An integrative psychophysiological approach to brain hemisphere functions in schizophrenia

The present paper proposes a new psychophysiological approach to the genesis of positive and negative schizophrenic symptoms. According to this approach, the initial factor in schizophrenic disorders is a functional insufficiency of the right hemisphere which can be determined by early emotional experience in combination with subtle brain damage. This functional insufficiency causes (a) the inability to grasp and select information before its realization; and (b) the inability to produce a polysemantic context which is crucial for creativity, psychological defense, and the restoration of search activity, all of which determine psychophysiological adaptation to the environment. Right hemisphere insufficiency causes left hemisphere hyperactivity as an ineffective attempt to compensate for this functional deficiency. As a result, normal search activity is replaced by artificial search activity which is represented by “positive” symptoms, and which uses the predisposition of the left hemisphere's catecholamine system for its increased activity. The suggestion is made that cognitive impairment in schizophrenia (the inability to use appropriate previous information in relation to current perceptual input) is related to the competition between information processing which requires left hemisphere activity, and the formation of positive symptoms, also based on left hemisphere activity.     

慢性精神分裂症与脑肿瘤患者认知状况比较分析

目的　探讨慢性精神分裂症患者脑功能缺陷与不同脑叶损伤间的关系。方法　运用威斯康星卡片分类测验、词汇流畅性测验、Stroop测验,对30名正常人、39例精神分裂症及88例脑肿瘤患者(其中左、右额叶各2 4例、颞叶2 0例、顶枕叶2 0例)进行测试。结果　精神分裂症患者与脑肿瘤患者均存在不同程度、不同特征的认知损伤,其中阴性症状为主的精神分裂症与右额叶脑肿瘤患者损伤类似,除完成分类数、总词汇数外,本研究所采用的测查其余指标差异无显著性(P >0 . 0 5)。结论　阴性症状为主的慢性精神分裂症患者右侧额叶功能受损明显,精神分裂症起病的器质性因素可能涉及右额叶。     

Effects of cognitive remediation on cognitive and social functions in individuals with schizophrenia

ABSTRACT

Individuals with schizophrenia exhibit cognitive impairments, which are related to impairments in social functions. This study investigated the effects of cognitive remediation on cognitive, social, and daily living impairment. Participants were individuals with schizophrenia between 20 and 60 years old (N?=?44). Participants were randomly assigned to two groups: a cognitive remediation intervention group and a non-intervention control group. The control group was provided with conventional drug therapy and either day care or occupational therapy. The intervention group was provided with the “neuropsychological educational approach to cognitive remediation” developed by Medalia and co-workers. We assessed cognitive functions using the brief assessment of cognition in schizophrenia (BACS), and evaluated social and daily living functions using the global assessment of functioning (GAF) scale. Significant group by time interaction effects indicated that verbal memory, working memory, attention, and executive function showed significantly greater improvement at post-intervention for the intervention group than the control group. Social and daily living function also improved in the intervention group and improvements were maintained one year after intervention. These preliminary findings indicate that the combination of cognitive remediation and psychiatric rehabilitation is effective for facilitating improvements in cognitive function and social and daily living functions in individuals with schizophrenia.     

Audiovisual integration of speech is disturbed in schizophrenia: An fMRI study

Speech perception is an essential part of social interaction. Visual information (lip movements, facial expression) may supplement auditory information in particular under inadvertent listening situations. Schizophrenia patients have been shown to have a deficit in integrating articulatory motions with the auditory speech input. The goal of this study was to investigate the neural basis of this deficit in audiovisual speech processing in schizophrenia patients by using fMRI. Disyllabic nouns were presented in congruent (audio matches visual information) and incongruent conditions in a slow event related fMRI design. Schizophrenia patients (n = 15) were compared to age and gender matched control participants. The statistical examination was conducted by analysis of variance with main factors: audiovisual congruency and group membership. The patients' brain activity differed from the control group as evidenced by congruency by group interaction effects. The pertinent brain sites were located predominantly in the right hemisphere and comprised the pars opercularis, middle frontal sulcus, and superior temporal gyrus. In addition, we observed interactions bilaterally in the fusiform gyrus and the nucleus accumbens. We suggest that schizophrenia patients' deficits in audiovisual integration during speech perception are due to a dysfunction of the speech motor system in the right hemisphere. Furthermore the results can be also seen as a reflection of reduced lateralization of language functions to the left hemisphere in schizophrenia.     

早发与非早发精神分裂症认知功能比较研究

目的 比较早发与非早发精神分裂症患者认知功能缺损特征.方法 对长期服氯氮平治疗(持续服用时间超过2年)且病程＞5年的住院精神分裂症患者按起病年龄分为两组,分别为早发精神分裂症患者组(起病年龄≤18岁)及非早发精神分裂症患者组(起病年龄＞18岁),进行阳性和阴性症状量表(PANSS)、重复性成套神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)及副反应量表(TESS)评定.结果 (1)共纳入精神分裂症患者189例,其中早发精神分裂症患者组91例,非早发精神分裂症患者组98例,两组之间比较在发病年龄及年龄上存在有差异,而在性别,文化程度,病程,家族史,服氯氮平时间及剂量上均无显著差异;(2)早发组与非早发组之间比较,PANSS各因子、总分及TESS总分差异均无统计学意义(P＞0.05);(3)早发组与非早发组之间比较,早发组在RBANS总分及即刻记忆因子分与语言因子分低于非早发组,差异有统计学意义(P＜0.05).结论 早发精神分裂症患者比非早发精神分裂症患者存在更严重的认知功能损害,主要表现在即刻记忆及语言上.     

利培酮对精神分裂症认知功能和血清细胞因子水平的影响

目的探讨利培酮对精神分裂症认知障碍的影响及其与血清白介素-2(IL2)、可溶性白介素-2受体(sIL2R)水平变化的关系。方法对符合中国精神障碍分类与诊断标准第3版(CCMD-3)精神分裂症诊断的60例患者予利培酮治疗6周;治疗前后分别采用数字划销测验(CT)、修订韦氏成人记忆量表(WMS-RC)、威斯康星卡片分类测验(WCST)评估注意功能、记忆功能和执行功能,同时采用酶联免疫吸附法(ELISA)检测血清IL2、sIL2R水平。对60名健康人(对照组)进行相同的认知功能和血清细胞因子检测。结果治疗前精神分裂症患者组认知功能测验成绩显著差于对照组(P<0.01),血清IL2水平显著高于对照组(P<0.05)。通过6周的利培酮治疗,CT的净分及WMS-RC的记忆商数均有显著提高,CT的失误率及WCST的总测验次数、持续错误数、随机错误数均显著下降,同时血清IL2水平显著降低,而sIL2R水平变化不明显;治疗前患者的失误率与血清IL2水平呈显著正相关(P<0.05),记忆商数与血清IL2水平呈显著负相关(P<0.05),治疗6周末失误率下降值和记忆商增加值均与血清IL2水平下降值呈显著正相关(P<0.05)。结论利培酮对精神分裂症注意、记忆功能的改善与降低的血清IL2水平相联系;精神分裂症认知功能障碍的部分特质可能与其紊乱的免疫功能(特别是细胞因子)有关。     

The relationship of social cognition to ward behavior in chronic schizophrenia

The relationship between social cognition (i.e., cognition for social stimuli) and ward behavior among individuals with chronic schizophrenia was investigated. Twenty-seven inpatients completed a battery of cognitive and social-cognitive tasks and were rated by staff on various indices of ward behavior. Overall, there was a relationship between the measures of social cognition and behavior on the ward. Social cognition contributed unique variance beyond cognition to maladaptive behavior on the ward (i.e., irritability). Implications for assessemnt and future research are discussed.     

精神分裂症认知功能障碍功能磁共振成像研究的进展

精神分裂症是一种使人类严重丧失社会生活功能的疾病,影响了1%的世界人口,发病率和死亡率较高[1-2].精神分裂症通常发生在青春期或成年早期,约70%转为慢性精神分裂症[3].精神分裂症患者存在严重的认知功能障碍,疾病改变了患者的大脑结构和功能,对人的思维、注意力和协调性方面有很大影响[4],主要表现在注意、记忆和执行功能等方面[5].随着神经功能影像学的发展,很多功能影像相关的技术成为研究精神分裂症的重要方法.最初,科学家们利用功能影像学研究精神分裂症认知功能障碍与大脑各个脑功能区域的联系,试图通过建立多个脑区之间广泛地功能连接来更好地解释精神分裂症患者混乱的认知功能.功能磁共振成像(Functional Magnetic Resonance Imaging,fMRI)作为一种比较成熟的功能影像技术,广泛地被科研人员应用于精神分裂症患者认知功能损害的研究中,并取得了一定成果.这些成果为我们提供了对精神分裂患者的大脑进行更细微研究的一些理解,现将研究进展综述如下.     

多巴胺受体在精神分裂症认知受损中的作用研究进展

精神分裂症是重性精神疾病之一,临床症状表现为阳性症状、阴性症状、认知症状、攻击敌意和焦虑、抑郁,其中认知症状被认为是疾病的原发性损害,影响患者社会功能的恢复,目前此症状发生的机制不清,研究范围涉及各种神经递质、激素、免疫等方面,现就神经递质多巴胺的受体在精神分裂症认知受损中的作用研究进展进行简要综述,供临床参考.     

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。     

Sleep quality and cognitive impairments in remitted patients with schizophrenia in Nigeria

BackgroundDespite the ubiquity of sleep disturbance in schizophrenia, it has generally been overlooked as a potential contributor to cognitive impairments. The main aim of this study was to find out if impaired sleep quality contributes to cognitive impairments in patients with a diagnosis of schizophrenia who are in remission.MethodsThe study was conducted at the University College Hospital, Ibadan and State Hospital, Ibadan, Nigeria. The Pittsburgh Sleep Quality Index (PSQI) and Screen for Cognitive Impairment in Psychiatry (SCIP) were applied in this cross-sectional study, to all consecutive and consenting remitted outpatients with schizophrenia (N = 130). Other instruments such as Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), sociodemographic and clinical measures were also applied.ResultsThere were 130 participants made up of 69 females (53.1%) and 61males(46.9%). The mean age of the participants was 38.5 ± 9.1 years. The prevalence of poor sleep quality in remitted patients with schizophrenia was 56.9%. Sleep quality was significantly negatively correlated with Verbal Learning Test-Immediate (VLT-I) (r(128) = -.18, P = .044) and Verbal Learning Test-Delayed (VLT-D) (r(128) = -.18, P = .037). The variables that independently predicted cognitive functioning were the VLT-I, odds ratio (OR) 0.66; 95% confidence interval ((CI) 0.49-0.88) and education (OR) 0.61;(CI) 0.40- 0.92).ConclusionPoor subjective sleep quality measured by the PSQI is linked to cognitive impairment in remitted patients with schizophrenia. We suggest that sleep quality in remitted patients with a diagnosis of schizophrenia should receive better attention by physicians.     

精神分裂症患者基于事件前瞻记忆缺陷的功能磁共振成像特点

目的应用功能磁共振成像(fMRI)技术探讨精神分裂症基于事件前瞻记忆缺陷的生物学基础及神经机制。方法采取横断面病例对照研究方法,共招募20名健康志愿者(对照组)和20例精神分裂症患者(观察组)入组,以双重任务前瞻记忆实验范式作为刺激任务,同时应用阳性与阴性症状量表和阴性症状评定量表评定精神症状严重程度,采用锥体外系不良反应量表评定锥体外系不良反应严重程度。应用Matlab2011b,SPM8软件对影像学数据进行预处理及统计分析。采用独立样本t检验分析比较两组的脑区激活情况,设定激活差异显著水平为P<0.005(未校正)。选取前瞻记忆主要激活脑区,应用REST1.8软件提取激活脑区的血氧水平依赖性信号强度,采用Pearson相关分析探究脑区激活强度的相关因素。结果预处理中发现,观察组2例被试者有明显的头部运动(移动>2.5 mm,转动>2.5°),剔除图像分析,最后观察组18例,对照组20例被试者的图像数据进入统计分析。相对于健康志愿者,精神分裂症患者在执行前瞻记忆任务时的正确率较低且反应时更长[(83.40±15.33)%比(94.30±10.94)%,(870.54±156.70)ms比(757.33±187.44)ms;均P<0.05]。进行中任务的反应时与阴性症状量表评分呈正相关(r=0.494,P=0.037),前瞻记忆任务的正确率与智商呈正相关(r=0.558,P=0.016),前瞻记忆任务的反应时与氯丙嗪等效剂量呈正相关(r=0.492,P=0.038)。fMRI扫描显示精神分裂症患者右额中回、双侧顶下小叶(角回、缘上回)、右前扣带回以及右楔前叶脑区激活明显低于健康志愿者(均P<0.005)。右缘上回(r=-0.589,P=0.010)、左角回(r=-0.593,P=0.010)、右楔前叶(r=-0.590,P=0.010)的激活程度与氯丙嗪等效剂量呈负相关。右前扣带回(r=-0.537,P=0.021)、右额中回(r=-0.501,P=0.034)的激活程度与进行中任务的反应时呈负相关。结论前瞻记忆需要消耗认知资源。精神分裂症患者存在显著的基于事件前瞻记忆缺陷,其缺陷机制可能与额中回、顶下小叶(缘上回、角回)、前扣带回以及楔前叶功能紊乱有关。     

精神分裂症脑萎缩的MRI研究

目的 了解精神分裂症患者的脑萎缩是疾病初期即已发生，还是随病程逐渐进展。方法 研究对象选取符合DSM-Ⅲ精神分裂症诊断标准的住院患者95例，正常对照组20例，按规定序列作头颅核磁共振扫描，测定第三脑室宽度、两侧第三脑室距脑岛面距离及两侧尾状核头部宽度。并以病程5年为限，分为短病程组和长病程组。结果 ①病例组第三脑室显著增宽，尾状核头部缩小。②短病程组与长病程组各组值无显著性差异。③病程与第三脑室宽度、两侧第三脑室距脑岛面距离及两侧尾状核头部宽度均无显著相关性。结论 精神分裂症患者脑萎缩明显，且与病程、服药无关，在疾病早期即已发生。     

Neurological soft signs in schizophrenia: Assessment and correlates

A German version of the Neurological Evaluation Scale (NES) was administered to 143 schizophrenic patients, 45 of them being severly chronic and disabled. Seventy-eight alcohol-dependent inpatients and 57 healthy volunteers were tested as control groups. Neurological soft signs (NSS) were rated with convincing agreement. Schizophrenic patients are more impaired on all scales than healthy controls. The chronic, severly disabled schizophrenic patients are more impaired compared with the main group of schizophrenic patients and both control groups. A significant patients and alcohol-dependent patients was only found for the subscale Motor Coordination. Compared with healthy controls the alcohol-dependent patients show a higher NES total score. The NES total score was related to the relative width of the third ventricle. Total score and subscales were correlated consistently with the level of cognitive functioning as measured by the Raven Standard Progressive Matrices and various neuropsychological tests presumably sensitive to dysfunctions of the prefrontal cortex. The NSS were related to positive as well as to negative symptoms, the correlations with negative symptoms being confined to items of Cognitive Disorganization. This close association of psychomotor and cognitive dysfunctions may be seen as related to the frequently discussed dysfunctions of the prefrontal cortex or the neurointegrative deficit postulated by Meehl.     

精神分裂症患者治疗后多项诱发电位的变化

目的 了解精神分裂症患者P300、听觉诱发电位（AEP）和脑干听觉反应（ABR）的特征以及治疗前后诱发电位的变化。方法 应用美国Nicolet Spirit脑诱发电位仪．记录34例精神分裂症患者和31名正常成人的P300、AEP和ABR．于治疗6个月时进行P300、AEP和ABR随访。结果 1．与NC组比较,精神分裂症组三项诱发电位主成份（P300-P3靶潜伏期、AEP-P2潜伏期和ABR-波V波幅）延迟,波幅降低（P〈0．05～0．01）。2．随访提示：P300中的P3靶潜伏期和波幅,AEP中的P2潜伏期和波幅以及ABR中的波Ⅲ潜伏期和波V波幅改变可能是属于该疾病的状态标志。结论 本组精神分裂症患者的诱发电位变化为状态标志,多项诱发电位指标联合应用可作为精神分裂症治疗监测的有用指标。     

精神分裂症脑结构的核磁共振研究

目的：采用核磁共振技术（MRI）分析精神分裂症患者的脑结构改变。方法：以精神分裂症住院患者101例为对象,正常30例为对照,作头颅核磁共振扫描。结果：病例组第三脑室显著增宽,尾状核体积较大,海马增厚,各部位海马信号强度减弱。结论：精神分裂症患者脑萎缩明显,尾状核增大。     

对住院精神分裂症患者认知功能障碍的相关因素分析

目的：探讨住院精神分裂症患者认知功能障碍的相关因素。方法：应用MMSE等量表,调查与认知功能障碍相关的因素。结果：单因素分析发现：女性、年龄较大、文化程度较低、 病程较长、住院时间较长、具阴性精神症状、父母文化程度较低等与认知功能障碍有关;logistic回归分析发现,与母亲文化程度较低、具阴性精神症状及住院时间较长关系更为密切。结论：认知功能障碍是缺少知识、学习的不良后果,但不能排除脑器质性病变引起的可能性。     

慢性精神分裂症病人局部脑血量的临床研究

目的 探讨长期住院的精神分裂症病人大脑前动脉的供血量，方法 由熟练的技师，用经颅多普勒诊断仪，经颞中窗对本院36例长期住院的精神分裂症病人大脑前动脉的平均血流速度进行测定，然后与本院43名健康成人大脑前动脉的平均血流速度对照分析。结果 长期住院的精神分裂症病人大脑前动脉的平均血流速度低于健康成人，差别具有显著性。结论 长期住院的精神分裂症病人大脑额叶供血量相对不足。     

Association between mismatch negativity and voxel-based brain volume in schizophrenia

Objective

This study aimed to investigate the association between mismatch negativity (MMN) and volumes of several brain regions measured using a semi-automated method in patients with schizophrenia and healthy controls.

Impaired interhemispheric integration in brain oxygenation and hemodynamics in schizophrenia

We examined 38 patients with chronic schizophrenia to find and qualify disturbances in interhemispheric integration in brain oxygen metabolism and hemodynamics during a psychological task. A group of thirty-eight age- and sex-matched healthy volunteers were monitored as controls. Multi channel near-infrared (NIR) spectrophotometry was used to observe real-time alterations in cerebral oxygenation in areas of both hemispheres of the forebrain adjacent to the forehead during the mirror drawing task (MDT). In response to MDT normal volunteers showed distinct and well-integrated patterns of changes in oxygenated hemoglobin Hb, deoxygenated Hb, and blood volume total Hb. On the other hand, half the schizophrenics showeddysregulated patterns between hemispheres which never appeared in normal volunteers. Certain schizophrenic symptoms may be related to defective interhemispheric integration.