缺陷型,非缺陷型精神分裂症患者WAIS—RC测验结果分析

目的 探讨缺陷型、非缺陷型精神分裂症患者认知功能障碍的特点。方法对21例缺陷型精神分裂症、33例非缺陷型精神分裂症患者进行WAIS-RC测验,同时对缺陷型精神分裂症患者进行SANS评定。结果 缺陷型精神分裂症患者除数字广度、词汇、木块图测验外,WAIS-RC总分及各分测验分均较非缺陷型精神分裂症患者为低,有显著性差异(P<0.05)。相关分析显示,缺陷型精神分裂症患者WAIS-RC总分及各成分与阴性症状总分均呈显著负相关。结论 缺陷型精神分裂症患者存有更为严重的认知功能损害,其严重程度与阴性症状密切相关。     

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。     

长期住院对精神分裂症患者认知功能的影响

目的：探讨长期住院对精神分裂症患者认知功能的影响。方法：对56例长期住院（≥5年）与49例住院时间较短（≤1年）的精神分裂症患者的精神症状和认知功能进行比较，采用阳性与阴性症状量表（PANSS）、韦氏成人智力量表（WAIS-R）、威斯康星卡片分类试验（WCST）等评定患者的认知功能。结果：长期住院（≥5年）组在智商、注意、记忆，以及信息整合与执行功能等均显著较差。结论：长期住院对精神分裂症患者认知功能有负面影响。     

精神分裂症患者执行功能损伤特点的研究进展

为进一步研究精神分裂症患者认知功能障碍各子领域损伤的特点,本文对执行功能这一子领域的损伤特点进行定性系统综述,为深入研究精神分裂症患者各认知领域发生机制提供参考,并为精神分裂症患者执行功能损伤提供临床诊疗指导。本综述将从精神分裂症患者执行功能损伤的评定方法、临床表现、与其他精神症状和其他认知功能障碍的关系、涉及机制和药物治疗等方面进行阐述。     

影响慢性精神分裂症患者认知功能的多因素分析

目的：探讨慢性精神分裂症病人认知功能的影响因素。方法：采用简明智能评定量表、简明精神病评定量表（BPRS）、自知力与治疗态度问卷（ITAQ）对80例长期住院的慢性精神分裂症病人进行评定，以简明智能评定量表的总分（智能百分比）及其6个因子变量，以能够反映病人病情的BPRS总分、BPRS的5个因子分、ITAQ总分以及病程、Andrensens分型、年龄、首发年龄、受教育年限、家族史等因素为自变量，进行因素分析。结果：显示认知功能和总病情、Andrensens分型和受教育年限等有关，而与病程及其它因素无明显相关，结论：精神分裂症的认知功能障碍与病情和阴性症状密切相关，但不随病程而加重，提示认知功能障碍是独立于阴性症状以外的第三个症状成分。     

多巴胺D3受体对精神分裂症患者认知功能的影响

认知功能障碍是精神分裂症患者核心症状之一,对患者的生活质量和日常功能有重要影响。研究发现多巴胺D3受体(DRD3)主要与注意、记忆及执行功能等认知功能相关。本文从DRD3与精神分裂症认知功能的相关性及其具体机制以及相关治疗进展进行综述,为改善精神分裂症患者相关认知功能障碍提供依据。     

首发及慢性精神分裂症患者与健康人认知功能的差异

目的比较首发及慢性精神分裂症与健康人认知功能的差异,并探讨影响认知功能的相关因素。方法符合美国精神障碍诊断与统计手册第四版（DSM—Ⅳ）诊断标准的首发精神分裂症住院患者90例,慢性精神分裂症患者89例,健康人94例;使用重复性神经心理测查系统（RBANS）检测认知功能,阳性和阴性症状量表（PAN-SS）、临床总体印象量表（CGI）评估患者精神症状及严重程度,Simpson锥体外系不良反应量表（SEPS）、异常不自主运动评定量表（AIMS）评定锥体外系不良反应及迟发性运动障碍。结果三组教育年限之间差异有统计学意义（F=41,P〈0．001）,即刻记忆和延时记忆因子在慢性患者和首发患者之间差异不显著,无统计学意义（P=0．42,P=0.13）,RBANS总分及其它因子分在三组之间均有显著性差异（P〈0.05—0．001）;慢性患者的受教育年限、既往住院次数、病程、精神症状、AIMS、SEPS与认知功能存在着显著相关性（P〈0．05～0．000）;首发患者的年龄、受教育年限、首次精神症状发生年龄、精神症状、CGI与认知功能存在着显著相关性（P〈0．05—0．000）。结论认知功能障碍是精神分裂症的核心症状之一;影响首发精神分裂症和慢性分裂症患者认知功能的因素有一定的差异。     

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。     

哈伯因对精神分裂症记忆障碍的疗效

目的：探讨哈伯因对精神分裂症患者记忆功能障碍的疗效。方法：80例首发精神分裂症患者平分为哈伯因合并奎硫平治疗(合用组)和单用奎硫平治疗(单用组)，疗程8周。采用阳性与阴性症状量表(PANSS)、韦氏记忆量表修订版(WMS—RC)评定精神症状及记忆功能，分别于治疗前、治疗8周各评定1次。结果：治疗后两组患者记忆功能损害和精神症状均获得显著改善，两组间无显著差异，记忆功能的改善与精神症状的改善相关。结论：哈伯因对精神分裂症的记忆功能障碍疗效不明显。     

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．     

长春西汀对认知功能障碍的疗效观察

目的：探讨长春西汀对恢复期精神裂症患者认知功能障碍的治疗作用。方法：对31例疗效已达显著进步以上的精神分裂症患者，随机分为研究组（16例）和对照组（15例），在予长春西汀治疗前、后、对两组患者分别评定其认知障碍及脑血流状况，进行分析。结果：研究组治疗前后有显著好转，而对照组差异无显著性。结论：长春西汀对改善精神分裂症患者的认知障碍有益。     

精神分裂症症状与认知功能损害的关系

目的：探讨精神分裂症症状与认知功能损害的关系。方法：对１８例阴性精神分裂症和１５例阳性精神分裂症采用氯氮平治疗;对１１例阴性精神分裂症和１３例阳性精神分裂症采用利培酮治疗。并分别评估其治疗前和治疗８周后的阳性症状,阳性症状记忆,注意及执行功能。结果：精神分裂症的记忆损害与阴性症状和阳性症状都呈显著性相关,注意及执行功能损害与阴性症状显著相关,与阳性症状无明显相关;记忆随思维贫乏的改善而改善,注意和执行功能损害的改善与症状的改善无明显相关。结论：精神分裂症认知功能损害主要与阴性症状相关,但精神分裂症的大部分认知功能并不随阴性症状改善而改善。     

Efficacy and tolerability of low-dose donepezil in schizophrenia

There have been many advancements in the pharmacologic treatment of schizophrenia; however, negative symptoms and cognitive impairment remain an intractable part of this illness. Donepezil is an anticholinesterase inhibitor with cognitive enhancing effects approved for the treatment of Alzheimer disease that has shown some benefit in the treatment of schizophrenia. In this study, 15 inpatients at a state hospital with a history of schizophrenia were administered donepezil in a randomized, double-blind, crossover design. Neurocognitive testing and psychiatric ratings were completed at baseline and at regular intervals for 18 weeks. Results indicated that donepezil treatment was associated with modest improvements in psychiatric symptoms and improved verbal learning. These results suggest that donepezil may be helpful as adjunctive therapy for the treatment of psychiatric symptoms and cognitive impairment in a subgroup of schizophrenic patients.     

认知功能障碍与血清白细胞介素2的关系

目的 :探讨精神分裂症患者认知功能损害与精神症状及血清白细胞介素 2 (IL 2 )水平的关系。　方法 :在 5 7例未服抗精神病药的患者中 ,采用数字划销测验 (CT)、韦氏成人记忆量表 (WMS RC)、威斯康星卡片分类测验 (WCST)测试认知功能 ,用阳性症状与阴性症状量表 (PANSS)评定精神症状 ,同时测定血清IL 2浓度 ,分析其间的关系 ;并将记忆商数 (MQ)≤ 85者与MQ >85者比较血清IL 2水平及精神症状。　结果 :阴性症状分与各项认知测验的成绩均呈显著相关 ,部分认知损害还与一般病理性症状分相关 ,阳性症状分与所有认知测验的成绩均无相关性 ;血清IL 2水平与注意力、记忆力测验成绩呈显著负相关 ,与WCST测验成绩不相关 ;MQ≤ 85者与MQ >85者比较血清IL 2水平及阴性症状显著增高。　结论 :精神分裂症认知损害与阴性症状相关 ,与阳性症状不相关 ;血清IL 2水平可能与精神分裂症的注意力、记忆力损害相联系     

Clinical significance of sleep EEG abnormalities in chronic schizophrenia

This study aimed to investigate the relationship between measures of clinical symptom severity and sleep EEG parameters in a relatively diagnostically homogeneous group of patients with schizophrenia. We obtained sleep EEG data in 15 drug-free inpatients who met DSM-IV-R criteria for schizophrenia, undifferentiated type, with 15 age- and sex-matched normal controls over two consecutive night polysomnographic recordings. Clinical symptoms were assessed by the Positive and Negative Symptom Scale (PANSS) and Hamilton Rating Scale for Depression. Characteristic features of sleep disturbance were seen in patients with schizophrenia: profound difficulties in sleep initiation and maintenance, poor sleep efficiency, a slow wave sleep (SWS) deficit, and an increased REM density. SWS was inversely correlated with cognitive symptoms. REM density was inversely correlated with positive, cognitive, and emotional discomfort symptoms as well as PANSS total score. Our data demonstrate that drug-free patients with chronic undifferentiated type schizophrenia suffer from profound disturbances in sleep continuity and sleep architecture. Both the SWS deficit and cognitive impairment found in schizophrenics in this study may relate to similar underlying structural brain abnormalities.     

Vulnerability to involuntary movements over a lifetime trajectory of schizophrenia approaches 100%, in association with executive (frontal) dysfunction

This study assessed the prevalence of involuntary movements among older inpatients with severe schizophrenia, many of whom had experienced a lifetime of illness and its treatment, and examined their neuropsychological correlates. The subjects of this study were 128 inpatients with a DSM-IV diagnosis of schizophrenia. They were assessed using the Abnormal Involuntary Movement Scale, the Mini-Mental State Examination for general cognitive impairment and the Executive Interview for executive dyscontrol; additionally, their medical records were reviewed in detail for treatment histories. Prevalence of involuntary movements was examined and their clinical correlates determined in relation to topography of movement disorder using logistic regression. In schizophrenia, prevalence of involuntary movements was: age <65years, 63%; 65-75years, 80%; >75years, 93%. The primary correlate both of overall and of orofacial movements was poor executive function, whereas the primary correlate of limb-trunkal movements was poor general cognitive function. On approaching the limits of human longevity following a lifetime trajectory of illness and its treatment, essentially 'all' patients with schizophrenia appear inherently vulnerable to the emergence of involuntary movements in topographically specific association with cognitive deficits.     

不同亚型精神分裂症患者的认知损害与精神症状及血清IL-2水平的关系

目的 探讨不同亚型精神分裂症患者认知功能损害与精神症状及血清白介素-2(IL-2)水平之间的关系。方法 对94例精神分裂症患者进行测验，评定其认知功能，即采用PANSS量表评定阴、阳性症状及分型，以数字划销测验(CT)、修订韦氏成人记忆量表(WMS-RC)、威斯康星卡片分类测验(WCST)，并用酶联免疫吸附法(ELISA)测定血清IL-2水平，比较认知功能损害与精神症状和血清IL-2水平之间的差异。结果 阴性亚型、混合型的认知损害程度较阳性亚型重；各亚型中认知损害主要与阴性症状相关，与阳性症状无关；各亚型间血清IL-2水平差异不显著；血清IL-2水平与认知损害有关，但各亚型不同。结论 认知损害与精神症状及血清IL-2水平之间的关系各亚型间存在差异。     

Self-awareness of cognitive functioning in schizophrenia

Poor awareness of psychiatric symptoms is associated with schizophrenia. It is unclear whether this lack of insight extends to the cognitive impairment that affects at least 85% of people with schizophrenia. Given the increasing efforts to develop treatments for cognitive impairment, and the link between awareness of disability and treatment compliance, it is important to understand whether people with schizophrenia have awareness of their cognitive deficits. Ratings of cognitive functioning from 185 outpatients diagnosed with schizophrenia, their clinicians' ratings and objective neuropsychological test results were compared in the following cognitive domains: attention, nonverbal memory, and verbal memory. The results indicated that there was poor concordance among the three assessments. Patients did not agree with their clinician's assessments and did a very poor job of accurately classifying their cognitive status. However, clinicians were also poor at classifying cognitive status consistent with neuropsychological test results. The implications of these findings for understanding insight in schizophrenia are discussed.     

Neurocognitive deterioration in elderly chronic schizophrenia patients with and without PTSD

Neurocognitive deficits are associated with chronic schizophrenia and aging. We investigated whether elderly chronic schizophrenia inpatients who also suffer from posttraumatic stress disorder (PTSD) have more severe cognitive impairment than elderly schizophrenia inpatients that do not. Fourteen schizophrenia inpatients that are Holocaust survivors and suffer from PTSD (survivor group) were compared with schizophrenia inpatients not exposed to the holocaust and without PTSD (comparison group) using neurocognitive assessments and psychiatric evaluation instruments. The survivors performed significantly worse on measures of processing speed and visual scanning, recognition memory, and general mental status, than the comparison group. Though nonsignificantly, the comparison group revealed better performance on tests that measured visuospatial perception, visuospatial planning and strategies, organizational and constructional skills. The survivor group displayed a greater severity of antipsychotic-induced side effects that were not associated with differences in cognitive performance. Comorbid PTSD may contribute to the severity of neurocognitive impairment in elderly chronic schizophrenia patients.