首发和慢性精神分裂症急性期患者的感觉门控P50

目的探讨病程对精神分裂症感觉门控抑制缺陷的影响。方法对58名健康志愿者、38例首发精神分裂症急性期患者和36例慢性精神分裂症急性期患者进行感觉门控研究。应用听觉P50抑制评估感觉门控,实验模式为条件刺激（S1）-测试刺激（S2）模式。结果首发患者、慢性患者及对照组的S1波幅分别为（3.7±2.5）μV、（4.5±2.0）μV和（5.8±3.8）μV（F=5.P〈053,.01）,首发患者的S1波幅低于对照组（P〈0.01）;S2波幅分别为（2.8±1.1）μV、（3.5±1.5）μV和（2.1±1.4）μV（F=11.47,P〈0.01）,首发和慢性患者的S2波幅均高于对照组（P分别为0.02,小于0.01）,并且慢性患者的S2波幅高于首发患者（P=0.02）。P50抑制指标在三组之间差异均有统计学意义（P均小于0.01）,首发和慢性患者的S2/S1波幅比均大于对照组（P均小于0.01）,而S1-S2波幅差值和100（1-S2/S1）均低于对照组（P均小于0.01）,但首发患者和慢性患者之间P50抑制指标差异无统计学意义（P均大于0.05）。结论首发精神分裂症和慢性精神分裂症均存在明显的感觉门控P50抑制缺陷,病程对精神分裂症的感觉门控P50抑制缺陷无明显影响。     

焦虑症患者认知电位P300及感觉门控P50特点

目的探讨焦虑症患者的认知电位P300及感觉门控P50的特点。方法选取2014年1月-10月在珠海市慢性病防治中心心理科门诊就诊的符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)焦虑症诊断标准的患者67例。采用汉密尔顿焦虑量表14项版(HAMA-14)评定病情严重程度,并进行认知电位P300及感觉门控P50检测,与40名正常人(对照组)进行比较。结果 1焦虑症组P300潜伏期较对照组长[(378.26±53.47)ms vs.(332.65±37.78)ms,(P0.01)];2焦虑症组P50抑制比(S2/S1波幅比值)高于对照组[(89±41)%vs.(55±20)%,P0.01]。结论焦虑症患者P300潜伏期较正常人长,认知功能减退;听感觉门控电位P50抑制存在缺损,不能有效滤过无关信息。P300及P50检测可能成为筛查焦虑症患者早期认知功能损害的辅助指标。     

抑郁症的事件相关脑电位P300实验研究

目的探讨抑郁症听觉事件相关电位P300的变化特点。方法对35例抑郁症患者和31名健康成年人，应用美国NieoletBravo脑诱发电位仪进行P300检测。结果与正常组相比，抑郁症组Oz点P3潜伏期延迟[正常组（315±29）ms，抑郁症组（341±31）ms，t=3．50，P〈0．01]，P2潜伏期延迟[正常组（165±19）ms，抑郁症组（175±21）ms，t=2．02，P〈0．05]，P3波幅降低[正常组（9．5±6．1）μV，抑郁症组（4．5±3．1）μV，t=4．27，P〈0．01]，非靶P2波幅降低[正常组（4．2±1．2）μV，抑郁症组（2．3±1．3）μV，t=6．14，P〈0．01]。结论P300是评定抑郁症患者大脑综合功能的有效工具，在临床上值得进一步推广应用。     

抗精神病药对精神分裂症首次发病患者听感觉门控P50的影响

目的探讨抗精神病药对精神分裂症首次发病患者听感觉门控电位P50的影响。方法采用配对听觉条件（S1）、测试（S2）刺激范式，对33例未经抗精神病药治疗的精神分裂症首次发病患者（患者组），给予第一代和第二代抗精神病药治疗，分别于治疗前、治疗6周后进行听觉诱发电位P50检测，并与30名健康成年人（对照组）对照。结果（1）治疗前，患者组S1波幅[（1．86±0．90）μV]低于对照组[（2．79±1．70）μV]，波幅比值S2／S1（1．03±0．61）高于对照组（0．46±0．26），差异均有统计意义（P〈0．05～0．01）；两组s2波幅及潜伏期的差异均无统计意义。（2）治疗6周后，患者组P50检测结果与治疗前相比，差异均无统计意义。（3）与第一代抗精神病药相比，第二代抗精神病药能提高S1波幅（P〈0．05）。结论精神分裂症患者治疗前已存在P50抑制异常，经两类抗精神病药治疗6周仍未能明显改善；与第一代抗精神病药相比，第二代抗精神病药治疗可提高S1波幅。     

无抽搐电休克治疗首发精神分裂症患者P300的对照研究

目的：观察无抽搐电休克（MECT）治疗首发精神分裂症患者前后事件相关电位P300的变化,探讨MECT对认知功能的影响。方法：应用美国脑诱发电位仪,对48例精神分裂症患者和50名正常者在MECT治疗前后进行P300检测,观察MECT治疗前后P300的变化。结果：与正常组比较,患者组P300中的靶刺激N2和P3潜伏期延迟（P〈0．01）,靶刺激P3波幅降低（P〈0．05）。患者组经过MECT治疗后P300靶刺激N2和P3潜伏期均有所缩短（P〈0．05）,靶刺激P3波幅升高（P〈0．01）。结论：MECT治疗精神分裂症患者后P300有显著变化,MECT可以改善精神分裂症患者的认知功能。     

精神分裂症首发患者的非匹配负波及P300随访研究

目的了解精神分裂症首发患者非匹配负波（MMN）和P300的特征以及治疗缓解后脑电波的变化。方法应用美国Bravo脑电生理仪,比较58例首发分裂症患者和54名健康人的MMN和P300电位,并用阳性和阴性症状量表（PANSS）评定患者精神症状。患者组于治疗5周和14周时随访MMN和P300。结果①精神分裂症首发患者组的MMN潜伏期[（222.4±33.0）ms]比正常对照组[（200.5±30.1）ms]延迟（t=3.66,P〈0.01）,波幅[（4.6±3.3）μV]比对照组[（7.9±3.9）μV]低（t=4.85,P〈0.01）。患者组P300中靶潜伏期P3同时延迟;②MMN潜伏期延长和波幅低,与PANSS阳性症状和思维障碍分呈负相关（r=-0.381,P〈0.05,r=-0.459,P〈0.01）;患者组经治疗14周后,MMN波幅呈增大改变和潜伏期缩短。结论MMN和P300联合应用可能作为精神分裂症首发患者临床检测指标。     

难治性精神分裂症患者治疗前后感觉门控P50的变化

目的探讨难治性精神分裂症患者治疗前后感觉门控P50的变化特点。方法采用配对听觉条件（s1）、测试（S2）刺激范式,对36例难治性精神分裂症患者进行听觉诱发电位P50检测,测量P50的潜伏期、波幅,并与32例健康被试（对照组）进行比较。结果（1）与对照组比较,患者组S1潜伏期显著延迟,波幅显著降低（P〈0．05）;S2潜伏期和波幅差异无统计学意义（P〉0．05）;s2／s1显著升高（P〈0．05）。（2）与治疗前（8Z．21±8．59）比较,患者组治疗6周后PANSS得分（37．00±6．86）显著降低（t=16．81,P〈0．05）。（3）与治疗前比较,治疗后S1潜伏期显著缩短,波幅显著升高（P〈0．05）,S2潜伏期、波幅差异均无统计学意义（P〉0．05）,S2／S1显著降低（P〈0．05）;与对照组比较,$2／S1仍显著偏高（P〈0．05）。结论难治性精神分裂症患者感觉门控抑制能力有缺陷,提示P50比率可能是难治性精神分裂患者的一个潜在的素质性生物学标记。     

帕金森病合并抑郁患者认知功能和P300的研究

目的 探讨帕金森病（PD）合并抑郁患者认知功能和P300的改变。方法 对67例PD患者依据Zung抑郁自评量表（SDS）和汉密顿抑郁量表（HAMD）评分分为PD抑郁组（22例）和PD非抑郁组（45例），分别对两组患者进行认知功能评定和P300检测，并对结果进行比较和相关性分析。结果 本组PD患者简明智力状态量表（MMSE）评分尚在正常范围，但明显低于正常对照组（P〈0．05），PD抑郁组MMSE评分更低（P〈0.01）；与正常对照组比较，PD组P300潜伏期延长、波幅降低（均P〈0．05），PD抑郁组改变更为明显（均P〈0．01）；PD组P300潜伏期与MMSE评分呈负相关（r=-0．413，P〈0．05），波幅与MMSE评分呈正相关（r=0．398，P〈0．05）。结论 PD患者存在认知功能障碍，以记忆损害最为明显；抑郁对认知功能有负性影响，P300检测可以早期发现PD患者的认知功能障碍。     

首发与复发精神分裂症患者空间认知功能的差异研究

目的探讨首发与复发精神分裂症患者空间认知功能的差异。方法对30例精神分裂症首次发作患者（首发组）、32例复发精神分裂症患者（复发组）进行视觉空间旋转任务的测定,测量其错误数和反应时,并与30名健康志愿者的结果进行比较。结果（1）与对照组（8．6±2．7）％相比,首发组（26．8±8．4）％、复发组（35．3±9．6）％错误率均显著升高,且首发组错误率低于复发组,差异有统计学意义（P〈0．05）。（2）与对照组（722．5±76．8）ms相比,首发组（801．2±85．1）ms、复发组（863．1±87．2）ms反应时显著延长,且首发组反应时显著短于复发组（P〈0．05）。（3）首发、复发组错误率、反应时正镜像差异消失（P〉0．05）。（4）线性回归分析发现,对照组正镜像错误率、反应时均随着旋转角度递增呈线性递增函数（P〈0．01）;首发、复发组正镜像错误率、反应时均没有随着旋转角度递增呈线性递增函数（P〉O．05）。结论首发、复发精神分裂症患者视觉空间认知功能均受损,更多受损发生在镜像转化为正像的平面外旋转,且复发患者受损程度大于首发患者。提示空间认知功能受损可能为一种更严重的继发性高级认知功能障碍。     

阿立哌唑和奎硫平对首发精神分裂症患者认知功能影响的临床研究

目的研究阿立哌唑和奎硫平对首发精神分裂症患者认知功能的影响。方法将44例符合CCMD--3的首发精神分裂症患者在治疗前用韦氏记忆量表（WMS）和事件相关电位P300进行相关评定;在正常人群中选取22例作为对照组。将44例首发精神分裂症患者按随机数字表分为两组,即阿立哌唑组24例和奎硫平组20例,分别给予阿立哌唑和奎硫平治疗6周后再次用WMS和事件相关电位P300进行相关评定。结果首发精神分裂症患者的长时记忆、短时记忆、瞬时记忆及记忆商数（MQ）受损较为明显,P300电位成分中P2、P3波幅明显降低,P2、N2及P3潜伏期明显延长,与对照组比较差异有统计学意义（P〈0．05）。阿立哌唑组和奎硫平组患者WMS的再认、联想、理解及MQ在治疗前后差异有统计学意义（P〈0．05）,而P300各指标在治疗前后差异无统计学意义（P〉0．05）。治疗后两组间WMS各项目、P300各指标之间比较差异无统计学意义（P〉0．05）。结论首发精神分裂症患者存在着认知功能障碍,阿立哌唑及奎硫平能改善首发精神分裂症的认知功能。     

Duration of untreated psychosis and neuropsychological function in first episode psychosis

PURPOSE: We investigated whether duration of untreated psychosis (DUP) prior to first presentation was associated with cognitive function in first episode psychosis (FEP) subjects. We predicted that longer DUP would be associated with greater neurocognitive impairment. METHOD: 180 subjects with schizophrenia (and 93 subjects with Other Psychoses) performed a neurocognitive battery assessing IQ, verbal learning, working memory, visual learning and speed of processing. DUP was defined as the number of days between first onset of psychotic symptoms and first contact with psychiatric services. RESULTS: Longer DUP was associated with impaired performance in verbal IQ (p=0.04), verbal learning (p=0.02), and verbal working memory (p=0.04) in FEP subjects with schizophrenia. These associations remained significant for verbal IQ when scores were corrected for age, gender, educational level and ethnicity. CONCLUSIONS: Longer DUP is associated with poorer neurocognitive ability in schizophrenia subjects at time of first presentation. Since this was a cross-sectional study we can not tell whether longer DUP was a cause or a consequence of the poorer performance.     

Influence of duration of untreated psychosis on auditory P300 in drug-naive and first-episode schizophrenia

P300 amplitude reduction in schizophrenia is, according to previous studies, partially recovered by treatment with neuroleptics. However, whether this medication-induced P300 recovery is associated with duration of untreated psychosis (DUP) remains unreported; the present study is a preliminary examination of this question. Auditory P300 was recorded from 18 drug-naive and first-episode schizophrenia patients, among whom 10 were identified as short DUP, and eight as long DUP. Follow-up event-related potential tests were carried out after treatment with haloperidol or bromperidol for approximately 2 months. Recovery of P300 amplitude was replicated after neuroleptic medication was administered. A significant interaction was found between DUP and the medication effect in P300 amplitude over the left temporo-parietal area; a significant P300 recovery was seen in short DUP but not in long DUP. These results suggest that first-episode schizophrenia patients with long DUP might have severe impairments in the left temporal structures, supporting DUP as a key variable in future neurobiological studies of first-episode schizophrenia.     

青海省藏族精神分裂症未治期及影响因素分析

目的探讨藏族精神分裂症患者精神病未治期(duration of untreated psychosis,DUP)的影响因素。方法采用精神分裂症患者精神卫生服务利用调查问卷及精神分裂症首发症状评定量表对188例藏族精神分裂症患者的社会人口学资料、精神疾病家族史、家庭类型、起病形式、医疗付款方式、居住地、自评家庭收入水平、首发症状出现的时间等进行调查,分析DUP影响因素。结果患者DUP呈偏态分布,中位数375 d(QL=4 d,QU=1661 d)。将患者分为短DUP组(DUP≤375 d)90例和长DUP组(DUP375 d)98例,不同DUP组患者的起病形式、婚姻状况、文化程度、家庭类型、居住地的组间差异有统计学意义(P0.05)。DUP影响因素的logistic回归分析显示,结构缺失的家庭(OR=2.340,95%CI:1.130~4.847,P=0.022)、慢性起病(OR=2.136,95%CI:1.172~3.891,P=0.013)、居住在农牧区(OR=2.239,95%CI:1.097~4.571,P=0.027)与长DUP相关联。结论藏族精神分裂症DUP较长,受多种因素影响,主要的危险因素有结构缺失的家庭、慢性起病、居住在农牧区。     

Clinical and social determinants of a longer duration of untreated psychosis of schizophrenia in a Japanese population

Aim: To measure the duration of untreated psychosis (DUP) among patients with schizophrenia in a Japanese population and to investigate clinical and social determinants of the DUP. Methods: A multicentre, retrospective study at seven medical centres in three cities (Tokyo, Toyama and Kochi) was performed. In total, 150 consecutive patients (78 men) with neuroleptic-naïve first-episode schizophrenia were investigated; their DUP and demographic, clinical and social variables were obtained from their medical charts and analysed. Results: The intraclass correlation coefficient for the DUP was quite good (ICC = 0.849). The mean DUP of all the subjects attending the seven psychiatric services was 20.3 months, and the median DUP was 6.0 months. Fourteen patients (9.3%) had a DUP of more than 60 months, and 47 patients, or about one-third, had a DUP of more than 24 months. No significant differences in the mean DUPs were observed among the three cities. Patients who were employed or who were students had a significantly shorter DUP (14.3 months). The median DUP for those with an insidious onset of psychosis (n = 85) was 18.0 months, compared with a median of 2.0 months for those with a sudden and acute onset (n = 61). However, no other clinical or social variables examined in this study were associated with differences in the DUP. Conclusions: The DUP of patients with schizophrenia is relatively long in Japan. The provision and modification of psychiatric services for easy access and a system for the early recognition and detection of mental illness are needed.     

Duration of untreated psychosis,ethnicity, educational level,and gender in a multiethnic South‐East Asian country: report from Malaysia schizophrenia registry

Introduction: Duration of untreated psychosis (DUP) determines the outcome of schizophrenia. Previously, there was no information about the DUP among patients in Malaysia with schizophrenia. The aim of the present study was to investigate the association between DUP and patients' demographic, social cultural background and clinical features. Method: This is a cross‐sectional study on patients who presented with first episode schizophrenia. Data from 74 primary care centers and hospitals between 1 January 2003 and 31 December 2007 were included in the analysis. All patients with first‐episode schizophrenia were enrolled in the study. Results: The mean DUP was 37.6 months. The indigenous community appeared to have the shortest DUP compared to the Malay, Chinese and Indian communities. Female, people with lower educational level, and comorbidity with medical illness during contact had longer DUP. Discussion: DUP in this multiethnicity country was found to be significantly short among the indigenous people, which may sugest that traditional values and strong family and community ties shorten the DUP. Educational level may need to be further investigated, because as upgrading the general educational level could lead to shorter DUP among the patients as well.     

Duration of untreated psychosis and treatment outcome in schizophrenia patients untreated for many years

OBJECTIVE: The duration of untreated psychosis (DUP) influences treatment outcome in schizophrenia but its relevance in untreated patients, ill for a very long duration, is not known. This study examined outcome and factors related to it after one year of treatment of schizophrenia patients who were ill for many years and not previously treated. METHOD: Among 75 never-treated patients with schizophrenia detected in a community survey in Chennai, India, 49 took treatment and were followed up prospectively for one year. Evaluation at intake and outcome was carried out using standardized methods. RESULTS: A good clinical outcome in 29%, social outcome in 35%, occupational outcome in 51% and global outcome in 31% was observed at the end of one year. Patients with poor global outcome did not significantly differ from those with good outcome on demographic and clinical variables at intake but for the presence of delusions and formal thought disorder. The proportion with good outcome in clinical, work and global measures fell steadily with increasing DUP. This difference was significant for clinical and global outcomes after a DUP of 5 years. CONCLUSIONS: The relationship between DUP and response to treatment held good even in chronic stages of schizophrenia with longer DUP associated with poorer outcome.     

Influence of self-efficacy on the interpersonal behavior of schizophrenia patients undergoing rehabilitation in psychiatric day-care services

Aim: The present study examined whether the self‐efficacy of interpersonal behavior influenced the interpersonal behavior of schizophrenia patients using psychiatric day‐care services. Methods: Thirty‐nine patients with schizophrenia were examined with the Interpersonal Relations subscale of the Life Assessment Scale for Mentally Ill, the Self‐efficacy Scale of Interpersonal Behavior, the Brief Assessment of Cognition in Schizophrenia–Japanese version, and the Positive and Negative Syndrome Scale. Results: The Life Assessment Scale for Mentally Ill score was significantly correlated with the self‐efficacy of interpersonal behavior, and was also significantly correlated with neurocognitive functions and negative symptoms. However, the Self‐efficacy Scale of Interpersonal Behavior score was not correlated with neurocognitive functions and negative symptoms. To examine the causal correlations between the above social, psychological and clinical factors, multiple regression analysis was performed with the self‐efficacy of interpersonal behavior, neurocognitive functions, and negative symptoms as the independent variables and interpersonal behavior as the dependent variable. The self‐efficacy of interpersonal behavior was found to contribute to interpersonal behavior as well as neurocognitive functions. Conclusion: The self‐efficacy of interpersonal behavior contributed to the interpersonal behavior as well as the neurocognitive functions in the case of schizophrenia patients in the community. This suggested that interventions targeting the self‐efficacy of interpersonal behavior, as well as those targeting neurocognitive functions, were important to improve the interpersonal behavior of schizophrenia patients undergoing psychiatric rehabilitation in the community.     

Duration of untreated psychosis is associated with orbital-frontal grey matter volume reductions in first episode psychosis

BackgroundDelay in treatment of psychosis is associated with poor clinical and social outcome and is measured as the duration of untreated psychosis (DUP) prior to treatment of the first episode. It has been suggested that this may be mediated through toxic effects of psychosis on the structure and function of the brain. Equivocal evidence exists regarding association between longer DUP and neuro-anatomical changes such as, reduced grey matter volume in specific regions in the brain and deficits in neurocognitive functions.ObjectiveTo examine if duration of untreated psychosis (DUP) preceding treatment of a first episode of psychosis is associated with structural brain abnormalities and deficits in neurocognitive functions.MethodWe investigated the relationship between DUP and grey matter volume using voxel-based morphometry techniques and with multiple domains of cognition. Eighty patients with a first episode of psychosis were separated into two equal sized groups based on a median split (18 weeks) of their DUP.ResultsCompared to the short-DUP group (mean DUP 7.9 weeks ± 5.6), the long-DUP group (mean 113.7 weeks ± 170.4) showed significant grey matter volume reductions in orbital–frontal regions (bilateral medial frontal gyrus and bilateral rectal gyrus, BA 11) and parietal regions (postcentral gyrus and superior parietal lobule) as well as a significant reduction in whole brain grey matter volume (p < 0.04). For schizophrenia spectrum cases only these findings were confined to left rectal gyrus. There were no differences in white matter or cerebral spinal fluid volumes or on cognitive functions. Results are controlled for antipsychotic medication exposure.LimitationsThe inherent difficulty in separating slow and insidious onset from long-DUP may limit the interpretation of our results and there may be an overlap between DUP and duration of illness (including the prodrome).ConclusionPatients with a longer delay in treatment of psychosis show a significant reduction in overall grey matter volume with specific reductions in the inferior-orbital region. These results provide some support to a possible neurotoxic effect of prolonged untreated psychosis.     

精神分裂症未治期及其影响因素研究

目的 了解精神分裂症患者首次正式开始治疗前的疾病未治疗期间(duration of untreated illness, DUI)和精神病未治疗期间(duration of untreated psychosis,DUP)及其影响因素.方法 应用诺丁汉起病症状量表(Nottingham onset schedule, NOS)调查上海市精神卫生中心的精神分裂症患者,共收集117例.同时,应用自编问卷对患者家属进行访谈,调查可能影响患者及时就诊的因素.结果 ① 精神分裂症患者DUI中位数是181天, DUP中位数是84天.② 首发非特异性精神症状以失眠和情绪障碍最为常见,出现频度超过50%;首发精神病性症状以幻听和被害妄想最为常见,出现频度达到47%.③ 影响患者就诊的主要因素是家属不认识精神病和患者不愿接受诊治.④ 以DUI中位数181天将患者区分为长DUI组和短DUI组,发现:长DUI组中回答家庭成员意见不一致是延误就诊因素的比例显著高于短DUI组(χ2=3.9,P<0.05).结论 精神分裂症患者从发病到开始治疗的疾病未治疗期间较长.影响DUI和DUP的因素是多方面的,值得进一步深入研究.     

Measurement and reporting of the duration of untreated psychosis

Aim: The aim of this study was to investigate the demographic, illness and methodological factors associated with mean and median duration of untreated psychosis (DUP). Methods: A systematic review and meta‐analysis of the published studies of DUP and an examination of available DUP distributions. Results: DUP was longer in samples with a higher proportion of patients with schizophrenia and was shorter in samples that included affective psychosis. Sex, age, and the methods of measuring the onset and end‐point of DUP and the type of service in which the studies were performed did not contribute to the heterogeneity of the mean or median DUP values. Mean DUP is significantly prolonged by a small number of patients, and the median DUP is a poor indicator of the rate at which patients present. Conclusions: The DUP of patients with affective and non‐affective psychosis should be examined separately in order to make measures of DUP more meaningful and comparable, and DUP should be reported using more comprehensive measures. We suggest a method of reporting DUP based on the rate of presentation of first‐episode psychosis patients rather than the length of DUP.