奥氮平对精神分裂症患者认知功能障碍的改善作用

目的探讨奥氮平对精神分裂症患者认知功能的改善作用。方法使用新韦氏记忆量表(WMSRC)、威斯康星卡片分类测验(WCST)、阳性症状与阴性症状量表(PANSS)、标准化的精神分裂症认知功能成套测验(MCCB)对患者的认知功能进行综合评定。结果治疗8周后,患者的记忆商数较治疗前有显著提高(P0.05);患者总测试次数、随机错误数、持续错误数均显著性下降(P0.05);但分类完成数、正确数无显著性变化(P0.05);患者治疗前后语言记忆及数字序列间存在显著差异(P0.01);治疗前后其迷宫、视觉记忆、空间广度及持续操作测试结果存在显著差异(P0.05),治疗前后患者连线及情绪管理检测结果差异无统计学意义(P0.05);阴性及阳性症状减分值、PANSS总分减分值与患者记忆商数增加值间呈显著正相关关系(P0.05或P0.01);患者PANSS总分减分值和一般病理性症状减分值与随机错误数减分值及阳性/阴性症状减分值与持续错误数减分值间均存在显著正相关关系(P0.05);治疗期间均未出现严重的不良反应。结论奥氮平可以显著改善精神分裂症患者的认知功能障碍,值得临床推广应用。     

首发精神分裂症患者心灵理论损伤的研究

背景 心灵理论(又称心理理论)是社会认知中最重要的认知成分之一,现在已经成为认知神经科学界关注的热点之一.目前的研究均证实精神分裂症患者存在心灵理论的损害,并且这种损害和其精神病性症状有一定的相关性.然而目前的研究大多集中在慢性或是服过药的精神分裂症患者中,尚不能完全排除药物的影响.因此本研究采用两种不同的心灵理论任务,并结合神经心理学背景测查对首发、未服药的精神分裂症患者进行了测试.以了解这种心灵理论的损害是否可以在首发、未服药的精神分裂症患者中得到重复.临床上以阴性症状为主的精神分裂症患者往往表现出更为明显的认知功能的损害,因此本研究还对以阴性症状为主的精神分裂症患者(阴性亚组)和以阳性症状为主的精神分裂症患者(阳性亚组)的心灵理论任务成绩及神经心理学背景测查成绩进行了比较.方法 对52例首发、未服药、能合作的精神分裂症患者和64名健康被试进行了眼区任务和失言觉察任务的心灵理论能力测查,采用言语流畅性和数字广度(包括顺背数字和倒背数字)任务对所有研究对象进行了神经心理学背景测试.采用阳性症状和阴性症状量表(PANSS)对精神分裂症患者的精神病性症状进行了评定.52例精神分裂症患者按照PANSS量表的复合量表分(阳性症状总分减阴性症状总分)进行了分组(复合量表分＞0者为阳性亚组,＜0者为阴性亚组),其中27例为阳性亚组,25例为阴性亚组.结果 在需要心灵理论认知成分加工的心理状态阅读任务和失言觉察问题得分上,以及言语流畅性成绩中精神分裂症组的成绩显著低于健康对照组,精神分裂症患者阴性亚组的心理状态阅读任务和言语流畅性成绩显著低于阳性亚组.心灵理论成绩和阴性症状总分呈显著负相关并和言语流畅性成绩呈显著正相关.结论 首发、未服药的精神分裂症患者存在心灵理论能力的损害,并且这种损害可能与其额叶功能的障碍有关.两种不同亚型的精神分裂症患者可能存在着不同形式的心灵理论的损害.     

Evaluating the causes of impaired irony comprehension following traumatic brain injury

Background : Individuals with traumatic brain injury (TBI) are known to have difficulty in understanding non-literal language devices such as irony. There are at least two possible explanations for poor irony comprehension following TBI; first, deficits might be caused by a specific impairment to theory of mind (ToM) and, second, deficits could be attributed to more general impairment in executive functioning (EF). Aims : This study aimed to evaluate the role of ToM and EF in the ability to comprehend non-literal ironic jokes. Methods & Procedures. Participants were 16 individuals who had sustained a TBI and 16 age- and demographic-matched controls. The ability to make inferences about mental states was compared to inferential reasoning capacity more generally. Participants were also assessed on other aspects of EF thought to contribute to inference making (working memory, concept formation, and fluency). The extent to which scores on these tasks were associated with participants' ability to comprehend ironic jokes was assessed using correlational and regression analyses. Outcomes & Results : Participants with TBI were significantly impaired on tasks measuring both ToM and EF. ToM was not significantly associated with irony comprehension. Instead, inferential reasoning, more broadly defined, demonstrated the strongest association. None of the component EF tasks were associated with irony comprehension. Conclusions : The results of this study do not support the theory that a specific impairment to ToM causes poor irony comprehension in TBI. In contrast, general inferential reasoning was a strong and significant predictor.     

Theory of mind in schizophrenia: The role of clinical symptomatology and neurocognition in understanding other people's thoughts and intentions

A wealth of studies has demonstrated that patients with schizophrenia are impaired in “theory of mind” (ToM). Here, we used a novel five-factor model of the Positive and Negative Syndrome Scale (PANSS) to test the hypothesis that selectivity of ToM deficits in schizophrenia depends on the predominating symptoms. We predicted that ToM impairments would be non-selective in patients with pronounced negative (NF) or disorganized symptoms (DF), whereas selective ToM impairment would occur in patients with predominant positive symptoms (PF). We recruited 50 patients diagnosed with schizophrenia or schizoaffective disorder and examined premorbid intelligence, executive functioning, ToM and psychopathology in comparison to a group of 29 healthy controls. Compared with healthy controls, patients performed more poorly on tasks involving executive functioning and ToM abilities. Using a novel PANSS five-factor model, we found a significant association of ToM deficits with the “disorganization” factor. Moreover, several individual PANSS items that were included within the disorganization factor correlated with impaired ToM, albeit the majority of correlations disappeared when controlled for executive functioning, and, to a lesser degree, when controlled for IQ. In addition, in the patient group we found interactions of poor ToM with symptoms belonging to the “emotional distress” factor of the PANSS. Contrary to expectations, associations of impaired ToM with positive symptoms were absent, and poor with regards to negative symptoms. This study lends further support to the assumption of differential associations of ToM deficits with individual symptoms and symptom clusters in schizophrenia.     

Humour appreciation and comprehension in children with intellectual disability

Background Data on typically developing children show that humour development starts from an early age. Studies investigating humour in children with intellectual disability (ID) are few and have generally focused on identifying differences between this population and other groups of children. This study focuses on children with ID as a heterogeneous group and seeks to answer the following questions: (1) what kinds of humour do children with ID appreciate most in a video cartoon? (2) How does the mode of presentation of jokes influence humour comprehension? Method This study examines humour appreciation and comprehension in school‐aged children (n = 9; chronological age: 7–11 years) with mild/moderate ID. Specific tools were developed to explore each aspect. Participants rated short scenes from a video cartoon to show their appreciation for different kinds of humour. A set of video‐recorded jokes, with different modes of presentation, were used in the comprehension task. Results The greatest appreciation was expressed for physical and visual humour. Non‐specific scenes (i.e. scenes with no particularly funny elements) were also rated highly. Jokes presented with gesture were understood more than jokes told without supports. These differences in comprehension, arising from supported/unsupported jokes, were statistically significant within the group studied. Conclusions The context of humour (e.g. being part of a video cartoon) is important in determining what children with ID find funny. The significant difference in comprehension brought about by a change in mode of presentation (i.e. supported/unsupported joke telling) suggests that humour comprehension can be facilitated.     

Risperidone,negative symptoms and cognitive deficit in schizophrenia: an open study

The aim of this study was to evaluate the effects of a new antipsychotic compound on negative symptoms and cognitive deficit in schizophrenia. Psychiatric symptoms and cognition were assessed in 25 patients with schizophrenia, at baseline and after they had taken risperidone for 4 weeks. The Positive and Negative Symptoms Scale (PANSS), the Wisconsin Card Sorting Test (WCST) and two WAIS sub-tests were used to assess the patients. After the study period, both negative and positive symptoms and also measures of cognitive performance improved significantly. The WCST results correlated with negative symptom scores before and after treatment. This suggests that negative symptoms and cognitive deficit have a common underlying substrate which is the target of the risperidone treatment. Our data show that risperidone may have a substantial effect on complex cognitive functions in schizophrenia, and they suggest that certain cognitive deficits are relatively dependent on the negative symptoms of this disorder.     

认知功能障碍与血清白细胞介素2的关系

目的 :探讨精神分裂症患者认知功能损害与精神症状及血清白细胞介素 2 (IL 2 )水平的关系。　方法 :在 5 7例未服抗精神病药的患者中 ,采用数字划销测验 (CT)、韦氏成人记忆量表 (WMS RC)、威斯康星卡片分类测验 (WCST)测试认知功能 ,用阳性症状与阴性症状量表 (PANSS)评定精神症状 ,同时测定血清IL 2浓度 ,分析其间的关系 ;并将记忆商数 (MQ)≤ 85者与MQ >85者比较血清IL 2水平及精神症状。　结果 :阴性症状分与各项认知测验的成绩均呈显著相关 ,部分认知损害还与一般病理性症状分相关 ,阳性症状分与所有认知测验的成绩均无相关性 ;血清IL 2水平与注意力、记忆力测验成绩呈显著负相关 ,与WCST测验成绩不相关 ;MQ≤ 85者与MQ >85者比较血清IL 2水平及阴性症状显著增高。　结论 :精神分裂症认知损害与阴性症状相关 ,与阳性症状不相关 ;血清IL 2水平可能与精神分裂症的注意力、记忆力损害相联系     

探索性眼球活动与精神分裂症患者临床症状的相关性研究

目的 探讨探索性眼球活动与精神分裂症患者临床症状的相关性.方法 选取2017年01月～2018年12月本院收治的58例精神分裂症患者作为此次研究的观察主体.入院后,对患者的反应性探索(RSS)、凝视点数(NEF)进行检测,同时在患者接受为期6周的抗精神病治疗后,追踪分析RSS、NEF与阳性与阴性症状量表(PANSS)评...     

Quality of life and cognitive dysfunction in people with schizophrenia

The main purpose of the present study was to examine the relationship between quality of life (QOL) and cognitive dysfunction in schizophrenia. Subjects were 61 stabilized outpatients. Quality of life and cognitive function were assessed using the Quality of Life Scale (QLS) and the Brief Assessment of Cognition in Schizophrenia (BACS), respectively. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). The BACS composite score and the BACS Verbal memory score were positively correlated with the QLS total score and two subscales. The BACS Attention and speed of information processing score had positive correlation with the QLS total and all the subscales scores. The PANSS Positive and Negative syndrome scores also had significant correlations with the QLS total score and all of the subscales. In addition, the CDSS score was negatively correlated with the QLS total score and some of the subscales. Stepwise regression analysis showed that the BACS Attention and speed of information processing score was an independent predictor of the QLS total score but it was less associated with the QLS than the PANSS Negative syndrome score and the CDSS score. The results suggest that negative and depressive symptoms are important factors on patients' QOL and also support the view that cognitive performance provides a determinant of QOL in patients with schizophrenia.     

Oral health and the symptoms of schizophrenia

The objectives of this study were to evaluate the oral health of a group of schizophrenic outpatients and a control group without psychiatric illness. The study also aimed to assess the influence of positive and negative symptomatology on oral health among outpatients with schizophrenia. The DMF-T Index (sum of decayed, missing and filled teeth) and the Community Periodontal Index of Treatment Needs (CPITN) were assessed in both groups. We evaluated the psychopathological state of the patient group using the Positive and Negative Syndrome Scale (PANSS). The schizophrenic patients had higher scores than the control group with respect to decayed teeth (4.39 vs. 0.72), missing teeth (5.66 vs. 1.50), the DMF-T index (13.51 vs. 7.8) and CPITN (2.32 vs. 1.04); and lower scores for filled teeth (3.53 vs. 5.54). The PANSS negative subscale score correlated positively with the oral health variables studied, whereas the PANSS positive subscale score correlated negatively and exclusively with the number of missing teeth. Age and smoking status affected oral health in both groups, but even when the influence of these factors was considered, the oral health of the patients was poorer than that of the control group.     

Deconstructing theory of mind in schizophrenia

First- and second-order theory of mind (ToM) abilities seem to form a hierarchy of mind states within the same construct. If so, no ability in higher comprehension of intentionality would be possible when the previous one is failing. The purpose of the study is to investigate this hierarchy in a sample of schizophrenic subjects. Insofar as ToM defines processes involved in a multi-level social cognitive processing, they could be part of a scenario of specialized areas performing different parallel computations. Therefore, we further investigated the relationship of ToM scores to metacognitive indexes, widely demonstrated to be involved in social cognition, symptomatology and global functionality, in two independent samples of subjects with schizophrenia.Thirty-eight subjects with schizophrenia were preliminarily examined for first- and second-order ToM, using only one story in each order. Cross-tabulation of subjects according to their answers revealed that 13.2% of subjects gave incorrect answers to ToM I but correct answers to ToM II. A more extensive examination of first- and second-order ToM in a sample of 42 subjects with schizophrenia was then performed. The results confirmed the existence of a group of subjects (11.9%) scoring incorrectly at ToM I but correctly at ToM II, which is unexplainable if the hierarchical hypothesis were true. While both ToM scores were highly correlated with metacognitive scores on the Positive and Negative Syndrome Scale (PANSS), for both positive and negative clusters, and only second-order ToM was correlated with scores on the Global Assessment of Function (GAF). On the other hand, meta-cognitive indexes were correlated with both PANSS and GAF scores. First-order ToM was found to play an essential role in determining clinical severity. ToM I and II order scores share a minor part of variance.Instead of hierarchically ordered mind states, first- and second-order intentionality can represent different constructs. The ability to ‘understand others’, i.e. ToM, can be dissociable, suggesting the existence of an interconnected network of different constructs deputed to an adequate understanding and management of the social world complexity.     

联用帕罗西汀治疗精神分裂症阴性症状研究

目的:探讨抗精神病药联用帕罗西汀治疗精神分裂症阴性症状的疗效.方法:以阴性症状为主的住院慢性精神分裂症33例,在原用抗精神病药基础上,联用帕罗西汀,疗程12周.使用阳性 与阴性症状量表(PANSS)和副反应量表(TESS)评定,在治疗前和治疗4、8、12周末各评定1次.结果:联用帕罗西汀12周后,PANSS总分、阴性症状因子分及情感迟钝、情感退缩、情感交流障碍、被动/淡漠及社交退缩因子分均比治疗前显著降低.结论:以阴性症状为主的慢性精神分裂症,在使用抗精神病药物的同时联用帕罗西汀,对改善阴性症状有明显作用.     

Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder

BACKGROUND: Symptoms of depression and anxiety are frequently encountered in the course of schizophrenia and are of considerable clinical importance. They may compromise social and vocational functioning, and they are associated with an increased risk of relapse and suicide. Various treatment approaches have been reported to be successful. METHOD: The sample comprised 177 patients with DSM-III-R or DSM-IV schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials at our academic psychiatric unit over a 7-year period and who were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Analysis was performed on baseline PANSS scores. The depression/anxiety score was compared in the men and women, first-episode and multiple-episode patients, and those with predominantly positive and negative syndromes. Correlations were sought between depression/anxiety scores and age, total PANSS score, positive score, negative score, general psychopathology score, and treatment outcome. Multivariate analysis was applied to determine contributions of individual variables toward depression/anxiety and outcome scores. RESULTS: Depression and anxiety symptoms were more severe in women (p = .007), first-episode patients (p = .02), and those with predominantly positive symptoms (p < .0001). Depression/anxiety scores were significantly correlated to age (r = -0.31, p < .0001), PANSS positive scores (r = 0.39, p < .0001), and treatment outcome (r = 0.25, p = .006). Multivariate analysis bore out these results, with the exception that first episode was not a significant predictor of depression and anxiety scores. CONCLUSION: PANSS depressive/anxiety scores were generally low in our sample, perhaps because patients with schizoaffective disorder were excluded. The finding that these symptoms were more prominent in women and first-episode patients is in keeping with previous literature. The higher scores in first-episode patients are likely due to the higher positive symptom scores in these patients. The association between depressive/anxiety scores and positive symptoms but not with negative symptoms points to a specific relationship between affective symptoms and the positive symptom domain of schizophrenia. The presence of depressive and anxiety symptoms may predict a more favorable outcome to treatment, although this may only apply to the acute exacerbations of the illness.     

阿尔茨海默病阳性与阴性精神症状临床对照研究

目的研究以阳性症状与阴性症状为主的阿尔茨海默病(AD)患者的临床特征。方法根据入组时阳性和阴性症状量表(pANSS)的复合分,将所有病例分为阳性症状组和阴性症状组,分别比较两组．AD病理行为评分表(BEHAVE—AD)、简易智力状态检查(MMSE)、日常生活能力量表(ADL)、急性生活事件的LEU总值、脑电图(EEG)改变、头颅CT值及经颅多普勒超声(TCD)的异同。结果阳性症状组有较多的偏执和妄想观念、幻觉、行为紊乱及攻击行为,有更大强度的生活事件,经治疗后阳性症状组改善较明显,且起效快,日常生活能力改善也更加明显。阴性症状组的双侧脑室前角距／颅内板距比(BFR)较阳性症状组为大。结论以阳性症状与以阴性症状为主的AD患者的临床特征有所不同,可供分型时参考。     

精神分裂症认知障碍及其与阴性阳性症状的关系

目的 探索精神分裂症认知障碍特点及其与阴性阳性症状之间的关系。方法 比较32例从未用过抗精神病药或停药2周以上的精神分裂症患者以及15例健康受试者的事件相关电位(ERPs)和威斯康星卡片分类测验成绩(WCST),并进行相关分析。结果 与正常受试者比较,多个位点N2和P3波潜伏期延长,P3波幅降低。WCST中分类完成数偏少,持续错误数和总错误数增加。N2潜伏期和波幅与PANSS阳性症状分呈负相关,而WCST总错误数与PANSS总分和阴性症状总分正相关。结论精神分裂症病人存在中枢信息处理障碍,认知障碍与阴性阳性症状之间具有一定的内在联系。     

抗精神病药合并帕罗西汀治疗慢性精神分裂症

目的：探讨抗精神病药合并帕罗西汀治疗慢性精神分裂症阴性症状的疗效。方法：对68例以阴性症状为主的慢性精神分裂症患者，在原用抗精神病药基础上，随机分为合用组和对照组，分别给予帕罗西汀和安慰剂，疗程12周。疗效和药物不良反应评定采用阳性与阴性症状量表（PANSS）和治疗中出现的症状量表（TESS），于治疗前及治疗4、8、12周各评定一次。结果：治疗第8周起合用组PANSS总分及阴性因子分均比治疗前显著降低。结论：以阴性症状为主的慢性精神分裂症患者，在使用抗精神病药同时联用帕罗西汀可改善阴性症状，两组不良反应无明显差异。     

精神分裂症患者攻击行为与临床症状、记忆及智力的相关性

目的探讨精神分裂症患者攻击行为与临床症状、记忆及智力的相关性,分析临床症状、记忆及智力能否作为精神分裂症患者攻击行为的预测因子。方法以2014年5月-2016年5月在中山市第三人民医院早期干预科住院的符合《国际疾病分类(第10版)》(ICD-10)精神分裂症诊断标准的患者为研究对象,所有患者均处于急性发作期。依据既往暴力史和修订版外显攻击行为量表(MOAS)加权总分为5分区分攻击组和非攻击组,其中攻击组69例,非攻击组39例。采用阳性和阴性症状量表(PANSS)评估临床症状,采用韦氏记忆量表修订版(WMS-R)、韦氏成人智力量表中国修订版(WAIS-RC)评估记忆和智力,并对MOAS与PANSS、WMS-R和WAIS-RC评分进行相关分析。结果攻击组MOAS加权总分、言语攻击、对财产的攻击和体力攻击的评分均高于非攻击组,差异均有统计学意义(P0.05或0.01)。攻击组PANSS总评分和阳性症状评分均高于非攻击组,差异均有统计学意义(P0.05或0.01)。两组WMS-R和WAIS-RC评分比较差异均无统计学意义(P均0.05)。MOAS加权总分、体力攻击评分与PANSS总评分、阳性症状评分和一般精神病理评分呈正相关(r=0.203~0.535,P0.05或0.01),体力攻击评分与心智评分呈负相关(r=-0.343,P0.05)。结论与非攻击组相比,攻击组的攻击行为体现在言语攻击、对财产的攻击与体力攻击方面。PANSS总评分与阳性症状可能与精神分裂症患者的攻击行为相关。记忆和智力与精神分裂症患者的攻击行为不相关,不能作为攻击行为的预测因子。     

Does premorbid IQ have a pathoplastic effect on symptom presentation in schizophrenic and bipolar disorders?

INTRODUCTION: The poor premorbid IQ has been considered as a predisposing factor for the development of schizophrenia and other psychoses as well as predictive of poor long-term outcome. We hypothesise that premorbid IQ could influence symptom expression during an index episode (i.e. a short-term outcome). AIM OF THE STUDY: We studied 48 patients with schizophrenic disorder and 56 with bipolar disorder during an 'index episode' using the test di intelligenza breve (TIB) for the premorbid IQ evaluation, and the positive and negative syndrome scale (PANSS). RESULTS: Using the premorbid IQ as a criterion variable (i.e. low versus high IQ groups) the one-way ANOVA analysis showed that low IQ schizophrenic patients had more PANSS positive symptoms and "thought disturbances" than both high and low IQ bipolars. The low IQ schizophrenic patients showed more cognitive symptoms than bipolar patients with high IQ. Furthermore, no PANSS differences were seen between high IQ schizophrenics and low IQ bipolars. In the total and bipolar groups the correlation coefficients between TIB scores and PANSS scales reached statistical significance for the cognitive cluster only. No correlations were seen in the schizophrenic group. CONCLUSION: This categorisation (i.e. low versus high IQ) adds clinically relevant knowledge to patients who, in spite of having similar symptom profile (i.e. high IQ schizophrenic patients and low IQ bipolar patients), fall into different diagnostic categories.     

The effects of normal aging on humor appreciation.

The importance of humor in healthy aging is being recognized. We compared elderly and young participants on their comprehension and appreciation of, and reaction to, verbal and nonverbal humor tests. Cognitive processes-working memory, cognitive flexibility, verbal abstraction, and visual scanning-were studied in relation to humor. Results indicated a relative deficit in the elderly in the cognitive comprehension of humor-selecting punch lines to jokes and in a cartoon array test. Measures of cognitive function correlated with humor comprehension. In contrast to this deficit in comprehension, the elderly showed intact affective appreciation and emotional reactiveness. Because of the hypothesis of frontal lobe degeneration as a basis for changes with aging, we compared the elderly to patients with focal frontal lesions. In this comparison, the elderly were significantly better than the patients in their comprehension of humor. They also displayed intact appreciation of humor compared to patients with frontal lesions. This preliminary study suggests that preserved affective responsiveness may underlie the success in using humor as a coping mechanism in the elderly.     

慢性精神分裂症患者认知功能与血清C-反应蛋白的关联研究

目的:探讨慢性精神分裂症患者血清C-反应蛋白(CRP)水平与神经认知功能的相关性。方法:检测50例符合《美国精神障碍诊断与统计手册》第4版精神分裂症诊断标准的女性患者(患者组)和50名健康志愿者(正常对照组)血清CRP水平;采用阳性与阴性症状量表(PANSS)评估患者的临床症状,威斯康星卡片分类测试(WCST)、连线测试(TMT)评估患者的认知功能;对CRP水平与临床症状及认知功能进行相关分析并与正常对照组进行比较。结果:患者组血清CRP水平明显高于正常对照组(t=9.203,P0.001);WCST、TMT测验成绩明显差于正常对照组(t=4.462~6.815,P均0.001)。患者组血清CRP水平与PANSS总分及阴性症状分呈正相关(r=0.422,r=0.372;P0.05);与WCST正确数、完成分类数呈负相关(r=-0.364,r=-0.375;P0.05),与WCST错误总数、持续错误数、随机错误数呈正相关(r=0.341,r=0.346,r=0.381;P均0.05);与TMT-A、TMT-B呈正相关(r=0.411,r=0.483;P均0.05)。结论:慢性期精神分裂症患者存在明显免疫异常,血清CRP水平与认知功能和阴性症状密切相关。