氯丙嗪和利培酮对首发精神分裂症患者认知功能的影响

目的 比较氯丙嗪和利培酮对首发精神分裂症患者认知功能的影响。方法 将100例首发精神分裂症住院患者随机分为氯丙嗪组（50例）和利培酮组（50例）,进行开放性对照研究。在治疗前和治疗后第8周末各做1次韦氏成人智力量表（WAIS-R）、韦氏记忆量表（WMS）和威斯康星卡片分类测验（WCST）。结果 治疗第8周末,利培酮组各项认知功能检查结果明显好于氯丙嗪组（P〈0．05）;在控制可能的干扰因素（入组时测查水平、年龄、文化程度、药物副反应的程度）后,大部分检查结果两组之间差异仍正著,利培酮组各项认知功能指标均有好转,而氯丙嗪姐6项中有3项恶化。结论 对首发精神分裂症患者,利培酮治疗对其认知功能有改善作用,而氯丙嗪对认知功能的某些方面有损害。     

精神分裂症患者利培酮治疗前后认知功能的研究

目的研究精神分裂症患者利培酮治疗前后认知功能是否有所改善.方法研究对象符合CCMD-3精神分裂症诊断标准,病程≤2年,首发住院,实际完成研究50例.采用中国修订的韦氏成人智力量表（WAIS-RC）,韦氏成人记忆量表（WMS-RC）,于治疗开始时和第8周末分别进行两次评定.利培酮的每日剂量为2～8mg.结果大多数分测验项目和言语智商、操作智商、智商总分、记忆商数,在治疗前后都有显著性差异.结论利培酮对精神分裂症患者的认知功能障碍有改善作用.     

首发精神分裂症患者近期和远期复发的相关因素

目的探讨引起首发精神分裂症患者近期和远期复发的相关因素。方法对164例首发精神分裂症患者进行长期随访,于治疗一年末、四年末各做一次韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击试验、动作功能测验、手功能协调测验、连线测验A和B、威斯康星卡片分类测验(WCST)及言语流利性测验10项神经心理测查及治疗一年内每月一次BPRS、SDSS评定,治疗一年至四年内每三月一次BPRS、SDSS评定。我们分别根据患者治疗一年内和一年至四年的BPRS结果将患者分为复发组和未复发组,即一年内或一年至四年只要有一次复发就分到复发组,分别比较治疗一年末和四年末复发组和未复发组各项认知功能及年龄、受教育年限、DUP(未治疗的精神病期)等特征有无显著性差异。结果治疗一年末复发组的DUP显著长于未复发组(24.4±18.4/16.5±17.4,t=-2.19,P<0.05),其余各项指标差异均无统计学显著性;治疗四年末复发组和未复发组各项指标差异均无统计学显著性。结论首发精神分裂症患者的DUP长短与患者的近期预后有关,DUP越短,近期预后越好;DUP为近期内复发的相关因素。     

用认知行为疗法治疗精神分裂症的继发抑郁

目的：探讨认知行为疗法治疗精神分裂症的继发抑郁的疗效。方法：使用“旧金山预防抑郁研究”教材录制的录像带，对２３例伴有抑郁症状，且符合ＤＳＭ－Ⅳ有关精神分裂症和分裂样精神障碍诊断标准患者，通过看录像进行认知行为疗法，每周一次，８周为一疗程。治疗前后用ＨＡＭＤ、ＣＥＳ－Ｄ、ＨＡＭＡ、ＢＰＲＳ、ＧＡＳ量表评定。结果：认知行为治疗后ＨＡＭＤ、ＣＥＳ－Ｄ、ＨＡＭＡ评分均有逐渐下降趋势、ＧＡＳ评分有逐渐上升趋势（Ｐ＜０．０５），而ＢＰＲＳ评分无显著差异（Ｐ＞０．０５）；治疗６周及８周ＨＡＭＤ减分率与ＢＰＲＳ减分率、ＧＡＳ变化值之间均呈密切相关（Ｐ＜０．０１）。结论：认知行为疗法能改善精神分裂症的抑郁和焦虑症状，能提高患者临床总体情况和功能水平     

利培酮与氯丙嗪对首发精神分裂症认知功能的影响

目的 探讨利培酮与氯丙嗪对首发精神分裂症患者认识功能的影响。同时研究首发精神分裂症患者认知功能损害的特点及影响因素。方法 将符合CCMD-3诊断标准的首发精神分裂症89例,随机分为利培酮组（44例）与氯丙嗪组（45例）,疗程8周,治疗前及8周末分别进行韦氏成人智力测验（WAIS—RC）,韦氏成人记忆测验（WMS-RC）,威斯康星卡片分类试验（WCST）测定。结果 89例患者在8周治疗后PANSS总分明显下降,但两者之间差异无显著性。治疗前,所有首发精神分裂症患者均有认知功能损害。8周后,利培酮与氯丙嗪两组患者成绩均明显提高,而利培酮组的改善显著优于氯丙嗪组。结论 认知功能损害是精神分裂症的原发症状之一,利培酮对其的治疗作用优于氯丙嗪。     

齐拉西酮对首发精神分裂症患者疗效及认知功能的影响

目的：探讨齐拉西酮对首发精神分裂症患者疗效及认知功能的影响。方法：将80例首发精神分裂症患者随机分为研究组与对照组各40例。研究组采用齐拉西酮治疗,对照组采用氯氮平治疗,均治疗12周。于治疗前、后用威斯康星卡片分类测验（ WCST）,韦氏记忆量表（ WMS）评定认识功能,阳性与阴性症状量表（ PANSS）评定临床疗效。结果：治疗12周后研究组,对照组PANSS、WCST、WMS均较治疗前显著性下降（ t＝2．872～5．648,P＜0．01）。两组间完成分类数,错误应答数,再生,联想,理解,背数比较差异均有显著性（t ＝2．175～2．683,P＜0．05）,不良反应比较有显著性差异（t＝2．071～2．534,P＜0．05）。结论：齐拉西酮与氯氮平对首发精神分裂症患者疗效相当,但齐拉西酮对认知功能的改善优于氯氮平。     

家庭干预对农村首发精神分裂症患者亲属心理健康影响

目的：观察家庭干预对农村首发精神分裂症患者主要亲属心理健康状况的影响。方法：对符合中国精神疾病分类方案与诊断标准第二版修订本（ＣＣＭＤ２Ｒ）精神分裂症诊断标准的５０例农村首发病人的主要亲属（Ａ组）进行住院８周的积极家庭干预及出院后维持干预,并与５０例条件相仿的农村首发精神分裂症病人主要亲属（Ｂ组）对照,用症状自评量表（ＳＣＬ９０）于病人入院时,入院第４和第８周末,出院后每隔１～３月随诊时分别评定其同一主要亲属的心理健康状况,用简明精神病量表（ＢＰＲＳ）评定病情严重程度,并进行２年随访。结果：Ａ组心理健康状况的改善明显好于Ｂ组,多在入院４周时即显示较好效果。随访期间复发病人亲属的ＳＣＬ９０增分Ａ组显著少于Ｂ组（Ｐ＜００１）,家庭干预对亲属为女性,受教育高者效果好。结论：家庭干预能显著改善农村首发精神分裂症患者亲属的心理健康状况。     

精神分裂症患者的脑功能显像与神经心理测验的相关研究

本研究应用单光子发射断层摄影术（ＳＰＥＣＴ）、ＨＲ成套神经心理测验（成人）修订本［ＨＲＢ（Ａ）－ＲＣ］和修订韦氏记忆测验（ＷＭＳ－ＲＣ）对３２例住院精神分裂症患者的脑功能改变及脑功能显像与神经心理测验之关系进行探讨。结果显示，精神分裂症患者存在额叶、颞叶和基底节的脑血灌流量降低，同时表现程度不同的神经心理功能损害，此改变在阴性症状和阳性症状的病人间无差异。脑血灌流量降低与损伤指数（ＤＱ）和记忆商数（ＭＱ）未见明显关系。相关分析表明，ＤＱ与ＴＥＳＳ评分呈显著正相关（ｒ＝０．３６，Ｐ＜０．０５）；ＭＱ与住院次数（ｒ＝－０．４２，Ｐ＜０．０５）、ＢＰＲＳ评分（ｒ＝－０．５６，Ｐ＜０．０１）、ＳＡＰＳ评分（ｒ＝－０．３９，Ｐ＜０．０５）和ＳＡＮ评分（ｒ＝－０．３７，Ｐ＜０．０５）呈显著负相关，与ＧＡＳ评分（ｒ＝０．５３，Ｐ＜０．０１）呈显著正相关     

C一WISC与WAIS一RC用于16岁正常学生测试结果的比较研究

本研究采用中国修订韦氏儿童智力量表（Ｃ一ＷＩＳＣ）与韦氏成人智力量表中国修订本（ＷＡＩＳ一ＲＣ）对５２名１６岁的高一年级学生进行了测试，结果发现：在ＷＡＩＳ一ＲＣ上的ＩＱ分及分测验量表分普遍高于Ｃ一ＷＩＳＣ，６个言语分测验平均相差１．５个量表分，５个操作分测验平均相差０．９个量表分，言语、操作及全量表智商分别相差６、１、４分，说明两套测验的结果不完全具有等值性，本文对其产生原因作了探讨。     

奥氮平对精神分裂症认知障碍的疗效及糖、脂代谢的影响

目的观察奥氮平对精神分裂症患者认知功能障碍的疗效及其对糖、脂代谢影响。方法将60例接受单一奥氮平治疗的精神分裂症患者,采用修订韦氏记忆量表（WMS--RC）评定记忆功能;威斯康星卡片分类测验（WCST）评定执行功能;PANSS量表评定精神症状;并检测血糖、胆固醇和甘油三脂,分别在治疗前、治疗8周末各测验1次。结果经过8周的奥氮平治疗后,记忆商数显著提高（P〈0．001）,威斯康星卡片分类测验的总测验次数、持续错误数及随机错误数均显著下降（P〈0．05或P〈0．01）;并且奥氮平对记忆功能、执行功能的改善与阳性症状、阴性症状的下降里显著正相关．治疗8周末血糖、胆固醇和甘油三脂水平均显著高于治疗前（P〈0．05或P〈0．01）．结论奥氮平能有效的改善精神分裂症患者的认知功能障碍,但应重视其对糖脂代谢的副作用。     

Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up

OBJECTIVE: Many studies have reported that cognitive ability may be predictive of the functional outcome for patients with schizophrenia. However, no study has prospectively examined these aspects in schizophrenia and bipolar disorders simultaneously. The present study attempted to analyze if neurocognition and clinical status predicts the real-life functioning for patients with schizophrenia or bipolar I disorder, using a longitudinal design. METHOD: Forty-seven schizophrenic and 43 bipolar I outpatients were assessed twice with a neurocognitive battery (Executive Functions, Working Memory, Verbal Memory, Visual Memory, Visual-Motor Processing, Vigilance, Vocabulary and Motor Speed tasks), clinical scales (the Positive and Negative Symptom Scale, the Hamilton Rating Scale for Depression and the Clinician Administered Rating Scale for Mania) and functional outcome measures (the Global Assessment of Functioning Scale, the WHO's Disability Assessment Scale and occupational adaptation level) over a one-year follow-up period. The cognitive performance of the patients was compared, at baseline and one year later, with that of 25 healthy subjects. RESULTS: In schizophrenia patients, global functioning one year later was predicted by a composite neurocognitive score and three specific domain (verbal memory, motor speed, vocabulary). Symptoms appeared to explain less of the variance in functioning. In bipolar I patients, changes in the composite neurocognitive score over one year, deficits in the visual/motor processing domain, severity of symptoms (psychotic, excitatory and affective symptoms) and premorbid adjustment at the first assessment were the variables that better predicted functioning or disability changes over follow-up period. CONCLUSIONS: Although the relationships between cognition, symptoms and functional capacity differ for schizophrenia or bipolar I patients, neuropsychological performance seems to be a principal longitudinal predictor of functioning in both disorders. Baseline neurocognition and cognitive changes over 12 months predicted changes in functioning over the same period, but only in bipolar I patients. These cognitive domains could be potential neurocognitive endophenotypes (endophenocognitypes) with regard to bipolar I disorder.     

Multivariate predictors of social skills performance in middle-aged and older out-patients with schizophrenia spectrum disorders

BACKGROUND: Cognitive impairment and negative symptoms are two of the primary features of schizophrenia associated with poor social functioning. We examined the relationships between clinical characteristics, specific cognitive abilities and social skills performance in middle-aged and older out-patients with schizophrenia and normal comparison subjects. METHOD: One hundred and ninety-four middle-aged and older schizophrenia out-patients and 60 normal comparison subjects were administered a standardized, performance-based measure of social skills using role-plays of various social situations [Social Skills Performance Assessment (SSPA)] and measures of current level of social contact (the Lehman Quality of Life Interview), psychiatric symptom severity [the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale (HAMD)], insight [the Birchwood Insight Scale (IS)] and cognitive functioning [the Mattis Dementia Rating Scale (DRS)]. RESULTS: Patients demonstrated worse social skills compared with normal subjects. Better performance on the SSPA was associated with having less severe positive and negative symptoms, fewer social contacts, and better attention, initiation/freedom from perseveration, visuospatial ability, abstraction ability and memory. After controlling for demographic, clinical and insight-related factors, abstraction ability was the strongest predictor of social skills performance, followed by frequency of social contact. CONCLUSIONS: Social functioning (as measured through direct observation of social skills performance) was related to cognitive ability in out-patients with schizophrenia. Addressing such cognitive impairment may help to improve social functioning and result in greater overall quality of life.     

Anomalous visual experiences, negative symptoms, perceptual organization and the magnocellular pathway in schizophrenia: a shared construct?

BACKGROUND: Schizophrenia is associated with impaired visual information processing. The aim of this study was to investigate the relationship between anomalous perceptual experiences, positive and negative symptoms, perceptual organization, rapid categorization of natural images and magnocellular (M) and parvocellular (P) visual pathway functioning. METHOD: Thirty-five unmedicated patients with schizophrenia and 20 matched healthy control volunteers participated. Anomalous perceptual experiences were assessed with the Bonn Scale for the Assessment Basic Symptoms (BSABS). General intellectual functions were evaluated with the revised version of the Wechsler Adult Intelligence Scale. The 1-9 version of the Continuous Performance Test (CPT) was used to investigate sustained attention. The following psychophysical tests were used: detection of Gabor patches with collinear and orthogonal flankers (perceptual organization), categorization of briefly presented natural scenes (rapid visual processing), low-contrast and frequency-doubling vernier threshold (M pathway functioning), isoluminant colour vernier threshold and high spatial frequency discrimination (P pathway functioning). RESULTS: The patients with schizophrenia were impaired on test of perceptual organization, rapid visual processing and M pathway functioning. There was a significant correlation between BSABS scores, negative symptoms, perceptual organization, rapid visual processing and M pathway functioning. Positive symptoms, IQ, CPT and P pathway measures did not correlate with these parameters. The best predictor of the BSABS score was the perceptual organization deficit. CONCLUSIONS: These results raise the possibility that multiple facets of visual information processing deficits can be explained by M pathway dysfunctions in schizophrenia, resulting in impaired attentional modulation of perceptual organization and of natural image categorization.     

Slowed lexical access is uniquely associated with positive and disorganised symptoms in schizophrenia

Introduction: This study addressed the relationship of both semantic priming and slowed lexical access to the symptoms of schizophrenia, and evaluated their association with other neurocognitive deficits. Methods: 57 outpatients with schizophrenia and 20 nonpsychiatric control subjects performed a lexical decision semantic priming task (LDT), and a brief neuropsychological battery. The schizophrenia group was also assessed with an extended Positive and Negative Symptom Scale. Results: As expected, the schizophrenia group had significantly slower reaction times (RTs) than the control group, and poorer performance on most neuropsychological tasks. Both groups exhibited semantic priming effects in both automatic and controlled processing conditions; these effects were not significantly different between groups. RT was unrelated to age, illness duration, GAF scores, or neuroleptic dose; controlled semantic priming effects were related to illness duration only. RT to real word targets (but not to nonwords) on the LDT was significantly correlated with positive and disorganised, but not negative symptoms. The neurocognitive correlates of RT slowing were: fullscale IQ and verbal fluency, but not attention; working memory; episodic memory retrieval; executive function, or manual speed. Both controlled semantic priming effects as well as the difference between controlled and automatic priming effects were related to executive functions in general. Severity of symptoms in the three major symptom groups was generally unassociated with impairment on the neuropsychological battery. The associations of RT slowing to positive and disorganised symptoms remained even after controlling for each of the above clinical and neurocognitive measures. Conclusions: These findings suggest that in schizophrenia, slowed lexical access is uniquely related to positive and disorganised symptoms. This relationship is not accounted for by more general cognitive deficits, overall illness severity, or generalised effects of symptoms on cognitive function. This relationship may reflect a specific impairment in the access to semantic memory.     

精神分裂症患者情绪认知缺陷及其与精神症状的相关性

目的 探讨精神分裂症患者的情绪认知活动及其与精神症状的相关性.方法 采用中国人面孔情绪测验(CFET)对61例精神分裂症患者进行测试,与57名正常健康者比较,同时作阳性症状量表(SAPS)和阴性症状量表(SANS)评定.结果 分裂症患者CFET6种情绪认知正确数评分均低于对照组,而远隔错误数评分除厌恶情绪外均显著高于对照组.患者CFET评分与诊断分型、住院次数、用药无关,但SAPS和SANS部分症状评分与CFET的正确数评分呈负相关,而与CFET的错误数评分呈正相关.结论 分裂症患者情绪认知损害较为广泛,在病程过程中相对稳定存在,可能与患者广泛脑区网络功能障碍有关.而患者的症状表现与情绪认知缺陷可能存在共同的病理生理基础.     

Why does age of onset predict clinical severity in schizophrenia? A multiplex extended pedigree study

Schizophrenia has substantial variation in symptom severity, course of illness, and overall functioning. Earlier age of onset (AOO) is consistently associated with negative outcomes and yet the causes of this association are still unknown. We used a multiplex, extended pedigree design (total N = 771; 636 relatives from 43 multigenerational families with at least 2 relatives diagnosed with schizophrenia and 135 matched controls) to examine among the schizophrenia relatives (N = 103) the relationship between AOO and negative and positive symptom severity, cognition, and community functioning. Most importantly, we assessed whether there are shared genetic effects between AOO and negative symptoms, positive symptoms, cognition, and community functioning. As expected, earlier AOO was significantly correlated with increased severity of negative and positive symptoms and poorer cognition and community functioning among schizophrenia patients. Notably, the genetic correlation between AOO of schizophrenia and negative symptoms was significant (R_g = ?1.00, p = .007). Although the genetic correlations between AOO and positive symptoms, cognition, and community functioning were estimated at maximum and in the predicted direction, they were not statistically significant. AOO of schizophrenia itself was modestly heritable, although not significant and negative symptoms, positive symptoms, and cognition were all strongly and significantly heritable. In sum, we replicated prior findings indicating that earlier AOO is associated with increased symptom severity and extended the literature by detecting shared genetic effects between AOO and negative symptoms, suggestive of pleiotropy.     

Effects of cognitive remediation therapy on neurocognition and negative symptoms in schizophrenia: an Italian naturalistic study

Introduction: Cognitive remediation therapy (CRT) has been reported to positively affect neurocognitive processes among patients with schizophrenia; however, the degree to which changes in cognition is linked to improved clinical symptoms, remains poorly understood. The current study aimed to investigate whether cognitive gains were associated to improvements in negative symptoms’ severity in patients with schizophrenia living in two Italian psychiatric facilities.

Methods: Patients with a diagnosis of schizophrenia were consecutively assigned to CRT (n?=?33) and compared with an historical control group (n?=?28). Assessments were performed at baseline and post-treatment using a neuropsychological battery (Trail Making Test A and B, Self-Ordered Pointing Task, California Verbal Learning Test), along with clinical and functioning measures.

Results: Visual attention (TMT-A score change) was found as the only significant predictor of improvement in negative symptoms subscale of the Positive and Negative Syndrome Scale. Furthermore, a mediation path analysis confirmed that better performance in visual attention acts as mediator of the positive association between CRT intervention and lower post-treatment negative symptoms score.

Conclusions: CRT can have a positive impact on a measure of visual attention in patients with schizophrenia and on negative symptoms reduction that is mediated by this significant intervention effect.     

阴性症状为主的精神分裂症男性患者认知功能及灰质密度改变

目的:运用基于体素的脑形态测量学方法(VBM),探讨以阴性症状为主的精神分裂症男性患者大脑结构形态学的改变,及其与精神病理学症状的关系。方法:15例阴性症状为主的成年男性精神分裂症患者和15例正常对照参与实验,所有研究对象均接受威斯康星卡片分类测验(WCST)与磁共振检查,获取磁共振T1加权像和高分辨率3D图像后进行VBM分析,比较患者组和正常对照组局部脑区灰质密度的差异性。结果:在威斯康星测验中,阴性症状为主的精神分裂症患者完成测查的总应答数、错误应答数和持续性错误数显著高于正常对照组,正确应答数和完成分类数与正常对照组没有显著差异。VBM分析显示患者右侧额上回,左侧额中回,左额内侧回,右侧楔叶,左侧颞中回的灰质密度较正常对照组低,未发现患者组灰质密度有明显增高的脑区。结论:以阴性症状为主的精神分裂症患者存在显著的额叶执行功能低下;双侧额叶灰质密度的下降可能是其执行功能损害的病理生理基础。     

Cognitive behavioral therapy of negative symptoms

Negative symptoms account for much of the functional disability associated with schizophrenia and often persist despite pharmacological treatment. Cognitive behavioral therapy (CBT) is a promising adjunctive psychotherapy for negative symptoms. The treatment is based on a cognitive formulation in which negative symptoms arise and are maintained by dysfunctional beliefs that are a reaction to the neurocognitive impairment and discouraging life events frequently experienced by individuals with schizophrenia. This article outlines recent innovations in tailoring CBT for negative symptoms and functioning, including the use of a strong goal‐oriented recovery approach, in‐session exercises designed to disconfirm dysfunctional beliefs, and adaptations to circumvent neurocognitive and engagement difficulties. A case illustration is provided. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:1–16, 2009.