精神分裂症脑诱发电位研究现状

本文对精神分裂症脑诱发电位（ＢＥＰ）研究现状作一综合性报道。内容所包括精神分裂症时脑诱发电位的异常发现，以及这些异常发现与精神分裂症病理学的关系。     

脑诱发电位在精神分裂症研究中的应用

精神分裂症的神经电生理研究近年来集中在脑诱发电位领域，本文对诱发电位的新老指标在精神分裂症患者中的异常进行了综述。     

脑诱发电位在精神分裂症研究中的应用

精神分裂症的神经电生理研究近年来集中在脑诱发电位领域 ,本文对诱发电位的新老指标在精神分裂症患者中的异常进行了综述。     

首发精神分裂症患者的脑诱发电位研究

目的：观察首发精神分裂症患者的脑诱发电位变化特点。方法：使用32导脑诱发电位仪对48例首发精神分裂症患者和46例正常人进行听觉和视觉诱发电位检测。结果：首发精神分裂症患者的脑诱发电位变化特点为：①波形变异性大，以主波群为主，后节律成分活跃性降低；②除潜伏期AEP-P1延长外，潜伏期。AEP-P2、N2和潜伏期VEP-N1、P2、N2、P3均显著缩短；③AEP、VEP的波幅N1-P2、P2-N2、P2均降低；④左右半球对称；⑤女性AEP、VEP的波幅均显著高于男性。结论：脑诱发电位变化对精神分裂症的诊断具有参考意义。     

急性精神分裂症患者听觉和视觉诱发电位临床纵向研究

有关精神分裂症患者脑诱发电位(BrainEvoked Potentials,BEP),欧美和苏联学者先后报导其与正常对照组有所不同。我们曾报告国内82例急性和慢性精神分裂症 BEP的资料,并就 BEP 在精神科的价值予以讨论。然而关于精神分裂症脑诱发电位与临床症状之间的相关分析,除夏镇夷等     

精神分裂症患者脑磁共振变化的比较

为探讨精神分裂症患者脑部结构的异常变化与精神分裂症发病机理的关系，对３８例精神分裂症患者（研究组）进行磁共振检查，测量脑室和脑沟的值，其中２４例测量了胼胝体前后径、厚度和面积。结果：研究组中１０例有局灶性脑结构异常，异常率２６％；对照组无异常发现。研究组哈氏值、侧脑室体部指数、前角指数、三脑室、左额叶脑沟、胼胝体前后径和面积与对照组差异有显著性（Ｐ＜０．０５），提示精神分裂症存在侧脑室、尤其侧脑室前角和三脑室、左额叶脑沟扩大及胼胝体缩小。精神分裂症Ⅱ型组哈氏值、前角指数、左额叶脑沟、胼胝体前后径与Ⅰ型组差异有显著性（Ｐ＜０．０５）。不同年龄组和病程组之间差异无显著性。提示早年的神经发育障碍可能是引起脑部结构异常及后来发生精神分裂症的原因。     

不同性别精神分裂症患者视觉、听觉诱发电位事件相关电位P300相关性研究

目的 探讨不同性别精神分裂症患者视觉、听觉诱发电位,事件相关电位P300异常的意义。方法 对129例不同性别的精神分裂症患者的视觉诱发电位（PS-VEP）、听觉诱发电位（AEP）、事件相关电位P300与同性别正常人比较。结果 男性和女性精神分裂症患者Cz点AEPP3、P300P3波潜伏期均延迟,女性PS-VEPP3波亦延迟;男性患者组AEPP2、N2波潜伏期延迟,与对照组比较差异均有统计学意义。结论 男性精神分裂患者有2项诱发电位P3波潜伏期延迟,女性3项诱发电位P3波潜伏期均延迟,结合临床对精神分裂症诊断有一定的意义。     

强迫症、精神分裂症患者感觉性脑诱发电位比较

目的 比较感觉性脑诱发电位在强迫症(obsessive—compulsive disorder，OCD)和精神分裂症(Schizophrenia，Sch)中的特征。方法 利用意大利百胜公司GalileoSirius电生理仪对36例OCD和36例Sch患进行了短声、闪光刺激，完成听觉脑诱发电位(Auditory evoked potentials AEP)、视觉脑诱发电位(Visual evoked potentials，VEP)，并与33例正常健康人进行比较。结果 发现OCD和Sch患无论在AEP还是在VEP中，其P3波出现率明显减少；AEP中P2波呈双峰率高；OCD、Sch和正常对照组三组相比，AEP中潜伏期N1、P2波，波幅N1波、VEP中P2潜伏期和波幅及P3波幅均有显性差异(P＜0．01—0．05)。结论 OCD和Sch患在听、视信息加工过程均有不同程度的异常，以Sch为重。     

高血压病的脑诱发电位与经颅多普勒,CT等对照研究：附160例分析

对１６０例高血压病患者进行体感诱发电位、脑干听觉诱发电位检查，按不同性别、年龄分为成年组（３０－５９岁）及老年组（６０－８０岁），与经颅多普勒、ＣＴ脑扫描或磁共振对照研究，探讨其实用价值。体感诱发电位总异常率７３．８％，脑干听觉诱发电位总异常率６５．０％，结论表明诱发电位对发现高血压病患者下脑部病损有重要价值，有利于脑血管疾病的早期防治。     

精神分裂症头颅MRI检查与精神症状分析

应用MRI对25例精神分裂症检查，发现8倒(32％)有MRI所显示的脑结构异常，主要为脑皮层萎缩和脑室扩大。进行临床症状分析发现，伴有脑结构异常的精神分裂症患关心健康、心情抑郁、概念紊乱、情感平淡及BPRS总分较不伴有脑结构异常的患严重。本就此进行了讨论。     

Long-term followup studies of schizophrenia: editors' introduction

What are the major long-term followup studies of schizophrenia from around the world? What have we learned about schizophrenia and its vicissitudes over a lifetime? Does the lifelong vantage point help us to identify the primary psychopathologic components of schizophrenia and to distinguish it from other forms of mental illness? What are the implications of the longitudinal perspective for reducting heterogeneity, for transcultural comparisons, and for updating nosology? Is it time to emphasize hypothesis testing in longitudinal studies? These and other questions about schizophrenia are addressed in the Bulletin issue which focuses upon the long-term followup study, its productivity, and its promise.     

An empirical conceptualization of the recovery orientation

OBJECTIVE: The recovery movement is having a growing impact on policy for people with severe mental illness. The empirical literature on the recovery orientation, however, is scant, and no empirical conceptualization of recovery has been published. METHOD: We identified items reflecting recovery themes and measuring aspects of subjective experience, and used principle components and confirmatory factor analyses to develop an empirical conceptualization of the recovery orientation, using data from a large, systematic study of schizophrenia. RESULTS: We identified four domains of the recovery orientation: empowerment, hope and optimism, knowledge and life satisfaction. CONCLUSIONS: We propose here an initial approach to measuring and conceptualizing recovery attitudes. We also suggest that the evidence-based practice (EBP) movement may help to identify interventions that promote the recovery orientation and help to advance recovery attitudes. We suggest that there is a bidirectional relationship between recovery attitudes and the positive clinical outcomes that are the goals of EBPs. Through the use of empirically derived conceptualizations of recovery, EBPs can provide a mechanism for identifying treatments that promote the recovery orientation. The conceptualization proposed here can, thus, serve as a tool to assess changes in recovery attitudes during participation in specific EBPs.     

Heterogeneity in schizophrenia; mixture modelling of age-at-first-admission, gender and diagnosis

OBJECTIVE: Identifying and explaining sources of heterogeneity in schizophrenia would help elucidate its aetiology and course. In this paper we examine heterogeneity in terms of age-at-first-admission, diagnosis and gender by decomposing a large dataset using mixture modelling. METHOD: Using the Queensland Mental Health Statistics System, we first extracted age-at-first-admission data for schizophrenia (ICD8/9 295) to represent a 'narrow' definition of schizophrenia (N= 7651); we then added paraphrenia (297) and other non-organic psychoses (298) for a 'broad' definition (N= 10 199). Mixture models were fitted to these narrowly and broadly defined distributions for both males and females. RESULTS: For narrowly defined schizophrenia a three-component model best fitted both male and female distributions. While the mean ages of these components were very similar for both males and females, the ratios of males to females crossed from an excess of males in the 'youngest' component to an excess of females in the 'oldest' component. When using the broad definition, four components best fitted the underlying distributions. While the first three were similar to those found for narrowly defined schizophrenia, the additional fourth component reverted to a male excess; however, the mean age for males was 10 years younger than for females. CONCLUSION: Our findings suggest that subtypes based on age-at-first-admission can be identified, although the number identified depends on how inclusively schizophrenia is defined. While there appear to be the same number with similar mean ages for both genders, there are differences in the proportions of males to females. Further work to fully characterize their nature is warranted.     

Predicting protein–protein interactions in the post synaptic density

The post synaptic density (PSD) is a specialization of the cytoskeleton at the synaptic junction, composed of hundreds of different proteins. Characterizing the protein components of the PSD and their interactions can help elucidate the mechanism of long-term changes in synaptic plasticity, which underlie learning and memory. Unfortunately, our knowledge of the proteome and interactome of the PSD is still partial and noisy. In this study we describe a computational framework to improve the reconstruction of the PSD network. The approach is based on learning the characteristics of PSD protein interactions from a set of trusted interactions, expanding this set with data collected from large scale repositories, and then predicting novel interaction with proteins that are suspected to reside in the PSD. Using this method we obtained thirty predicted interactions, with more than half of which having supporting evidence in the literature. We discuss in details two of these new interactions, Lrrtm1 with PSD-95 and Src with Capg. The first may take part in a mechanism underlying glutamatergic dysfunction in schizophrenia. The second suggests an alternative mechanism to regulate dendritic spines maturation.     

Components of care for patients with schizophrenia

To assist in the planning of mental health services for Metropolitan Toronto, the Mental Health Care Committee of the Metropolitan Toronto District Health Council convened a Task Force on Mental Health Epidemiology to help determine the need for services for patients suffering from schizophrenia. As part of its work, the Task Force described components of care which comprise a comprehensive treatment model. Underlying this approach was the recognition that many efficient, effective interventions for the treatment of schizophrenia have been developed and evaluated, but few attempts have been made to apply these various interventions in a systematic, comprehensive manner. This report presents an inventory of state-of-the-art approaches to dealing with schizophrenia which should be of interest both to practicing clinicians and health care planners.     

Social cognition as a mediator of cognition and outcome among deaf and hearing people with schizophrenia

It has been suggested in the research literature that facial affect processing (FAP) and theory of mind (ToM) are both potential mediators of the well-established relationship between cognition and functional outcome among people with schizophrenia. The current project tests the mediating potency of these two domains of social cognition among deaf and hearing people with schizophrenia. Sixty-five people (34 deaf, 31 hearing) were assessed using measures of verbal and visual memory, attention, visual processing, FAP, and ToM. The results suggest that each domain of cognition, save vigilance, exerts an effect on functional outcome indirectly through its influence on social cognition. The patterns of mediation varied when the samples were broken down by hearing status and analyzed separately. Namely, the cognitive tasks directly involving linguistic ability (early visual processing [EVP] and word memory) were best mediated by social cognition for hearing subjects. For deaf subjects, the nonlinguistic cognitive tasks (e.g., visual-spatial memory-recall and copy [VSM-recall and VSM-copy]) were best mediated by social cognition. While FAP and ToM were equally effective as mediators for hearing subjects, FAP was a more potent mediator than ToM for deaf subjects. This study extends prior work in the area of social cognition and schizophrenia and indicates that the development of cognitive rehabilitation strategies should include not only interventions targeting specific cognitive abilities, such as attention and memory, but should include an emphasis on social-cognitive domains, including FAP and ToM. Further, deaf and hearing subjects may benefit from interventions addressing aspects of cognition that support linguistic ability, especially as they relate to social cognition.     

Symptomatic presentation and initial treatment for schizophrenia in children and adolescents

Childhood-onset schizophrenia is a rare variant of adult-onset schizophrenia. Patients with early-onset schizophrenia typically have a more chronic course of illness, greater cognitive impairment, increased negative symptoms, and more severe social consequences than patients with adult-onset schizophrenia. Misdiagnosis of childhood-onset schizophrenia is common, but certain clinical features, such as predominant negative symptoms and premorbid developmental abnormalities, can help to differentiate the disorder from other psychiatric disorders in childhood. Treatment regimens that include both pharmacotherapy and psychosocial interventions are needed to comprehensively treat children and adolescents with schizophrenia.     

The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder

OBJECTIVE: Aim of the study is to examine the impact of labelling on public attitudes towards people with schizophrenia and major depression. METHOD: In Spring 2001, a representative survey was carried out in Germany involving adults of German nationality (n = 5025). RESULTS: Labelling as mental illness has an impact on public attitudes towards people with schizophrenia, with negative effects clearly outweighing positive effects. Endorsing the stereotype of dangerousness has a strong negative effect on the way people react emotionally to someone with schizophrenia and increases the preference for social distance. By contrast, perceiving someone with schizophrenia as being in need for help evokes mixed feelings and affects people's desire for social distance both positively and negatively. Labelling has practically no effect on public attitudes towards people with major depression. CONCLUSION: Our findings illustrate the need for differentiation, differentiation between the different components of stigma as well as differentiation between the various mental disorders.     

Adjunctive psychosocial therapies for the treatment of schizophrenia

Antipsychotic pharmacotherapy is the standard of care for the treatment of schizophrenia. Although pharmacotherapy effectively improves some symptoms, others can remain. Pharmacotherapy alone also tends to produce only limited improvement in social functioning and quality of life. Supportive psychosocial therapies have been used as adjuncts to pharmacotherapy to help alleviate residual symptoms and to improve social functioning and quality of life. Additionally, therapies with psychoeducational components can focus on improving medication adherence and reducing relapse and rehospitalization. This review describes the major psychosocial therapeutic strategies that have been used effectively in patients with schizophrenia (cognitive-behavioral therapy, family intervention, social skills, and cognitive remediation), with emphasis on their utility in improving medication adherence. Therapies that integrate various psychosocial therapeutic approaches are also discussed. It is concluded that psychosocial therapy is an effective adjunct to pharmacotherapy for schizophrenia. However, these therapies vary significantly in the functional domains that they address. It is therefore important to identify the form of psychosocial intervention most likely to benefit the individual patient, and to recognize that the effectiveness of any psychosocial intervention could be influenced by such factors as the presence and severity of psychotic or affective symptoms or cognitive impairment.     

Visuo-spatial processing in a dynamic and a static working memory paradigm in schizophrenia

Recent findings suggest that the visuo-spatial sketchpad (VSSP) may be divided into two sub-components processing dynamic or static visual information. This model may be useful to elucidate the confusion of data concerning the functioning of the VSSP in schizophrenia. The present study examined patients with schizophrenia and matched controls in a new working memory paradigm involving dynamic (the Ball Flight Task - BFT) or static (the Static Pattern Task - SPT) visual stimuli. In the BFT, the responses of the patients were apparently based on the retention of the last set of segments of the perceived trajectory, whereas control subjects relied on a more global strategy. We assume that the patients' performances are the result of a reduced capacity in chunking visual information since they relied mainly on the retention of the last set of segments. This assumption is confirmed by the poor performance of the patients in the static task (SPT), which requires a combination of stimulus components into object representations. We assume that the static/dynamic distinction may help us to understand the VSSP deficits in schizophrenia. This distinction also raises questions about the hypothesis that visuo-spatial working memory can simply be dissociated into visual and spatial sub-components.