难治性抑郁症患者认知功能与神经内分泌激素相关性研究

目的 探讨难治性抑郁症患者认知功能与神经内分泌激素的相关性.方法 将60例难治性抑郁症患者设为研究组,抽取同期住院的60例非难治性抑郁症患者设为对照组.检测两组血清胰岛素、皮质醇、促肾上腺皮质激素、三碘甲状腺原氨酸、游离三碘甲状腺原氨酸、甲状腺素、游离甲状腺素、促甲状腺激素等神经内分泌激素;采用威斯康星卡片分类测试、韦氏记忆量表、字色干扰实验、连线实验、语言流畅性测试、画钟实验评定两组患者的认知功能,对评定结果进行相关分析.结果 研究组血清胰岛素水平显著低于对照组,促肾上腺皮质激素水平显著高于对照组(P＜0.05或0.01);威斯康星卡片分类测试总应答数、持续错误数、随机错误数显著高于对照组(P＜0.01),正确应答数及韦氏记忆量表图片回忆、视觉再认、视觉再生、触觉因子分,词汇流畅性检测、画钟实验评分均显著低于对照组(P＜0.05或0.01).研究组血清胰岛素水平与威斯康星卡片分类测试正确应答数,韦氏记忆量表记忆商数、图片回忆、视觉再认、视觉再生因子,连线实验A,语言流畅性测试均呈显著正相关(P＜0.05或0.01);与威斯康星卡片分类测试持续错误数、随机错误数呈显著负相关(P＜0.01).皮质醇与威斯康星卡片分类测试持续错误数呈显著正相关(P＜0.05);与总应答数、正确应答数及韦氏记忆量表数字倒数,连线实验,画钟实验呈显著负相关(P＜0.05或0.01).甲状腺素与画钟实验呈显著负相关(P＜0.05).游离甲状腺素与韦氏记忆量表时空定向呈显著正相关(P＜0.05).促甲状腺激素与威斯康星卡片分类测试总应答数、韦氏记忆量表数字倒数语言流畅性测试等呈显著正相关(P＜0.05),与威斯康星卡片分类测试持续错误数、随机错误数呈显著负相关(P＜0.05).结论 难治性抑郁症患者在注意、短时记忆、执行能力等方面的认知功能缺陷更为严重,且与胰岛素等神经内分泌激素水平密切相关.     

Adjunctive treatment of bimodal repetitive transcranial magnetic stimulation (rTMS) in pharmacologically non-responsive patients with schizophrenia: a preliminary study

Objectives

We evaluated the efficacy of bimodal repetitive transcranial magnetic stimulation (rTMS) in treating pharmacologically non-responsive patients with schizophrenia.

Methods

Ten patients with DSM-IV schizophrenia, unresponsive to pharmacological treatment, underwent treatment with 15 rTMS sessions, as an adjunctive therapy, for three weeks. Each session comprised 40 trains, beginning every 30 s: 20 trains of 10 Hz rTMS to the left dorsolateral prefrontal cortex (DLPFC) with a 3-s duration and 20 trains of 1 Hz rTMS to the left temporoparietal cortex (TPC) with a 30-s duration. We assessed patients via the Positive and Negative Syndrome Scale (PANSS) and Korean Version of the Calgary Depression Scale for Schizophrenia (K-CDSS), at five time points: baseline, Days 8, 15, and 22, and 1 week after final treatment (Day 29). Patients who agreed to take neurocognitive tests underwent neurocognitive function evaluations at baseline and 1 week after final treatment.

Results

At Day 29, all PANSS subscale scores in had decreased significantly compared to baseline (Z = − 2.214, p = 0.027, positive; Z = − 2.132, p = 0.033, negative; Z = − 2.023, p = 0.043, general pathology; Z = − 2.371, p = 0.018, total). Effect over time was significant for the PANSS positive and negative subscale scores and total score (χ² = 13.35, p = 0.010; χ² = 10.27, p = 0.036; and χ² = 16.50, p = 0.002, respectively) but not for the general pathology subscale. Among the neurocognitive tests, the fourth and fifth trials and total K-AVLT scores showed significant increases (Z = − 2.041, p = 0.041; Z = − 2.251, p = 0.024; and Z = − 2.201, p = 0.028, respectively), suggesting improvement in short-term auditory verbal memory.

Conclusions

Bimodal rTMS stimulation of left DLPFC and left TPC induced clinical improvement in pharmacologically non-responsive schizophrenia patients and may have improved their short-term verbal memories.     

Wisconsin Card Sorting Test performance in children with developmental coordination disorder

The primary purpose of this study was to investigate and compare the executive functions measured by the Wisconsin Card Sorting Test (WCST) between children with developmental coordination disorder (DCD) and age-matched normal controls. A second purpose was to examine the relations between executive functions and school functions in DCD children. Seventy-one children with DCD and 70 children without motor problems were recruited from 14 public schools. Executive functions and school functions were assessed using the WCST, and the School Function Assessment - Chinese Version (SFA-C) respectively. Univariate analyses demonstrated significant between-group differences in five WCST measures. The logistic regression analysis showed differences between two groups on eight SFA-C subscales, and significant correlation between items measured on WCST and SFA-C was also found. The result of the study provides further evidence of impaired sub-domains of executive functions (i.e., mental shifting, flexibility) in children with DCD. The finding also adds to recent investigations into the relationship between executive functions and school functions in DCD. Implications for rehabilitation professionals and recommendations for further research are discussed.     

Leukemia inhibitory factor gene is associated with schizophrenia and working memory function

Leukemia inhibitory factor (LIF), a member of the interleukin-6 cytokine family, regulates the neuronal phenotype and coordinates astrocyte, oligodendrocyte, microglia, and inflammatory cell responses. The LIF gene is located on 22q12.1–q12.2, a hot spot for schizophrenia. Three polymorphisms of the LIF gene (rs929271, rs737812, and rs929273) were examined in a case–control association study of 390 patients with schizophrenia and 410 age- and sex-matched controls. Effects of a risk genotype of LIF on cognitive domains were evaluated by the Wechsler Adult Intelligence Scale—Revised, Wechsler Memory Scale—Revised, and Wisconsin Card Sorting Test (WCST) in 355 healthy volunteers. The LIF gene showed significant associations with schizophrenia at rs929271 and a haplotype consisting of rs929271–rs737812. After stratification by subtype of schizophrenia, the hebephrenic, but not paranoid, type was associated with the LIF gene at rs929271 (allele, P = 0.014) and the haplotype (permutation P = 0.013). Having the T-allele and T-carrier genotypes (TT and TG) of rs929271 were risks for hebephrenic schizophrenia, and the odds ratios were 1.38 (95% CI: 1.21–1.56) and 1.54 (95%CI: 1.19–1.98), respectively. Subjects with T-carrier genotypes made significantly more errors on the WCST compared with those without (P = 0.04). The present study indicated that the LIF gene variant may produce susceptibility to hebephrenic schizophrenia and deterioration of working memory function.     

Tone duration mismatch negativity deficits predict impairment of executive function in schizophrenia

Impairment in mismatch negativity (MMN) potentials is a robust finding in schizophrenia. There are few studies which examined the correlation between MMN deficits and neuropsychological performances. The purpose of this study was to investigate the relationship between deficits of tone duration MMN and various neuropsychological measures in schizophrenic patients (n=23). The results demonstrated a significant correlation between low MMN amplitude and poor performances of executive function in Wisconsin Card Sorting Test, Stroop Test and Trail Making Test. Our finding suggests MMN deficits in schizophrenia predict deficits of executive function and might reflect ongoing functional abnormality of fronto-temporal interaction.     

What About Inhibition in the Wisconsin Card Sorting Test?

The commercially available Wisconsin Card Sorting Test (WCST) is one of the most commonly used tests for assessing executive functions within clinical settings. Importantly, however, it remains relatively unclear exactly what processes are assessed by the test. Conceptually, increased perseverative errors in sorting cards are usually related to deficient inhibition processes. Empirically, evidence supporting this conclusion is limited. In a sample of 38 healthy adults we addressed the question to what extent inhibition mechanisms assessed by the go/no-go and the stop-signal paradigm are related to WCST performances. Inhibition-related scores were found to predict non-perseverative errors better than perseverative errors. Consequently we conclude that the non-perseverative errors score reflects processes that are partly dependent on inhibition functions.     

Age-Related Changes in the Wisconsin Card Sorting Test Performances of 8- to 11-Year-Old Turkish Children

The leading aim of the present study was to examine developmental trends in performance on a computerized version of the Wisconsin Card Sorting Test (WCST) in Turkish children. Participants were 449 children aged between 8 and 11. Findings suggested that children's WCST scores improve with age, and developmental changes in executive functions follow distinct processes as assessed by different components of the WCST. The most striking improvement was noted in perseverative tendencies around age 10. This study also explored the effects of parental education on WCST performances of children, and maternal education emerged as the most important predictor.     

Modified Wisconsin Card Sorting Test (MCST,MWCST): Normative Data in Children 4–13 Years Old,According to Classical and New Types of Scoring

According to Nelson's (1976) criteria, the MCST (MWCST) is a simplification of the Wisconsin Card Sorting Test (WCST). As the MCST is particularly suitable for children, the aim of this study was to establish the normative data presently lacking for that group. The MCST was administered to 1126 normal children aged 4 to 13 years. Scoring was based on all the classical parameters, according to existing criteria, plus two new ones that we propose (“categorizing efficiency” and “categorizing efficiency plus”). Strong correlation (or inverse correlation) with age is found for most parameters, including all criteria used for perseverative responses. This does not occur for “failure to maintain set,” calculated according to the usual criteria. “Categorizing efficiency” and “categorizing efficiency plus” avoid the ceiling effect occurring at higher ages in the parameter categories. The MCST may be used in children 4 years of age and above. Most, but not all, of its parameters show regular improvement with age, demonstrating their validity. However, our data suggest that a participant's performance on the MCST may be based essentially on two parameters: categorizing efficiency (or categorizing efficiency plus), measuring the participant's ability to categorize, and perseverative errors (or percent perseverative errors), measuring his or her difficulty in shifting, both considered typical executive functions.     

氟西汀联合重复经颅磁刺激治疗对抑郁症患者疗效及认知功能的影响

目的：探讨氟西汀联合重复经颅磁刺激治疗对抑郁症患者疗效及认知功能的影响。方法将60例抑郁症患者随机分两组,每组30例。研究组口服氟西汀联合重复经颅磁刺激治疗,对照组口服氟西汀联合假经颅磁刺激治疗,观察6周。于治疗前后采用汉密顿抑郁量表评定临床疗效,威斯康星卡片分类测验评估认知功能,副反应量表评定不良反应。结果治疗第2周末研究组有效率显著高于对照组（P＜0．01）,治疗第4周、6周末两组比较差异无显著性（P＞0．05）。治疗后研究组威斯康星卡片分类测验的正确反应数及完成分类数均较治疗前显著升高（P＜0．01）,且研究组显著高于对照组（P＜0．05）;两组汉密顿抑郁量表评分较治疗前显著降低（P＜0．01）,治疗第2周、4周末研究组显著低于对照组（P＜0．05）。治疗过程中,两组均未出现严重不良反应。结论氟西汀联合重复经颅磁刺激治疗抑郁症疗效显著,起效快,安全性高,且能显著改善患者的认知功能,优于单用氟西汀治疗。     

精神病司法鉴定中威斯康星卡片分类测验结果对照分析

目的 初步探讨精神病司法鉴定中威斯康星卡片分类测验（WCST）的应用。方法 将我院2004～2005年鉴定中的刑事案例，分成具有精神病诊断的研究组54例和正常组32例，收集一般资料，完成WCST，并对数据进行统计学处理。结果 两组WCST结果不存在显著性差异；研究组中的精神分裂症患者与正常组无显著性差异；研究组中完全责任者、限定责任者、无责任者之间WCST结果的两两比较也不存在显著性差异。结论 WCST结果受多种因素影响，在精神病司法鉴定中，WCST的运用有待进一步研究。