精神分裂症脑萎缩及其相关因素研究

目的 探讨精神分裂症患者脑萎缩的发生率及其相关因素。方法 对142例精神分裂症患者(病例组)和46例正常对照组进行了脑部磁共振(MRI)检查,应用MRI定量测量分析脑室、脑沟、并对病例组的脑萎缩与临床相关因素进行了相关分析。结果 精神分裂症患者的脑萎缩发生率为31.7％;两组的脑萎缩发生率和脑萎缩评分(GA分)、第三脑室最大宽度(TVW)、前角指数(FHI)、脑室脑比率(VBR)的值均有显著性差异;病例组GA评分、TVW、FHI、VBR的值均与病前适应能力、病程、阴性症状量表总分、副反应量表总分等有显著相关性,而与性别、年龄、家族史、起病形式、阳性症状量表总分、简明精神病评定量表总分、脑电图(EEG)异常、药物治疗总时间、药物最大日剂量、住院次数、电休克(ECT)治疗次数、临床疗效总评量表的疗效总评项目分等无显著相关性。结果 提示精神分裂症可能与非特异性脑室、脑沟结构异常有关,特别是与脑萎缩程度有关,但其因果关系有待进一步研究。     

精神分裂症不同症状的MRI对照研究

选择４０例住院精神分裂症病人（其中阳性症状组３０例，阴性症状组１０例），和正常对照组２０例检测头颅ＭＲＩ。结果：精神分裂症脑结构异常率为３２．５％，其中脑软化７．５％，海马回梗塞１７．５％，脑白质变性１５％，额颞皮层萎缩２５％，阴性症状组病人的两侧脑室前角，三角区间距，三脑室宽径，大脑纵裂前半间距，左、右侧裂池宽距比正常对照组明显扩大，阳性症状组病人的两侧脑室三角区间距，三脑室宽径亦比正常对照组明     

精神分裂症患者脑部CT临床对照研究

为探讨精神分裂症患者脑ＣＴ结果与临床的相关性，对１９９５年１月～１９９６年５月住院符合ＣＣＭＤ—２—Ｒ诊断标准的精神分裂症患者进行脑部ＣＴ检查，以同期门诊神经症患者的脑ＣＴ检查报告作对照，并与临床相关因素进行对照分析。结果发现精神分裂症组脑ＣＴ异常６９例（３２．４％），与对照组比较有极显著差异；前者病程＞５年，年龄４０岁以上，以阴性症状为主患者的脑萎缩发生率最高。     

氯氮平合并舒必利治疗精神分裂症阴性症状的对照研究

为评估氯氮平合并舒必利对精神分裂症阴性症状的疗效，将９２例以阴性症状为主的精神分裂症患者随机分为氯氮平合并舒必利组（３１例）和两个对照组（氯氮平组３２例，舒必利组２９例）。经临床疗效评定和简明精神病量表、阴性症状量表、临床疗效总评量表评定，结果显示：显效率（痊愈率＋显著进步率）：氯氮平合并舒必利组为６８％，氯氮平组为３１％，舒必利组为３４％。经χ＾２检验，氯氮平合并舒必利组显著优于氯氮平组和舒必利     

首次发病伴有抑郁症状的精神分裂症临床研究

试图确定首次发病的精神分裂症患者抑郁症状发生率及其严重程度。通过对４６例患者在治疗前及治疗三月后以简明精神病量表、汉密顿抑郁量表、阴性症状评定量表评定，结果发现首次发病精神分裂症的抑郁症状发生率为６３．０％；抑郁症状与精神病性症状关系密切，与阴性症性无明显相关，作者认为抑郁症状是精神分裂症症状的组成部分，随着精神分裂症其它症状的缓解而改善，提示对伴有抑郁症状的首次发病精神分裂症患者不一定需合并抗郁     

拉莫三嗪对精神分裂症阴性症状的辅助治疗作用

目的：探讨拉莫三嗪合并抗精神病药，治疗精神分裂症阴性症状的疗效与安全性。方法：对以阴性症状为主的精神分裂症患者50例，按入院顺序随机分为抗精神病药物合并拉莫三嗪组，（合用组）和单用抗精神病药物组（单用组），疗程12用。采用阳性与阴性症状量表（PANSS）评定疗效．用治疗中出现的症状量表（TESS）评定不良反应，于治疗前及治疗4、8、12周各评定一次。结果：合用组显效率64％，单用组硅效率40％。从治疗4周起，合用组PANSS总分及阴性症状分均显著低于单用组。结论：以阴性症状为主的精神分裂症患者．在使用抗精神病药物同时联用拉莫三嗪，可改善阴性症状，两组不良反应无明显差异．     

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。     

精神分裂症患者与同胞的脑CT相关因素分析

为了论证精神分裂症与脑结构异常的关系，将符合ＣＣＭＤ—２—Ｒ的５１例精神分裂症患者与４３例健康同胞进行脑ＣＴ对照研究。采用Ｋａｙ阳性和阴性症状量表对精神分裂症进行评定，并对患者的年龄、病程和阴性症状评分与脑ＣＴ作相关的分析。结果发现，患者的侧脑室指数及侧裂池与同胞对照组有显著差异（Ｐ＜０．０５）。年龄与脑结构异常呈相关性，在非同病双生子的研究中，上述关系更为显著。提示部分精神分裂症患者的脑结构异常与环境因素有关，脑室扩大的程度反映环境创伤。可将其归于非遗传的发病机理，但需要进一步研究证实。     

早期干预对首发精神分裂症患者的影响

目的：探讨早期干预对首发精神分裂症患者疗效和社会功能康复的影响。方法：干预组为50例首发精神分裂症患者，在药物治疗同时辅以心理和社会综合干预措施，50例与之匹配的对照患者单用药物治疗。采用阳性症状和阴性症状量表(PANSS)及社会功能缺陷筛选量表(SDSS)分别进行随访评定。结果：干预组随访时PANSS阴性量表分的改善明显优于对照组；SDSS的职业和工作、家庭外社会活动、家庭职能、个人生活自理、责任性和计划性5项因子分的改善明显优于对照组。结论：早期干预措施有助于提高精神分裂症患者的疗效和促进社会功能的康复。     

美多巴及舒必利治疗精神分裂症阴性症状的对照研究

目的探讨美多巴、舒必利治疗精神分裂症阴性症状的效果。方法用美多巴、舒必利分别合并抗精神病药物及单用抗精神病药物对各３０例住院精神分裂症病人进行１３周的对照研究，用阴性症状量表（ＳＡＮＳ）、简明精神病量表（ＢＰＲＳ）、副反应量表（ＴＥＳＳ）于治疗前后评定。结果美多巴、舒必舒利与单用抗精神病药物对阴性病状治疗有效率分别为５０％、５３３％和２０％。结论美多巴、舒必利合并抗精神病药均能提高对阴性症状的疗效，提示精神分裂症存在生物学异质性。     

SPECT study of Chinese schizophrenic patients suggests that cerebral hypoperfusion and laterality exist in different ethnic groups.

Hypofrontality is a common finding in schizophrenia in many countries. To date, there have been few studies on Chinese patients with schizophrenia. We thus wondered whether hypofrontality exists in Chinese patients with schizophrenia. We investigated 45 patients with schizophrenia and 21 healthy controls using brain perfusion single photon emission computed tomography (SPECT). Subjects were also administered the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Halstead-Reitan Neuropsychological Battery (HRNB) and the Wechsler Memory Scale-Revised (WMS-R). Images were analyzed using a semi-quantitative reading and a quantified region of interest analysis. We found that schizophrenic patients showed hypoperfusion in the frontal and temporal lobes and hyperperfusion in the basal ganglia. Schizophrenic patients with both negative and positive symptoms showed asymmetric perfusion in the temporal lobe. Schizophrenic patients with prominent negative symptoms also showed asymmetric perfusion in the prefrontal lobes. Negative symptoms showed a significantly negative correlation with regional cerebral blood flow (rCBF) in the left frontal lobe. Improved memory quotient (MQ) was significantly correlated with increased rCBF in the left temporal lobe. These findings from Chinese patients confirm a similar regional neuroanatomic dysfunction as in Western patients with the disease.     

Prognostic variables at intake and long-term level of function in schizophrenia

OBJECTIVE: This study assessed the relationship between symptoms and cognitive measures at intake and functional outcome 2-8 years later (average 3 years) in first-episode and previously treated schizophrenia patients. METHOD: A composite cognitive score was assessed at intake to determine the influence of cognition on later functional outcome. At intake and follow-up, positive and negative symptoms were assessed with the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms, and affective symptoms were assessed with the Hamilton Depression Rating Scale. Level of function in seven domains (social function, occupational function, independent living, symptom severity, fullness of life, extent of psychiatric hospitalization, and overall level of function) at intake and follow-up was assessed with the Strauss-Carpenter Level of Function scale. The contributions of sex, education, and duration of illness to functional outcome were also examined. RESULTS: The results indicated that symptoms at intake had distinct patterns of prognostic significance for functional outcome in previously treated patients, compared with first-episode patients. In addition, male and female patients differed in the degree to which initial symptoms were correlated with later function. CONCLUSIONS: Initial level of function, symptoms, sex, education, and duration of illness are all important predictors for functional outcome in patients with schizophrenia.     

The incidence of negative symptoms in early schizophrenia, mania and other psychoses

Despite increasing interest in negative symptoms in schizophrenia there has been little work on their incidence in early schizophrenia or in other psychoses. This study examined 79 nondepressive psychotics within 2 years of onset of illness, diagnosed by Research Diagnostic Criteria and assessed for negative symptoms using the Scale for the Assessment of Negative Symptoms. Marked negative symptoms were observed in nearly half of patients diagnosed as suffering definite schizophrenia and were rarely found in other psychoses. Negative symptoms were not significantly correlated with positive symptoms, depression or exposure to neuroleptics, but were correlated with developing extrapyramidal side effects.     

Relationship Between Metabolic Syndrome and Clinical Features,and Its Personal-Social Performance in Patients with Schizophrenia

The aim of this study was to evaluate the metabolic syndrome (MS) criteria and also to investigate the effects of MS on medical treatment, clinical course and personal and social performance in patients with schizophrenia. One hundred-sixteen patients with schizophrenia were included in the study. Measurements of MS were calculated in all patients. Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia, Personal and Social Performance Scale (PSP) were applied. The frequency of MS according to IDF criteria was 42.2 % among the patients. There was no significant difference between patients with and without MS in terms of age. The ratios of MS were 62.5 % for the group taking typical and atypical antipsychotics together and 35.7 % for the group taking two or more atypical antipsychotics together. The duration of disorder in patients with MS was higher than those without MS. Furthermore there was no significant difference between the schizophrenic patients with and without MS, in terms of PSP scores. Our findings showed that the duration of illness, high scores of BMI, use of clozapine or concurrent use of typical and atypical antipsychotics, depressive and negative symptoms of schizophrenia were significant risk factors for the development of MS.     

Family history of schizophrenia and the relationship of stress to symptoms: preliminary findings

OBJECTIVE: It has been hypothesized that patients with a diagnosis of schizophrenia who have a positive family history for schizophrenia will show greater reactivity of their symptoms to increasing levels of stress or negative affect than will patients without such a family history. In the past this hypothesis has only been tested through manipulations of negative affect in laboratory settings. In this paper we test this hypothesis using longitudinal clinical data. METHOD: Data were derived from an earlier longitudinal study using monthly assessments of daily stressors (Hassles Scale) and symptom measures (the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms). We compared longitudinal stress to symptom relations in 12 patients with schizophrenia for whom a positive family history of schizophrenia could be identified with 12 matched schizophrenic patients without any known family history of psychiatric illness. RESULTS: There was evidence that patients with a family history of schizophrenia demonstrated a stronger relation between stress and total score on the Scale for the Assessment of Positive Symptoms. This difference appears to have primarily reflected a greater reactivity to stress of reality distortion symptoms in the positive family history group. The two groups did not differ in apparent reactivity to stress of the disorganization and psychomotor poverty dimensions of symptomatology. CONCLUSIONS: The results of this study provide support from a naturalistic, longitudinal clinical study for the hypothesis that reactivity to stress of some symptoms of schizophrenia may vary as a function of family history of the disorder.     

Do the obsessive-compulsive symptoms have an effect in schizophrenia?

Objective

Schizophrenia presents with different symptom domains and functionality during its course. Obsessive-compulsive (OC) symptoms in schizophrenia have many themes to be clarified. Our aim was to compare schizophrenia patients with and without OC symptoms in terms of symptom domains, cognitive functions, and quality of life.

Method

Sixty-two patients who met schizophrenia diagnosis were assessed with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition consecutively over a period of 12 months in the setting of an outpatient clinic at medical university hospital. Yale-Brown Obsessive-Compulsive Scale, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, and neuropsychologic tests were used. Quality of life was assessed with Quality of Life Scale for Patients with Schizophrenia.

Results

Obsessive-compulsive symptoms along with schizophrenia were present in a considerable number in our sample (35.5%). Level of psychotic symptoms was more severe and quality of life was lower in schizophrenia patients with OC symptoms. A positive correlation was found between obsessions and delusions. Moreover, there was a positive correlation between compulsions and total Scale for the Assessment of Positive Symptoms score and bizarre behaviors subscore. There was no difference between the 2 groups regarding neurocognitive functions. The level of quality of life of schizophrenic patients with OC symptoms was lower. Besides, no correlation was found between OC symptoms and neurocognition and quality of life.

Conclusions

The findings of this study indicate that schizophrenia patients with OC symptoms had severe psychotic symptoms with a distinctive clinical picture including good neurocognition but poor functioning.     

Obsessive-compulsive disorder in adolescent schizophrenia patients

OBJECTIVE: The co-occurrence of obsessive-compulsive disorder (OCD) in adult patients with schizophrenia has been increasingly recognized. However, the rate of OCD comorbidity in adolescent schizophrenia patients has yet to be systematically evaluated. METHOD: The rate of DSM-IV OCD was evaluated in 50 adolescent inpatients with schizophrenia or schizoaffective disorder. The severity of schizophrenia and OCD symptoms was assessed with the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Thirteen schizophrenia patients (26.0%) also met the DSM-IV criteria for OCD. This subgroup scored significantly higher on the SANS subscale for affective flattening or blunting. The total SANS score positively correlated with the total Yale-Brown Obsessive Compulsive Scale score. CONCLUSIONS: A substantial proportion of adolescent schizophrenia inpatients have concomitant OCD. A prospective study is needed to evaluate the clinical course, response to treatment, and prognosis for this complex disorder.     

Non-verbal behaviour deficits in schizophrenia: an ethological study of drug-free patients

The aims of this study were (i) to define the dimensions of non-verbal behaviour which distinguish between schizophrenic patients and control subjects and (ii) to examine the relationship between patients' non-verbal behaviour and clinical symptoms. The non-verbal behaviour of 28 drug-free patients with schizophrenia according to Research Diagnostic Criteria (RDC) and 25 control subjects was videotaped during interviews and scored according to an ethological scoring system. Patients' symptoms were rated on the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms and the Brief Psychiatric Rating Scale. As a group, schizophrenic patients showed a global restriction of non-verbal expressiveness, as indicated by their lower scores on prosocial behaviour, gesture and conflict. However, some patients had normal ethological profiles. Non-verbal behaviour was largely independent of negative and positive symptoms. Deficits in non-verbal behaviour may play a role in determining or aggravating dysfunctional patterns of relating in schizophrenia. Ethological analysis provides further support for the model that conceptualizes positive symptoms, negative symptoms and disorders of social relationships as three separate dimensions of the schizophrenic syndrome.     

T-cells and psychopathology in schizophrenia: relationship to the outcome of neuroleptic therapy

Until recently, attention has been focused on the pathogenetic aspects of immunological findings in schizophrenic patients. There has been no mention of the relationship between such findings and schizophrenic symptoms. To study the probable relationship between T-cells and T-cell subgroups in the course and prognosis of schizophrenia, immunological and psychopathological parameters were correlated in 55 patients suffering from schizophrenia (ICD-9: 295.0–295.6) or schizoaffective psychosis (ICD-9: 257.7) before neuroleptic treatment. The correlations were performed for a second time in 24 of these patients after clinical improvement at a reinvestigation. Positive correlations of the Brief Psychiatric Rating Scale and the Scale for Assessment of Negative Symptoms with the numbers of CD3⁺ and CD4^- T-cells (total T- and T-helper cells), which were enhanced compared with controls, were found at the reinvestigation after clinical improvement, whereas no significant correlation could be detected at the pretreatment investigation. These results show that the cellular immune parameters are related to the course of the psychopathological symptoms in schizophrenia and, possibly, are a marker of the therapeutic outcome of neuroleptic treatment.     

Obsessive-compulsive disorder in hospitalized patients with chronic schizophrenia

Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. In this study, we assessed the rate of occurrence of OC symptoms and the interrelationship between OC and schizophrenic symptoms in 68 hospitalized chronic schizophrenic patients. The patients were interviewed with the Structured Clinical Interview for Axis-I DSM-IV Disorders - Patient Edition (SCID-P) and the appropriate rating scales including the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Barnes Akathisia Scale, the Abnormal Involuntary Movement Scale, and the Social Behaviour Schedule (SBS). Sixteen patients (23.5%) met the DSM-IV criteria for OCD. A comparison of schizophrenic patients with and without OCD showed that the schizo-obsessive patients were significantly (1.7-fold) more impaired in basic social functioning, as reflected by the SBS score. No significant between-group differences for any of the other clinical variables were found. There was no significant correlation between OC and schizophrenic symptoms within the schizo-obsessive subgroup. The mean Y-BOCS score for the patients with both schizophrenia and OCD was within the typical range (22.8+/-1.7) observed in OCD without psychosis. The findings provide further evidence for the importance of the OC dimension in schizophrenia and may have important implications for the application of effective treatment approaches in this difficult-to-treat subgroup of schizophrenic patients.