up after discharge. BPRS, SAPS, and SANS were monthly recorded during the follow-up. Differences in clinical characteristics, relapse, and rehospitalization rates were analyzed in patients with or without ECT treatment.Thirteen patients were treated with ECT. They were low educated and were more likely nonparanoid subtypes (catatonic, disorganized). The ECT group had higher BPRS scores on admission and their hospitalization period was longer than the antipsychotic group. On the contrary, BPRS and SAPS scores of the ECT group were lower at discharge. The ECT group presented shorter follow-up duration than the antipsychotic group during the follow-up period. In conclusion, the efficacy of ECT was very satisfactory in acute term in first-episode schizophrenia, but the same efficacy was not continuous during the 1-year follow-up.     

哌泊噻嗪、氟哌啶醇癸酸酯与氟奋乃静癸酸酯治疗精神分裂症的对照研究

建桐翁正【摘要】目的验证和比较哌泊噻嗪、氟哌啶醇癸酸酯、氟奋乃静癸酸酯三种长效抗精神病制剂对精神分裂症的疗效及副反应。方法采用多中心、开放随机对照研究，以简明精神病评定量表（ＢＰＲＳ）、阳性症状评定量表（ＳＡＰＳ）、阴性症状评定量表（ＳＡＮＳ）、临床疗效总评量表（ＣＧＩ）和副反应量表（ＴＥＳＳ）、锥体外系副反应量表（ＲＳＥＳＥ）综合评定。结果治疗后哌泊噻嗪组患者的ＣＧＩＳＩ与ＣＧＩＧＩ分值和ＳＡＮＳ量表总分均低于其它两组，差异均有显著性（Ｐ＜０．０５），而ＢＰＲＳ和ＳＡＰＳ量表总分治疗结束时三组间差异无显著性（Ｐ＞０．０５）。ＴＥＳＳ总分和ＲＳＥＳＥ总分在整个治疗过程中均以氟奋乃静癸酸酯组最高，哌泊噻嗪组最低。结论三组中以哌泊噻嗪对精神分裂症的疗效较好，对阴性症状的改善优于氟哌啶醇癸酸酯组和氟奋乃静癸酸酯组，对阳性症状的疗效近似。哌泊噻嗪组副反应较少，安全度较好     

Improvement in social functioning in outpatients with schizophrenia with prominent negative symptoms treated with olanzapine or risperidone in a 1 year randomized, open-label trial

GENERAL PURPOSE: To evaluate the social functioning of schizophrenic outpatients after switching to second-generation antipsychotics. METHODOLOGY: Multi-center, randomized, open-label, parallel, flexible-dose, 1-year study of schizophrenic outpatients with prominent negative symptoms (defined as a SANS Global score > or =10), previously treated with conventional antipsychotics. Patients were randomly assigned (1:1 ratio) to treatment with an initial dose of at least 10 mg/day olanzapine (N = 120) or at least 3 mg/day risperidone (N = 115). Dosage could be modified during the study according to clinical criteria. Social functioning was evaluated using the total and subscales scores of the Social Functioning Scale (SFS) (validated Spanish version). Other efficacy measures included the SANS, SAPS, and CGI-S scales. Response was defined in advance as a 30% improvement in the SANS Global score. RESULTS: The mean doses during the trial were 12.2 mg/day (S.D. = 5.8) of olanzapine and 4.9 mg/day (S.D. = 2) of risperidone. There were no significant baseline differences in SFS total scores or other relevant clinical variables. At 1 year, olanzapine-treated patients presented a mean improvement in SFS total scores (7.75) that were significantly higher (p = 0.0028) than for risperidone-treated patients (-0.92). Treatment with olanzapine resulted in a greater numerical improvement than risperidone in all SFS domains and reached statistical significance in such categories as social engagement or withdrawal (p = 0.01), independence (performance) (p = 0.0098), independence (competence) (p = 0.04), recreational activities (p = 0.0391), and occupation/employment (p = 0.0024) in which the greatest difference between the olanzapine and risperidone groups was found (0.86 vs. -3.06). Significantly more patients treated with olanzapine reached or surpassed the SFS typified total scores corresponding to a functional level that is representative of a sample of stabilized Spanish outpatients with schizophrenia without prominent negative symptoms (p = 0.0009). Associated factors were treatment with olanzapine and a 30% improvement or more in SANS global score or SAPS global score. CONCLUSIONS: Long-term treatment with olanzapine was associated with overall greater improvement in social functioning (as measured by SFS) compared to risperidone-treated patients.     

工娱疗合并舒必利治疗精神分裂症阴性症状的对照研究

目的 探讨工娱疗合并舒必利对精神分裂症阴性症状的治疗康复作用。方法 将60例以阴性症状为主的精神分裂症患者随机分成两组,进行为期8周的对照研究,分别用工娱疗合并舒必利（研究组）和舒必利（对照组）治疗;采用BPRS、SANS、SAPS和临床疗效评定标准进行评定。结果 研究组在治疗后4周、8周末SANS评分较治疗前均有显著性差异。对照组仅在治疗后8周时SANS评分较疗前显著性差异。两组在治疗后4周,8周时SANS减分均数比较均有非常显著性差异（P＜0．01）。结论 工娱疗合并舒必利对精神分裂症阴性症状的疗效优于单用舒必利,且起效快。