混合型注意缺陷多动障碍儿童工作记忆特征的神经心理研究

【目的】 探索混合型注意缺陷多动障碍(attention deficit/hyperactivity disorder, ADHD)儿童语音工作记忆和视觉空间工作记忆的特征。 【方法】 采用威斯康星卡片分类测验(Wisconsin Card Sorting Test, WCST)、方块图敲击试验(tapping test)以及中国修订-韦氏儿童智力量表(C-WISC)对39名混合型ADHD儿童(男29例,女10例)和35名正常儿童(男26例,女9例)进行了测试分析。 【结果】 混合型ADHD儿童在WCST中的完成分类数和概念化水平明显低于对照组(P<0.05),完成第一个分类所需应答数、持续性应答数和坚持性错误数明显高于对照组(P<0.05),但两组的总正确率和不能维持完整分类数差异无统计学意义(P>0.05);在方块图敲击测试中的顺向答题数、顺向得分、逆向答题数以及逆向得分都明显低于对照组(P<0.05),且在C-WISC的算术及数字广度分测试中的得分也明显低于对照组(P<0.05)。 【结论】 混合型ADHD儿童存在执行功能缺陷,其语音工作记忆和视觉空间工作记忆均受到罹及。     

Cognitive endophenotypes in OCD: A study of unaffected siblings of probands with familial OCD

Background

Impairments in executive functions and non-verbal memory are considered potential endophenotype markers of obsessive–compulsive disorder (OCD). For the neuropsychological deficits to be considered endophenotypes, they should be demonstrable in unaffected family members.

Aim

To compare the neuropsychological performance in unaffected siblings of probands with familial OCD with that of individually matched healthy controls.

Methods

Twenty-five unaffected siblings of OCD probands with familial OCD, and 25 individually matched healthy controls were assessed with tests of attention, executive function, memory and intelligence.

Results

Unaffected siblings showed significant deficits in tests of decision making and behavioural reversal i.e., the Iowa Gambling Task (IGT) and the Delayed Alternation Test (DAT) respectively, but performed adequately in other tests.

Conclusions

Our study suggests that the deficits in decision making and behavioural reversal could be potential endophenotypes in OCD. These deficits are consistent with the proposed neurobiological model of OCD involving the orbitofrontal cortex. Future studies could couple cognitive and imaging strategies to identify neurocognitive endophenotypes in homogenous samples of OCD.     

利培酮联合氢溴酸加兰他敏对精神分裂症患者认知功能的影响

目的 探讨利培酮联合氢溴酸加兰他敏对精神分裂症认知功能的影响.方法 将60例精神分裂症患者随机分为两组,每组30例,两组均口服利培酮治疗,研究组联合氢溴酸加兰他敏治疗,对照组联合安慰剂治疗,观察12周.于治疗前及治疗第6周、12周末采用阳性与阴性症状量表评定临床疗效,采用威斯康星卡片分类测验、沟槽钉板测验、连线测验A、韦氏智力量表中的数字符号、数字广度测验、韦氏记忆量表中的视觉再生测验评定两组患者的认知功能,采用副反应量表评定不良反应.结果 治疗后两组阳性与阴性症状量表评分均较治疗前显著下降(P＜0.01),同期两组间比较差异均无显著性(P＞0.05).治疗12周末两组威斯康星卡片分类测验完成分类数和持续错误数、连线测验A、数字符号、数字广度、视觉再生测验和沟槽钉板测验均较治疗前明显改善(P＜0.05或0.01);研究组数字广度和视觉再生测验变化值显著高于对照组(P＜0.05或0.01).两组不良反应均轻微,研究组不良反应发生率为63.3%,对照组为53.3%,两组差异无显著性(χ2=0.48,P＞0.05).结论利培酮联合氢溴酸加兰他敏治疗能更好地改善精神分裂症的记忆功能.     

艾司西酞普兰与氟西汀治疗精神分裂症后抑郁对照研究

目的 探讨艾司西酞普兰与氟西汀治疗精神分裂症后抑郁的疗效和安全性以及对认知功能的影响.方法 将60例精神分裂症后抑郁患者随机分为两组,每组30例,在维持原用抗精神病药物治疗的基础上,研究组晨口服艾司西酞普兰治疗,对照组晨口服氟西汀治疗,观察8周.于治疗前及治疗1周、2周、4周、6周、8周末采用汉密顿抑郁量表评定抑郁症状...     

Systematic review of biomonitoring studies to determine the association between exposure to organophosphorus and pyrethroid insecticides and human health outcomes

For the appropriate protection of human health it is necessary to accurately estimate the health effects of human exposure to toxic compounds. In the present review, epidemiological studies on the health effects of human exposure to organophosphorus (OP) and pyrethroid (PYR) insecticides have been critically assessed. This review is focused on studies where the exposure assessment was based on quantification of specific biomarkers in urine or plasma. The 49 studies reviewed used different epidemiological approaches and analytical methods as well as different exposure assessment methodologies. With regard to OP pesticides, the studies reviewed suggested negative effects of prenatal exposure to these pesticides on neurodevelopment and male reproduction. Neurologic effects on adults, DNA damage and adverse birth outcomes were also associated with exposure to OP pesticides. With regard to exposure to PYR pesticides, there are currently few studies investigating the adverse health outcomes due to these pesticides. The effects studied in relation to PYR exposure were mainly male reproductive effects (sperm quality, sperm DNA damage and reproductive hormone disorders). Studies' findings provided evidence to support the hypothesis that PYR exposure is adversely associated with effects on the male reproductive system. The validity of these epidemiological studies is strongly enhanced by exposure assessment based on biomarker quantification. However, for valid and reliable results and conclusions, attention should also be focused on the validity of the analytical methods used, study designs and the measured toxicants characteristics.     

发育性运动协调障碍儿童执行功能状况初步研究

目的初步探讨发育性运动协调障碍儿童执行功能与正常对照儿童的差异。方法采用威斯康星分类卡片测验（WisconsinCardSortingTest,WCST）对37例发育性运动协调障碍儿童（观察组）和37例健康儿童（对照组）的执行功能进行评估。结果在WCST测验中,发育性运动协调障碍儿童错误应答数、持续性应答数和持续性错误数、非持续错误数、完成第一个分类所需应答数明显高于正常儿童;而完成分类数、正确应答数、概念化水平百分比均明显低于正常儿童,差异具有统计学意义。结论发育性运动协调障碍儿童可能存在执行功能缺陷,应早期干预。     

Neuropsychological performance in OCD: a study in medication-naïve patients

Background

Obsessive-compulsive disorder (OCD) is associated with impairments in multiple neuropsychological domains but the findings are rather inconsistent across studies. One potential reason for poor replication is the confounding influence of medications. There is limited research on neuropsychological performance in medication-naïve, never treated OCD patients.

Methods

In this study, we assessed 31 medication-naïve, never-treated, DSM-IV OCD patients free of comorbid major depression and 31 healthy controls individually matched for age, gender and years of education, with tests of attention, executive function, memory reasoning and visuo-spatial function.

Results

Medication-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Patients performed somewhat poorly only on the highest goal hierarchy of the Tower of London (TOL) test (p = 0.001, effect size = 0.68).

Conclusions

It is intriguing to find that symptomatic, drug-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Our finding of medium effect size on TOL highest goal hierarchy test suggests that brain regions outside the affective orbitofrontal loop may also be perhaps involved in OCD. This finding however needs replication because of modest effect size. Future studies should focus on studying medication-naïve, co-morbidity-free patients and relatives using symptom dimensions for consistent and robust findings.     

Contribution of divergent thinking to community functioning in schizophrenia

Fluency deficits have been associated with poor community functioning in patients with schizophrenia. In our previous study we demonstrated that the ability to generate higher-quality responses on tasks of divergent thinking as measured by several fluency tests was impaired in patients with schizophrenia. The purpose of the present study was to investigate the contribution of the deficits in divergent thinking to community dysfunction in schizophrenia. Forty Japanese outpatients with schizophrenia and 32 healthy control subjects were recruited for this study and assessed over a broad spectrum of the neurocognitive domain. Their capacity for divergent thinking was assessed by idea, design, and word fluency tests. Community functioning was assessed by using the Global Assessment of Functioning (GAF), the Life Assessment Scale for the Mentally Ill (LASMI), and the Social Functioning Scale (SFS). The results confirmed the qualitative deficits of divergent thinking in schizophrenia. Stepwise multiple regressions using neurocognitive and demographic/clinical variables as predictors revealed that the higher-quality response scores on the tasks of divergent thinking significantly contributed to community functioning. Moreover, the deficit on the verbal task of divergent thinking significantly contributed to impairment in the area of daily living, and the deficit on the nonverbal task of divergent thinking significantly contributed to impairment in the area of interpersonal relations. The results of this study reveal the importance and the possibility of cognitive remediation and cognitive training with strategies that target capacity for divergent thinking to improve community functioning in patients with schizophrenia.     

Separable neural mechanisms contribute to feedback processing in a rule-learning task

To adjust performance appropriately to environmental demands, it is important to monitor ongoing action and process performance feedback for possible errors. In this study, we used fMRI to test whether medial prefrontal cortex (PFC)/anterior cingulate cortex (ACC) and dorsolateral (DL) PFC have different roles in feedback processing. Twenty adults completed a rule-switch task in which rules had to be inferred on the basis of positive and negative feedback and the rules could change unexpectedly. Negative feedback resulted in increased activation in medial PFC/ACC and DLPFC relative to positive feedback, but the regions were differentially active depending on the type of negative feedback. Whereas medial PFC/ACC was most active following unexpected feedback indicating that prior performance was no longer correct, DLPFC was most active following negative feedback that was informative for correct behavior on the next trial. The current findings show that inconsistent results about the role of prefrontal cortex regions in feedback processing are most likely associated with the informative value of the performance feedback. The results are consistent with the hypothesis that medial PFC/ACC is important for signaling expectation violation whereas DLPFC is important for goal-directed actions.     

首发精神分裂症患者听感觉门控P50及认知功能的相关性研究

目的 探讨首发精神分裂症患者听感觉门控P50与威斯康星卡片分类测验之间的相关性.方法 采用配对听觉条件、测试刺激范式及威斯康星卡片分类测验对51名首发精神分裂症患者和51名健康常人进行检测,并进行相关性分析.结果 患者组听感觉门控P50抑制明显高于对照组(P<0.01);威斯康星卡片分类测验结果显示,患者组完成分类数和正确分类数显著低于对照组,而错误数和持续错误数显著高于对照组(P<0.01);患者组听感觉门控P50抑制与威斯康星卡片分类测验指标间无相关性.结论 首发精神分裂症患者存在认知功能损害与额叶功能缺陷,反映出可能存在不同的神经发生机制.